Problem with Lantus

Hi, I am a T1D fro 4 years, currently on MDI with lantus and humalog. I was using tresiba (2 years) till last month. Then due to a different city, different diabetologist, and sudden higher pre-meal levels, I was asked to use lantus. I could have increased tresiba dose, it may well have worked out. But new doctor insisted on using lantus, on the ground of its significantly lower cost and my higher levels with tresiba in past week. Its been over a month with lantus but I have not been able to figure out its right dose, time of dose and whether it should be splitted during 24 hours. I am currently taking it with morning bolus. (I was taking tresiba also in morning). I am continuously getting higher fasting levels in morning (in 250s). On this my doctor said higher fasting can be fixed just by increasing lantus dose by 10 %. Splitting the same dose wont make any difference for fasting levels. I tried raising the dose & I got bad hypos in middle of night. I tried to do simple basal test on initial dose. I noted level increased from 180 to 250 during night. So dose sounds less from this angle. But I am taking full dose in morning. I am not sure what will be the correct way to resolve it. Should I use it in evening instead Or split it in morning and evening Or raising the dose and keep a check on hypos. Any thoughts are highly appreciated.

Before I was on Tresiba, I was on Lantus and I had to split the dose to avoid highs in the 4 hours prior to my once-daily dose. It lasts about 20 hours for me, and many other people find that too (though some do ok with once a day injections). That said, Tresiba is so much better IMO and many others… that seems unreasonable of your endo. Now that you’ve given his dumb idea a try, will he support you switching back? If not, can you see someone else? Besides—why does he care how expensive it is?

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You can get better results by splitting it. From what you are describing it sounds like it doesn’t work exactly 24 hours for your.

The advantage of splitting lantus is that you can take different amounts morning and night. If your daytime and nighttime basal needs are different, split it in the amounts you need.

Yes, 100% definitely, try to split it and see how that works!

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@cardamom Thanks. Seems lantus is working only around 20 hrs till about 4 am. And then possibly dawn phenomena and no left lantus raise levels in morning. I dont think doctor gave much thought on how fasting level should be dealt in this situation. For last 2 years tresiba worked fine for me. I will now try splitting the lantus and after that I will consider changing the endo.

@Eric2 Thanks. I will definitely try splitting. Either I use tresiba or splitted lantus. That seems to be the only way. I will start with 50/50 proportion. It will also provide some flexibility.

I like the split dose a lot. Sometimes I also use a small bit of NPH to help cover nighttime basal and dawn. You can get NPH without a prescription and it’s cheap. Try it!

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I always split Lantus but as a cation, you may expirence higher than expected BS on the first full day of the split until things get into sync. I think it takes about 20 hours for me to get the blood sugar down when i start using the 50/50 lantus split.

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When I was on Lantus I didn’t split the dose for the first year and a half, and then began splitting it when my endocrinologist suggested that it seemed to be wearing off after 20 hours for me. Splitting it made a huge difference to my control, to the point that my endocrinologist went, “These don’t look like your numbers!” when I walked in to my next appointment.


@Rphil2 Thanks. Yes I noticed higher level b/w meals in first few hours when using reduced basal in morning. Hopefully in a day or two, levels will be in normal range.

@Jen Thanks. I hope my endo agrees to idea of splitting and I get the same response.:slight_smile: