Splitting Lantus Doesage...Need Help cuz its not working?

Hello everybody, I am new to the forum. After doing some browsing the last couple of days, I have noticed this forum is really strong and has good people that like to help others out. So I am glad to be a part of it and hope to help others as they help me.

Here is a little about me. Im a Type1 diabetic, I take Lantus and Novolog. For the longest time I have been on a 1:10C ratio for my Novolog, and I was taking a once daily 45 units of Lantus before bed. Everything was fine until about 6 months ago and I noticed a change. I would wake up to lows and in the middle of the day my sugar would go low. So I saw my Endo and he suggest to me to split my doesage...Told me to go 25 at night and 20 in the morning. This seemed to work for about a week...then I was back to the same thing. So I tried going to 20 @ night, 15 in morning...lows went away but now my sugars went back to running high all day, except in the afternoon, then they drop.

Here is a good example of what is confusing to me. This is based on yesterdays doesage...

9:00pm - BS: 162 - 25L
5:30am - BS: 118 - 15L (before I head to work..watch how sugar rises next)
8:00am - BS: 210 - 5N (Notice..BS actually raised from earlier..Ate granola bar @ 30 carbs)
11:45 am - BS: 295 - 12N (Ate 4 small slices of pizza @ 70 carbs)
3:00 pm - BS: 378 - 5N (seems like all the N i took at lunch did nothing)
5:00pm - BS: 315 - (again, seems like all the N did nothing..yet watch what happens in the next hr with NO novolog taken)
6:30pm - BS: 180 - 4N (Ate sandwich, chips - 45 carbs)
9:30pm - BS: 145 - 25L
4:00am - BS: 42 - (yes, woke up to lows again....)

So something seems to be happening, because during the daytime my sugars run high, even though I take enough Novolog to compensate...however, between 5-7pm, my BS will drop atleast 100 pts...and then I also still wake up to lows in the morning. This is an everyday battle for me lately, as my HbA1C was 8.2 at my last visit to the Endo in September...I've been trying to get ahold of my Endo for the last 2 weeks and have gotten nothing back from him...I am going to switch doctors soon because this isn't the first time I felt like he doesn't care to help.

Based on what I am describing...I am wondering if the Lantus I am taking isn't really the problem...I'm wondering if its more tweaking the Lantus dosage so that it stays more "flat" and actually switching from Novolog back to Humalog that I used to be on (I actually found it to work better than Novolog for me). The only reason I got off of Humalog before was because my insurance didn't cover it or any Eli Lily brand product...I have since switched jobs and this doesn't matter now...I am wondering if this is possibly more likely to be the answer? I might add that I suggested this to my doctor and he told me that Novolog/Humalog are the same and are not any different...even though I beg to differ, this is the attitude I get back when I ask questions to him. I mean I could be completely wrong, but if I am dropping low in the morning and evening times, those are times that are somewhat fasting (around 6 hours since last eating)...My high sugars seem to occur when I "start" my day and after I eat something/anything. It seems like the Novolog doesn't matter how much I take just doesn't seem to cut it. I dont know...Im grasping for straws here trying to find help in figuring this out

Can anyone provide me with some help? Maybe some of you have had the same experience? This "rollercoaster" is really starting to annoy me

Thanks~

Whether you need a flat basal or one that is higher during certain parts of the days is a very individual thing. From your very first pattern you appear to have Darn Phenomenon (DP) which means you struggle with needing more insulin overnight (despite your low).

The best thing to do is basal testing. That involves starting with normal blood sugars and fasting for intervals during the day. Lantus peaks at about 6 hours and lows are most likely at 5-10 hours. And it isn't just getting the dosage right you can also modify the times, for instance you may find taking your evening dose at dinner works out better.

In either case, once your blood sugar has gone high or low the test is essentially cancelled. And if you eat and bolus during the test you can also confuse the answers because if the bolus was too low or two high that can lead to wrong conclusions.

My suggestion is to start simple and conservative. I would not eat after dinner and reduce your evening dose to say 22-24L and then see how your morning blood sugar does. Take an average reading for 3 days. If you go high, increase the dose. If you have lows, reduce. Only change by 5%. If you can't get your morning readings normal without during the night lows then you can try adjust the timing of your evening lantus dose.

Sometimes this stuff is like flying an airplane with 28 million different buttons and switches and it is really, really hard to know how to get it right.

I do a split dose of Lantus. I take half in the morning at 7 am and the other half at dinner time, 5 pm-ish. Then I’m on a bit of a sliding scale with my humalog at meal times. As previous poster said it sound like you are experiencing a morning liver dump. I have that too. I take 3 to 5 units of humalog in the morning just to accommodate that.

Could your afternoon high be from all the carbs you had at lunch time? I know if I ate 70 grams of carbs at lunch time, my blood sugar would be over 300 too. Then in the afternoon you’ve taken some correcting shots of novolog which all of a sudden have caught up with you.

I the morning when you wake up try taking a couple of units of novolog and then eating a protein breakfast (a hard boiled egg maybe). See if that prevents the liver dump.

At lunchtime, go a little easier on the carbs. You could have a great sandwhich with ham, cheese, lettuce, tomato, pickle and onion on two slices of whole wheat bread and it might be a little easier on you and the carb count than pizza.

Try splitting your Lantus into two even doses and do it for a few days. Add one unit to adjust each day depending on what time of day you are trying to fix until you get the right dose. It might take a week or more to get it right but its better to do it gradually than to make big changes every other day.

See if some of these little changes even things out a little more.
It’s hard, I know. I have been on a split of Lantus for about 5 years. It’s working okay for the most part but its constant tweaking as you know. Best of luck.

I'd rather not attempt to give any specific dosing advice, but I will say this. If you make a change to your dosages, less is sometimes more. I'm not sure if its a medical practice or just a rule of thumb, but most people try not to change a their dosages by more than 10% at a time. you went from 45u/day to 35u/day, which is about a 22% change! that a fairly big jump!

you can calculate this by doing this equation if you are into math
(new dose - original dose)/(original dose) x100 = %change in your dose.

Since you know that 45 units is too much, but 35 units is too little. The basal rate best for you should fall somewhere in between those two numbers. It might take a bit of trial and error, but you can figure it out. Good Luck!

Also about the novolog, it will probably work, its just very difficult to determine an accurate insulin/carbohydrate ratio until you can have stable numbers throughout the day. Once you have your basal rate figured out, it will be much easier to figure out novolog!