T1s on MDI: What's your Lantus split (and how'd you figure it out)?

Back in October I began splitting Lantus; at first the split was even but has since gravitated to 90/10 (AM/PM).

I first would like to know if anyone else has such a wildly imbalanced split and, second, if there is such a thing as a “pointless” dose of Lantus (e.g., 1 unit).

  1. I’m a very insulin-sensitive type 1, so I’m at 16/0 (AM/PM) but yes, it is very unbalanced.
  2. I was told by my endo that people who drop below 10/0 usually are removed since it is decreasingly effective at those doses. I would assume that a matter of 1-2 units would be menial.

G2, forgive my ignorance… but it doesn’t appear that you are on a split dose (16/0)?

I’m trying to figure out how to get reliable 24-hour coverage. I shoot 17 in the morning (to ward off shooting high mid-afternoon), with 1 or 2 at night so as not to wake high. If I shoot 2 at night I tend to tank a bit after breakfast but shooting 1 seems to result in waking higher than recommended; have tried to move up the clock for night dose but worry about tanking proportionately earlier.

I suppose I could also play with I:C ratios, but I could swear I read somewhere on this board that one should stabilize basal before playing with bolus.

No, not on a split dose, but then again, how much more split can you get from 0? Just kidding…

The endo recommended the split. True enough, I could ask – but there’s value (most of the time) in putting the question out here.

As for I:C, it’s low (1:6) compared to what I’ve seen people here post. I could mess with it but, as mentioned previously, I’ve been under the impression that basal should be stable before messing with ratios.

Then again, this isn’t a one-size-fits-all disease…

Haven’t asked about Levemir.

Curious… how does one effect 1/2 units of Lantus on MDI?

I’m a pen-centric dope – I always forget about syringes :slight_smile:

I question if your bolus ratio is correct. You can test basal by fasting. If you’re eating, there’s no way to know if a high is a possibly delayed spike from food. Basal is more difficult to get right than bolus. You can juggle Lantus doses for weeks, but if your bolus is the problem you’re not going to get anywhere calculating the correct basal dose for the daytime. Many people are most insulin resistent/carb sensitive in the morning, if you don’t have different ratios for different times of the day.

One reason for splitting your basal is to give “flatter” response. In my case, I don’t need a flat response, I need an overnight dose of basal insulin that is like twice my dose during the day. Depending on your needs, you may or may not want a flat response. If you have certain times of the day you are low or high, moving towards a flat basal may not help, you may do better with a single injection and simply moving the timing of the injection to more closely match your needs.

I am not on Lantus but am on Levemir which is even less strong and I am only taking 2 units, some parts of the month 3 units.

on MDI using Lantus (though moving to pump again soon). I was one of those people who split to get more even results since with a single larger dose it never seemed to be absorbed the same from day to day. I was taking 21units and split roughly 50/50 (11 am and 10 at night). How it ends up being split will really vary especially since the effect of Lantus seems to vary between people (I’m closer to it lasting a full 24 hours than 12, though there is a drop off in the 23rd hour) However, with larger single doses at bedtime, I would either be dropping too much in the am or remain relatively high during the day (since it seemed to peak for me in the morning).
Though basal rate testing only seems to be suggested to pump users there is value for MDI users because you can see how well the lantus is working w/o the interference of food, so you might try basal testing to see how it works.
One thing that may be happening too is if your coverage last for more than 12 hours (mine does), some of your am dose is covering the night and increasing the effect of your nightime bolus.
On a related note, I was reading some ultramarathoning type 1 runner who split her lantus 3 ways and her pm one was ultra small, but it worked for her…

Xanthasun, the night-time effect you mention was the same thing I was experiencing.

I guess I just have to bite the bullet and figure out how to do basal testing. sigh

Thx for the input.

I used to take 12 units of Lantus in the morning and 1 unit in the morning. I eventually kept waking up with severely low blood sugars, so I ended up eliminating it. Now I take anywhere from 12-17 units of Lantus in the evening (based on time of the month) and still nothing in the morning. To answer your question more directly, the 1 unit did make a difference when I needed it - and apparently still did when I didn’t, so if you’re sensitive, you can notice it for sure!

Thanks, joeynicole – it helps to hear that others have/had disproportionate split doses.

Trying 17-18u mid-morning only for the next few days, and play with 80/20 or 60/40 splits on meal boluses.

I keep wondering what I used to do with all the time now spent calculating and planning…

I had started with 6/evening and 6/morning, so it did take awhile to figure out that 12/0 worked best, plus, as I figured it out my blood sugars became better and my sugars decreased, so it was definitely a process! It can be exhausting, but it’s definitely worth the tracking, calculating, and hard work :slight_smile:

I am even more extreme. I am actually on NPH which has a 14 hour duration of action. I take 15 units in the morning at 6am and them 25 units at 10pm. Stack in that way means that my insulin levels overnight are about three times higher than my levels in the late afternoon/evening. If you asked many advanced pumpers, they would tell you that they have several basal levels depending on the time of day. I know one pumper whose overnight basal is 6 times his daily levels. It really is YMMV.

So you get your lantus in a vial? I’ve been wanting to do 1/2 doses for a while but I know the pens don’t do 1/2 doses…

Aagh! I was diagnosed over a year ago and taking anywhere from 7-10 units Lantus before I went to bed worked fine… until recently. It seems I’m in a different game now. 10 is not high enough some days, 9 is not high enough some days, 10 is too high and 11 works maybe once and then I have hypos – I don’t know where I’m at anymore. This weird pattern for a few months now.

Is it time for me to do basal fasting test again?.. I guess what I’m saying is, I’m 43 years old and I’m wondering whether during this crazy hormonal period in a woman’s life when things are probably gearing up for an eventual permanent change, does it make sense to assume that your needs may change all over the place till that “change?”

Yes, they do. Novopen Junior pens come in half units.