[Re-post] T1s: Lantus split dose timing

[This was posted at 8:30 Thursday morning on the Lantus/Humalog Users' Forum but has received zero response; re-posting here with the hope someone will answer.]

I did a single shot of Lantus at night for about a year, recently switching to split doses to alleviate highs after lunch and morning lows. Been futzing around with proportions and timing for four or five weeks to correct bad crashes overnight and after breakfast, and a few lows in the evening. The single shot dose was 19u, so I began with an even split at 12-hour intervals. Now the split is 60/40, 12u AM/9u PM -- the interval is still approximately 12 hours. The overnight and after-breakfast lows have decreased for the most part, but I now question the wisdom of the timing.

Given a morning dose that is 25 percent higher than the evening's, is it reasonable to conclude that the morning shot should be given earlier?

(Does anyone else out there waste brain cells on such questions?)

I had problems with Lantus because it had definite peaks. I tried every configuration. Hate Lantus.

Basal takes about 2 hours to start working. Regarding timing, all that matters is that you find what works for you.

You can save yourself a lot of calculating & experimenting by switching to Levemir. It’s far more level & stable. I don’t have the lows I had on Lantus & take the same doses. Levemir is best taken in two doses. They don’t have to be 12 hours apart. Levemir doesn’t sting & I can use a vial for 6-8 weeks. Lantus is kaput at 28 days & I could tell it was losing potency at day 25. Lantus has also been linked to cancer.

Varena, good to hear from you! If you increase the night-time Lantus when you know you’ll be sleeping in, does that help the morning number?

Gerri, I’ll ask the new endo at my next appointment if a switch to Levemir is justified. They haven’t suggested it, even after reviewing the records I sent in (during the first few weeks of starting the split I was averaging one low per day, with four occurring in one afternoon). The more I read the threads relating to Lantus, the more I think it beneficial to at least try. Levemir is available only in vials?

Be well, both of you!

Hi Muragaki. I also had to split my Lantus dose. I take 7 units at night and 6 in the am, around 12 hours apart. It definitely worked better than the one dose at night but recently I find every couple of weeks my numbers go high or low and I have to mess with the basal dose so I am going to start on Levemir shortly. I think there is so much individual variation that you just have to find what works for you.

I’m a bit confused as to your question as at the end you say the lows have discontinued for the most part but you still question the timing. If it works, than it is the right timing for you! Also you mentioned some lows after meals and for those I would question your bolus doses and perhaps tweaking your I:C ratios, rather than the basal. I only look at the fasting and the in between numbers when the basal is the culprit.

Levemir is available in pen form also. If your after breakfast and after lunch numbers are off, I would look at the carb ratios. Increasing the night time lantus when you know you will be sleeping in might just make you get up overnight due to a low. Even though the dose is split, the insulin is still active in your body for 24ish hours.

I wouldn’t worry about an even 12 hour split between the doses either. Find what works for your body and go with it, even if it dosn’t seem to make sense = ).

I switched to levemir and that took care of the overnight lows I would often have with my lantus, combined with the “running out” I seemed to have in early evening. Eventually, I switced to a pump, because that was the only way to take care of my dawn phenomenon.

I second looking at bolus (if you are using bolus). It may be that by splitting it is working more effectively throughout the day.
I’ve tried splitting dose but personally have found that the most consistent for me is a single one in the evening.

I wouldn’t think you would need to inject earlier though just because it is larger. I would consider it, if you find that your evening dose tapers off too soon or ends before the morning dose kicks in. Or vice versa, if you have lows in late afternoon, evening (when you inject the evening dose) there may be too much basal overlapping, so you might also consider there.

It’s hard to say though because the duration and strength of lantus really varies between people (despite its 24 hour claim). I’m also pretty sure that day to day it doesn’t release at the same rate for the same person (or so it has been my experience).

And it’s not wasting brain cells, but enriching them to prevent their loss/deterioration in the future :wink: