When best to inject basal?

[Quatrelle]

I have been T1 for the past few years. Using Lantus for basal, I inject 22 units every evening around 7.30. My waking number is usually between 5 and 6. For the past week I have tried injecting in the morning, around 8.30, thinking that it might be better to have any immediate benefits from the injection while I am awake during the day, rather than at night when asleep. Also that as the injection wears off it’s best it does that at night when I don’t eat etc. (I don’t have a problem with not eating after 7pm).

Now, however, my waking number is around 8, presumably because it’s getting on for 24 hours since I injected (and not 12 hours), and the Lantus has worn off.

Does this mean I haven’t been injecting enough basal? I inject usually about 6 units of NovoRapid before meals.

Any comments would be appreciated, and thanks for reading this far!

 

[searley]

I have been T1 for the past few years. Using Lantus for basal, I inject 22 units every evening around 7.30. My waking number is usually between 5 and 6. For the past week I have tried injecting in the morning, around 8.30, thinking that it might be better to have any immediate benefits from the injection while I am awake during the day, rather than at night when asleep. Also that as the injection wears off it’s best it does that at night when I don’t eat etc. (I don’t have a problem with not eating after 7pm).

Now, however, my waking number is around 8, presumably because it’s getting on for 24 hours since I injected (and not 12 hours), and the Lantus has worn off.

Does this mean I haven’t been injecting enough basal? I inject usually about 6 units of NovoRapid before meals.

Any comments would be appreciated, and thanks for reading this far!

Lantus does not typically last a full 24 hours and typically has a spike in action after about 3 hours

I found this was better taken in the evening as I typically have larger evening meals and helped my not go high in the night

But it’s whatever is best for you.. but more risk of hypo in the day due to more activity

 

[becca59]

In my opinion Lantus really needs to be split to get its full benefit. For me those splits needed to be higher am than pm. Am now on Tresiba which I find is more stable.

 

[Quatrelle]

In my opinion Lantus really needs to be split to get its full benefit. For me those splits needed to be higher am than pm. Am now on Tresiba which I find is more stable.

Can you explain how to split the Lantus? I will bear Tresiba in mind and look into it. Thanks

 

[Deleted member 527103]

I never needed to split Lantus. It is only necessary if your day and nighttime basal needs are significantly different. But, if that is the case, Levemir is a better option.
I dosed my Lantus in the evening. It tended to run out after 22 hours and I "filled the gap" by increasing my bolus slightly.
I did not I ject Lantus in the morning as it would run out while I was asleep.

 

[becca59]

It was the consultant that told me to split it as it was just not lasting 24 hours. I take very small doses of basal. 6.5 presently. Levels to take are very personal but when splitting it is best to take 12 hours apart.

 

[Tony337]

Hi
If your waking number was between 5 and 6 why would you want to change the time?

Please don't think i'm being rude i just don't understand.

Thanks

Tony

 

[MODY3]

Every change at the hour you inject Lantus takes time to adjust. Typically lantus lasts 24 hours. Doctors insist in taking it at night before sleep. As it has peak after three hours i tried many times to take it at night but i was waking up during night from the alarm as i had hypos. Then a bad day as in the morning it was high. I decided to inject in the morning. So for my way of life 11 o clock is convenient to my style. Bur recall each day same hour + 1 otherwise hypo. When you change the hour i believe you should wait 4 days to see any change as your organism and your life habits have to adjust accordingly. However it is not if you wake up with 5 or 6 it is the average that you should look to be less than 7 in a month. Also do not forget the most important is how long you are in the thresholds set up by your doctor. Usually 70 to 180. the time inside the limits should be 70 per cent in the thresholds. Talk always with your doctor before any change

 

[Quatrelle]

Thanks for all the replies.
A quick bit of background - I'm 85 and have been T1 for about four years. I have lived in France for the past 27 years. My change from T2 to T1 happened about the same time as a major stomach operation, since when I have become much less active (I'd always felt 20 years younger than I actually was - not any more, sadly).
I changed from injecting in the evening to the morning because I felt that as the Lantus wore off it would be better if it wore off when I was resting rather than during the day. My waking number was usually between 5 and 6, now of course it is nearer 8. I also now need to get up far fewer times at night, surely not a coincidence (the joys of being an old man!).
I have yet to speak to a specialist (ignorance is bliss) but that matter is now in hand. I will ask about CGM, which my GP cannot authorise.

 

[SimonP78]

Have you seen a corresponding lower BG level in the afternoon when taking your basal in the morning?

I moved mine (Abasaglar which is similar to Lantus) around as I was running low overnight taking the full amount (which was also 22U iirc), but when I moved it all to the morning I'd run high after supper (iirc, it was a while back now.)

In the end I simply split it 50-50% pre-breakfast and pre-bed and it seems to work (with the added advantage that I can reduce the morning dose if I'm going to be particularly active during the day.)

I'm not too bothered about the exact timing, as long as it's within a 3 hour window at either end of the day it seems to work - whatever variability this introduces is vastly outweighed by the variability of other things during the day.

 

[Jasmin2000]

I split my Lantus between waking up (12-14 units) and going to bed (8-10 units).

Lantus does not typically last a full 24 hours and typically has a spike in action after about 3 hours

Thanks for this - I get modest lows at 2-3 am and didn't ascribe it to Lantus as I thought it took 6-8 hours to peak. So I'll take it down a notch.

 

[SimonP78]

Thanks for this - I get modest lows at 2-3 am and didn't ascribe it to Lantus as I thought it took 6-8 hours to peak. So I'll take it down a notch.

I thought the peak was around 5h, so we've all got a slight different number, but in the same ballpark.

iirc there's also something of a dosage relationship to the peak time, and absorption variability may also play a part.

 

[Quatrelle]

Have you seen a corresponding lower BG level in the afternoon when taking your basal in the morning?

I moved mine (Abasaglar which is similar to Lantus) around as I was running low overnight taking the full amount (which was also 22U iirc), but when I moved it all to the morning I'd run high after supper (iirc, it was a while back now.)

In the end I simply split it 50-50% pre-breakfast and pre-bed and it seems to work (with the added advantage that I can reduce the morning dose if I'm going to be particularly active during the day.)

I'm not too bothered about the exact timing, as long as it's within a 3 hour window at either end of the day it seems to work - whatever variability this introduces is vastly outweighed by the variability of other things during the day.

It's difficult to get a comparable reading because of the 14-hour no-food gap between my 6pm evening meal and my BG reading in the morning. I moved it to the morning thinking it would be better if the Lantus wore off while I was resting at night rather than during the day. I don't take exercise into the equation because I have quite painful osteoarthritis in my left knee, and other than doing the odd kilometre on my exercise bike (bit too hot at the moment) and some maintenance around the house and garden, walking with a stick is about is all I do.

I appreciate your thoughts about how to split the Lantus dose. About a fortnight ago I had a corticosteroid injection in my knee, so need to give things a few weeks to settle down before I proceed.