Split dose Lantus is driving me insane any help would be amazing

Type 1 and LADA
#1

I've had this problem recently with my lantus dose at night. I tried 9..not enough..10 not enough..11 sometimes ok. 12 makes me go low in the nights. so I decided to try to split the doses I do and see what happens. Yesterday I took 10 at bed and 3 when I woke up for breakfast at 7am. My bloodsugars were spot on all the way through lunch which I had at 2. I counted my carbs accurately..but then my bloodsugars soared after lunch when I tested at 4 and into the evening. I corrected and leveled out but then the highs returned after dinner.

Today I thought ok try taking the second dose later..took 10 at bed and at noon took 5. At lunch my bloodsugar was high again. Corrected at the meal and hours later was still high. Its starting to come down now.

With my lack of lantus knowledge though I am wondering when does lantus really start to kick in? I want to get to a point where I can be level through the day. I'm starting to get afraid to split dose though because I keep screwing up. I am sure it is a learning process. I'm just wondering if anyone has any suggestions, your experiences with lantus and its effectiveness and any tips on figuring out when to take a second dose...

thanks so much anyone that can respond. Tomorrow is my birthday and I've been a mess as a result of this..heh

#2

It's hard to hit target areas precisely with long acting insulin, so you will just have to try playing with it to cover your problem times. Your original breakdown seemed like much more at night and very little in the morning and you might need a larger portion during the day. Noon might be on the late side to get effective daytime coverage, especially if your problem times are after lunch.You might want to do say 9PM and 9AM. Also, you said your bloodsugars soared 2 hours after lunch which might be due to your bolus not your basal. You might have been covering some of that with your basal before and now need to increase your I:C ratio. In general, for basal you look to changes at least 3-4 hours after a meal or before the next meal.

Don't get discouraged, it takes time to get it right. And have a great birthday despite all this D crap!

#3

Why do you split the dosage unevenly? Why not 5/5 seperated by 12 hours? The reason for the split is just to have a more even distribution over 24 hours. The two dosages will combine nicely to allow just that. After this step it takes two days to see if this really works out. You should also make sure that your menstrual cycle does not interfere with your current Lantus experiment. Quite certainly the hormonal levels in the first week before ovulation will invalidate your results.

#4

After going off the pump and back on MDI's, I tried the full dose of Lantus just once a day - tried several different times throughout the day - ended up splitting it, unevenly like you. After months of "trying", I finally got it down to a 50/50 split, one at 10pm and one at 10am. It's working quite well, although I still get the occasional high or low for absolutely no reason, but unfortunately, that's the nature of this beast. I did wait 3 days after each change, though, before adjusting again.

#5

Jackie, what was your experience with the pump, if I may ask?

#6

I used to shoot NPH one time a day, in the AM for about 23 years. When I switched over to Lantus about eight years ago, I ended up keeping the same schedule, but have had uneven performance for what seems like ever since then.

My Endo and I discussed my issues and against his better judgment we ended up splitting my doses 50/50 -- one in the AM and one on the PM (not late at night), but I have been experiencing some bad lows AND highs in the wee hours as a result of the split dosing.

I just saw my doc again two weeks ago, and he agreed that our experiment failed, so he told me to shoot one dose only, and implored me to do it when I brush my teeth just before bed ("Brush teeth, shoot insulin... it rhymes, right?" is what he said to me as a way to remember... kind of a joker, this doc :).

He also said that Lantus is intended to be dosed in the late PM, and not at variopus times during the day, nor in the morning -- it was developed to work up during the night, then sustain your basal for the day. So I am now doing the one big one (25u) at bedtime (my i{hone reminds me every night now), and my numbers do seem to be evening out after only a couple weeks.

So, you might want to talk to your Endo about this, then give the one dose thing a try just before bed. Lantus takes some time to ramp up, so hopefully that will take care of overnight ups and downs for you.

Good luck.

/\/\

#7

"...but other than that it was great!"
Now,that made me chuckle!
And I don't think you're "odd" - I pumped for 8 years and went back to injections after trying the Omnipod (was pumping with the Animas Ping). I liked not having the tubing anymore, but bruised terribly with the pod and had absorption issues (going as high as 350...ugh!). I finally quit it after 2.5 months. I never did have "perfect" control while pumping. I'm doing pretty good with the injections and don't know if I'll go back to a pump. It all sucks, in my opinion. I thought I was "odd" for going back to shots. Glad I'm not alone.

#8

I used to take 30 units of Lantus every night at 9 pm. But I never got decent control with that and ended up having some scary lows at night, and some scary highs at dinner time around 6-7 pm. I ended up splitting the dose initially 20 in the morning and 10 at night. That was working ok but sometimes I ended up being really low before lunch or dinner. At least the nights were sorted out. I used that split for about 6 months. My A1C went from 7.5 to 6.1 in that time - of course counting carbs helped as well. More recently I have been waking with some high mornings so I chatted with the CDE (I never talk to the endo) and decided to do a more even split, and also I have cut down from 30 units to 26, so for now 13 at breakfast and 13 at 9pm works. But it has been a work in progress for 6 months and like every thing else with D, your experience may vary. None of this happens overnight you just have to take it one day at a time. Happy Birthday ! I hope you have a wonderful day.

#9

I do a split Lantus dose of 50/50. I take half in the morning and half in the later afternoon/dinner time. It has worked for me quite well. It does take some adjusting to get it right so you'll need more than one day to fine-tune it.

#10

I think splitting is the way to go but definitely may take some tweaking. I need around 26 units/daily and with increased training sometimes less. Regardless, my morning dosage is a bit higher at 14 units and my evening dosage is around 12 units. If heavy training that day my needs are less so I usually begin by cutting evening back 1 unit to 11, etc. Hope you find that balance!

#11

Another suggestion if over time you just aren't having success with your Lantus split is to try Levemir which some of us find a bit smoother. I have to say now that I'm on a pump both seem pretty inexact to me!

#12

I did split dose Lantus from the time it was first released in 2000 until just a couple years ago. As Holger suggested, try making your morning and evening shots about equal. Most T1's need approximately the same amount of basal insulin throughout the day, so for most it works best to get the basal shots about the same. If you have been taking only one shot a day, you may find that you were covering a fair amount of your bolus needs with your basal shot (or visa versa) - if so you may need to change the amount of basal you are taking relative to bolus.

I switched to Levemir about two years ago, and prefer that now. My control is much better, but that is mostly for other reasons I think. I do like the fact that Levemir stays in my system for a shorter period of time (close to 12 hours) so there is less overlap between morning and evening shots than there was with Lantus. I still use MDI and continue to split dosage of Levemir about 50/50; actually take slightly more at night. My suggestions:

. Start with 50%/50%, then vary it as needed based on when you go low/high. Be prepared to increase or decrease if some of your one-shot basal was covering bolus needs.
. Try different timing of the basal shots. I take morning shot when I wake up (whenever), but found it works best to take evening shot no earlier than 10pm. This made a big difference with Levemir, maybe not so important with Lantus.
. Try Levemir if you aren't happy with Lantus.