I've been reading a lot about people who make their Lantus evening injection in to two injections, one in AM and one in PM. Splitting the total amount in two and thus getting more control. I am on Lantus 31 units; humalog sliding scale usually 3 units before meals, Janumet 500 mg twice a day. I would love to have more control during the day...and noto worry about lows in the middle of the night,. How did you go about working this out,. Did you work with your doc or make your choice on your own. I am still in the testing stages of lantus...so how would I do that when I have to up the lantus amounts? Has this worked for you>? My doc pretty much leaves it up to my CDE and myself to figure out these things and then let her know.....So I am looking for guidance from here,
I split my Lantus. I take half upon waking and then half at dinner time. I found the Lantus didn’t quite stretch to cover for 24 hours. I found it conked out at around 20 hours which left me for four hours in the evening with no coverage at all. I made the suggestion of splitting the dose and my doctor went along with it. He just gave me the go ahead to start doing it. It’s been about 5 years. I don’t remember having any problems with it. All j remember is that I started by splitting the total but I ended up having to add several units to each one. So if you take a total of 30, you might not end up with an even 15/15 split. It might be more like 20/20 when all is said and done. Plus my evening dose is a little bigger than my morning dose. This works for me because I have more insulin working during the evening hours which is when I eat my biggest meal of the day. Definitely get your doctors approval first but it shouldn’t be a hard transition to make.
I would start with a basal test, you may need to google a USA one
http://www.diabetes-support.org.uk/info/?page_id=120
but in general splitting can be a good idea
http://www.dafne.uk.com/uploads/223/documents/PU04.009,%20Version%201%20-%20September%202013%20-%20Insulin%20statement.pdf
In my opinion the one injection per day is the selling point of Lantus. If that does not work I would like to recommend to switch to two shots of Levemir per day. The Levemir binds to hemoglobin of your blood. Because of that it makes no difference if you accidentially hit a blood vessel or not. In contrast with Lantus you have an elevated risk that the injected insulin will not bind effectively to the fatty tissue. As a result it can unfold its action rather quickly. I have read about multiple experiences with these freak events. As you are experiencing I also think that one huge shot has a tendency to be a bad compromise: you reduce the dosage to prevent lows at night but then the coverage will not be good for 24 hours and vice versa. Last but not least I have experienced that two injections of Lantus per day did not supplement each other as nicely as with Levemir. I have seen unpleasant effects like an extreme volatility / instability for specific hours of the day. With Levemir in contrast the two shots will just combine nicely. Two injections of Levemir also allow to adjust the dosage with more flexibility. This is because every shot will only last for 12 to 14 hours. Sport in the evening > reduce the night shot. Catching a cold > you can increase the basal sooner to compensate.
Dr. Bernstein has covered this topic several times in his free monthly webcasts. He has emphasized that basal insulins (Lantus and Levemir) serve but one principal task—to keep blood sugar from rising while fasting. However, too many physicians continue to advise patients to increase their basal dosages to also cover post meal rises which often results in periodic hypos. In his experience, neither one of the basals lasts a full 24 hours. In fact, depending upon the patient, the duration of action can be as short as eight hours and as long as 18 hours. However, none quite meet the 24-hour criteria. Bernstein’s recommendation is to split the dose but not the way you might expect. The two doses should not be taken 12 hours apart. Instead, he recommends that one half-dose be administered in the morning upon arising and the other half-dose injected at bedtime. The slight overlap between the two doses will cover the dawn phenomenon and this has been very successful with patients in his practice. Split doses have also been discussed in previous forum posts and you might find this thread to be of interest:
https://forum.tudiabetes.org/topics/making-lantus-a-two-dose-med
I'm doing it on my own, but I had never heard of doing a split until recently. I was favoring setting my Lantus as high as I could to accommodate the day time highs, and then just dealing with the night time lows (which weren't as hard to deal with as the day time highs). Until, I started having real bad, real consistent lows at night, and was waking up every couple hrs to eat something.
I needed about 35 u Lantus to prevent brutal highs upon waking up in the morning. So, when I did the split, I just cut that in half, to 17 units, and took it in the AM. Before doing the split, I tried to estimate what I was gonna need overnight by cutting the Lantus down, one unit at a time, and then seeing what happened overnight. The night time lows started to become managable around 27 units, but they were still there. I couldn't cut any farther than 27 units without getting pretty sick during the day, so I just estimated that my before bed dose might be 25/2 = 12 - 14 units. I started with 14 units because I was kinda worn down by high blood sugar and figured I'd work my way down from there, if necessary.
First shot at it was: Night time dose: 14 Lantus at 10 pm. Morning dose: 17 Lantus.
Seems much better, after only a day of trial. I'm come online to watch Bernstein recommondation.
