One thing to keep in mind about splitting long-acting doses: The total dose over 24h must equal your total 24 hour requirement.
When thinking about basal, remember there is a "base level" of insulin you need to have all the time. To make the math easy, let's say it's 1U/hr.
Your doctor would then prescribe 24U of lantus 1x day. The idea being that that 24U results in about 1U of active insulin at all times.
What happens in the real world is this stuff varies a bit from person to person because of the biochemistry by which it is "time released", which varies slightly from person to person. So, it may only last 20 hours in you, for example.
This means that, nominally, you're getting 24/18 = 1 1/3U per hour, and after 18 hours it's falling off heading toward zero (not immediately).
Now, splitting doses of long-acting basal is tricky, especially for a T1. If you split it in half and overlap at the 12h mark, you're only getting 1/2 the amount (1.33/2 = 2/3U) an hour for the first 12 hours. This will be insufficient to meet your fasting basal needs (remember, 1U in this example), so your BG will slowly climb, you'll correct with fast-acting, it will drop, then slowly climb again, on and on.
This is because you do not have enough basal insulin.
Finally, at the 12h mark, you take another 12U injection. Since the Lantus works in you 20h, this will stack on the previous injection, getting you now to 1.33U (remember, because of the shorter total duration, we're basically over-administering a little bit). Now what happens?
You're BG slowly falls, and keeps falling while you're fasting, because you only need 1U/hr, and your getting 1.33. This can take you to hypo territory, where you correct. Then, hours later, it happens again. In fact, this situation will persist until you reach the 20 hour mark from the whole start, at which point (first-order approximation) you'll drop back to 2/3U for 4 hours and BG will start to slowly rise again. Until the next shot 4 hours later.
All this happens because:
- Prescribed dosing of Lantus/Levemir is based on a 24h efficacy model. Most people get less than 24h, so this tends to over-dose for the active period of the injection
- Changing to an MDI approach for long-acting requires some recalculation, and care and awareness when the "low spots" are during the 24h day when basal concentrations will be lower than is needed (the times the multiple injections do not overlap in action)
- Long-acting insulins are very low-resolution in response, providing no means to distribute the hormone unevenly through the day as basal requirements wax and wane
Learning what your average fasting basal requirement is with precision, how long Lantus/Levemir continues to act in your body, and how many injections you want to use to deliver it during the day (1-3 typical) all can then be plugged in to a simple formula to get your dosing.
Without measuring and accounting for these factors, but instead just estimating it based on the Prescribing Information the doctor uses may result in the rollercoaster described above if the patient is not a true 24h miracle in which Lantus actually does last that long.