Splitting Lantus Dose -- Juggling Various Concerns

OK – I am trying to take all the various points of advice and problems into consideration and here’s what I’ve come up with:

  1. I think my total Lantus dose is about right (it holds me steady when there’s no food or Novolog on board;

  2. I’m splitting it again starting today: 25 IU in the morning and 30 IU at noon. That way there won’t be such a steep drop-off between three and six a.m. (it doesn’t last 24 hours in me);

  3. I’m taking the Lantus in the morning/noon instead of at night because I have dropped hypo in my sleep or in the wee hours due to the Lantus (e.g. with no Novolog in the picture) so we think it’s better if I can inject it and monitor it when I’m awake – both my endo and my diabetologist recommending switching to the daylight hours to facilitate watching for Lantus-related hypos;

  4. Everyone used to say that it lasted 24 hours. Now even the manufacturer admits that it lasts from 18 to 26 hours. From their website: “As with all insulin preparations, the time course of action for LANTUS may vary in different individuals or at different times in the same individual and is dependent on many conditions, including the local blood supply, local temperature, and physical activity.” YDWV (“your diabetes will vary”).

  5. Everyone used to say that it doesn’t have peaks. That is incorrect. Here’s a pretty picture. Notice that it does go up, does have some variability in how fast it is absorbed, does have peaks and does dwindle away at various times. It’s not as perfectly level as a pump can drip-drip-drip and it’s not as humpy as NPH or Novolog. It’s somewhere in-between.

Note that these tests were performed four times each on nine individuals, which shows the variability not only between individuals, but within the same individual on different days.


http://www.medscape.com/viewarticle/479477_3

How much time will there be between morning & noon doses? Am wondering if there will be enough of a time lag for you to know if this is better. Split doses usually means more of a spacing between doses. Just by way of example (I refuse to use YMMV because I’m sick of seeing that expression), I took Lantus right before bed & then after breakfast. It didn’t last close to 24 hours for me, but I took small doses. I take Levemir the same way. I have to take it before bed or DP rears its ugly head.

I’m spacing them six hours apart (six/noon) in the ideal situation (e.g. when I start working full time again) fudging up to seven/one when my unemployed person time-flakiness rears its head. I know that this isn’t ideal. But as I was going hypo in my sleep (1:30 or 2:00) when last I was working, the diabetologist said to switch to morning, but I’ve been worried about that period between 3:00 a.m. and 6 a.m. ever since. By moving 60% to noon, I should have a wee bit more coverage during the wee hours and still have a good nine hours after the second dose (at least) before I go to sleep. As most of what I’ve read says that it peaks (if it peaks at all) for most folks at four to six hours, I will be up and around to notice and deal with it (instead of waking up in a cold sweat, heart pounding and very, very confused as when it peaked four to six hours after my former dinner-time injection).

I also chose the noon to one period as a good time for this second injection because that’s when I’ll usually have a break at work, whereas injecting it at say, 3 p.m. or later might put me smack in the middle of a work meeting or my evening commute.

Sounds like a plan!

If you are comfortable with two shots then I would recommend to switch to Levemir. Two shots will combine nicely to cover 24 evenly. The next chart shows the activity pattern of one shot (the dotted lines show two different dosages of Levemir in comparison to the solid NPH line). It shows that Levemir acts for 24 hours but after 12 hours half of its potency is gone. This is why the second shot is important for Levemir. If you look at the combined result of these two shots you will have an even pattern. Of course with some higher levels in between but in general it can be said the lower the dosage of every single shot the more even the combined result.

Thank you, Holger. I would like to try Levemir, for the reasons you mentioned and also because Lantus too often burns under my skin. However, my current insurance plan (HMO) does not cover Levemir and I am unemployed; I cannot afford to buy it myself. I hope to try it in the future.