On MDI, how do you determine whether to take your basal shot at night or in the morning? Why do some of you prefer one over the other? How have you all decided what time to take your basal dose in the morning or at night?
I canât really remember how I decided to take Tresiba in the morning, but I would imagine that it was because when I was taking a split dose of Lantus, it was much easier to remember my morning injection.
I am quite happy with the performance of my morning Tresiba which I take around 7:00 am.
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I was prescribed Lantus as a type 2 before I began MDI. I was told to inject it before bedtime. I began having hypos about 6 hours later, so I began splitting the dose 2/3 at night and 1/3 12 hours later. This flattened the alleged flat curve of Lantus.
Fast forward to when I started MDI. I was seeing an unacceptable rise in BG 3-4 hours after lunch. I then split the dose into 3 during the day. So I was doing a minimum of 6 injections per day - 3 basal and 3 bolus. This was my regime for the year before I got a pump.
It worked very well with my night BG almost perfectly flat 89 to 99mg/dl. Daytimes were good as well with HbA1c averaging 5.5%.
I wonder if I wouldâve had the nocturnal hypo and hyper issues with Tresiba because of itâs more steady levels.
I am on MDI and totally gave up Basal insulin as soon as I got a CGM so that I could prove to my pig-headed endo that the basal, no matter how little I took, always gave me night hypos no matter when I took it or tried to split the does, etc. My body can handle 1 unit of Lantus/Levemir in a 24 hr period and that is it. At 1.2 units I go hypo so just totally gave it up and never looked back. I exclusively use Humalog, roughly 8 shots per day.
When i have to use lantus I use it as a split dose. But if that did not work, I would use it in the morning because I need coverage in the evening and over night and it takes several hours to peak.
When I was diagnosed, I was told to take my basal (Abasaglar) at 10pm, give or take an hour.
After a few months, I noticed I was dealing with regular nighttime hypos so I started taking it at the same time as my dinner bolus (around 7pm). I still had regular hypos but dinner notice any negative differences taking it a few hours earlier.
Abasaglar is a one-a-day injection, but I started splitting my dose between breakfast (5u) and dinner (3u) and had good success with that. I had fewer nighttime hypos and my basal was linked to my bolus injections so it was easy to remember.
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I take my Lantus twice a day â with breakfast/brunch around 12 noon, and again with dinner around 7 pm.
Seems to give me more coverage, and no lows. BG does go up pretty high for several hours after those mini-meals, however. A1c is dropping (with increasing to 22-25 units per injection which nurse suggested), but is still around 8 (as indicated by CGMâs GMI being 7.5, because thereâs consistently that 5- point difference). When I asked Nurse Practitioner about adding mealtime insulin, she dismissed the idea â saying that mealtime insulin can cause lows, and more weight gain. Iâve already gained 10 pounds in the 8 months since I started Lantus. Will ask doc for referral to endo when I see him in a couple months if A1c has not dropped satisfactorily.
Do you think Iâm too cautious with increasing the dosage?
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@dogramma are you a member of my clan - type 2? Thatâs what it sounds like from your post above, that you are only using a long insulin like Lantus. These set basal rate and can be helpful at least for a while in lowering HbA1c, but they really shouldnât be used to reduce postprandial rises by increasing the dosage. This may cause hypos especially at night when there is little or no glucose entering the bloodstream from digested food.
I think it is time for you to see an endo. There may be more than meal time insulin to address your BG management.
I will say that weight gain from insulin in T2DM is not absolute. I have been on MDI/pump for nearly 30 months now without weight gain. Part of that may be that I exercise daily which increases insulin sensitivity.
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Yes, Iâm type 2. Thanks for the reply. Luis. How can I put my Type 2 status under my username like yours?
Glad to see that youâre having success with your pump in addition to your exercise. I need to get back into my workout routine, after being thrown off course due to family responsibilities.
Which pump did your endo prescribe, and what types of insulin do you put in it?
I think I pitched a fit- I donât remember. It really is helpful to know when responding.
âWhich pump did your endo prescribe, and what types of insulin do you put in it?â
I had done a lot of reading about the 3 pumps available at the time OmniPod (not 5) Medtronicâs and Tandem. I was leaning to Tandem as it would integrate with the Dexcom G6 I was already using. I started MDI with Humalog because my insurance wouldnât covero which was originally prescribed. So I used Humalog for a year.
My insurance decided to cover Novolog now, so Iâve been using it for 3 months. I am not sure if it is any better than Humalog in managing BG, but it is definitely better for putting in the pump cartridge. Humalog seems more viscous and prone to hard to clear bubbles than Novolog .
I will probably stick with Novolog.
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Click on your icon add Type 2. From the pulldown.
Review Luisâs page for example.
You can also post a summary of you or diagnosis, etc.
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I prefer Novolog, and for me seems like it was quicker and more predictable than Humalog.
When I was diagnosed ~2.5 years ago I read that taking Lantus at night can cause lows, so I started off taking it all in the morning. I did that for a while, then my morning #s started to be higher. So I tried just one of the units at night (I take 6 total), did that for a while, but morning numbers were still higher than I wanted too much of the time. So for a few months now Iâve been doing half at night and half in the morning. It seems to be working, w/out causing night lows. So much is guessworkâhow do I decide? I try my best to make a decent hypothesis, treat based on that hypothesis, see what happens, give it enough time, change if needed. Thereâs a lot of noise in the system, so itâs hard to know what exactly is the cause/result of what. I just try my best. 
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Thatâs the ticket!
Thanks, MM1; I added âtype 2â, but it only shows up when my Avatar is clicked on.
Wasnât loving waking up >150 in the morning so I asked my endo questions about how Lantus works and got more hand waving than answer. I reviewed the prescribing info for Lantus and decided to try splitting the dose for two weeks. My morning numbers improved but not enough to be significant. I then tried taking Lantus before dinner for two weeks. Lantus has a little peak 1-2 hours after taking it and I (irrationally) missed having it post breakfast. My morning numbers still werenât significantly better so I went back to taking Lantus in the morning.
When life changes Iâll have to try again.
Did you select Type 2 from dropdown, for the âtitleâ box?
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Its strange but not all members have this title option. Iâm not sure why, I have tried to understand why with no success.
An administrator has the ability to add a title for you. I have taken the liberty of adding this title for you.
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Definitely go see an endo and do not take no for an answer
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@dogramma I remember now is was the great Stemwnder Gary who added it for me. I think that it could be done by the user in the past but for some reason that was eliminated.
I really wanted it for me, because as a pump using type 2 I could be mistaken for a type 1.
Thanks, Gary.
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