Split Lantus dose - DAFNE Online

May 24, 2012 14:30

DianeW DAFNE Graduate
South West Essex PCT 115 posts

I've recently started splitting my Lantus to morning and bedtime instead of all in the morning. Wonder if anyone can give me advice. If my BG is high at bedtime, will the Lantus bring it down at all or will it keep my BG at approx the same level it was before bed? If I'm high at bedtime, should I be doing a correction of QA as well as my Lantus. I don't like to go to bed any lower than 8, so say I'm 12 for example.

Are you supposed to take roughly equal levels of Lantus morning and bed? My morning dose is for 16 hours and my bedtime dose 8 hours. I am getting confused!

May 25, 2012 10:57

Garry DAFNE Graduate
North Lincolnshire and Goole NHS Foundation Trust 328 posts

[Shared diary only visible when logged in]

Have split my Lantus for just over 2 years.
Personally I only use equal doses and try to get the timings 12 hours apart.
Seems the simple way to get an 'even' BI always available for your body to use.
Like you I can't see 16 hours versus 8 hours being helpful and going to bed high to avoid hypoing during the night can't be good long term. Need get BI right so you can go to bed at a BG in range and get up in the morning in range. Lots of things get in the way of that....but that's what we must try and achieve.
Lantus dose changes, for most of us, seem to have a long reaction time - up to 3 days to see any resultant BG change. Some other people use BI doses with a small differential of 2 or 4u....depending on your BI resistance of course.
I normally take QA and BI insulin before breakfast at 06:45 and before dinner at around 19:00. So for me it works.
At weekends, or on holiday, when getting up later.....dinner tends to be later too.....so it still works.
Here are the last few days diary included for your consideration DianeW.

Regards
Garry

May 25, 2012 11:35

DianeW DAFNE Graduate
South West Essex PCT 115 posts

This is very helpful Garry. My nurse said to take it breakfast and bed at 28 units each time and I have always thought, well I sleep for 7-8 hours but I am up for 14-16 hours so how can that work. Surely I will be overloaded with BI during the morning and I have had a couple of hypos just before lunch. I am generally at a good figure before breakfast, 6-7, which suggests the overnight BI is ok? From looking at your diary I am similar to you in that I go a bit high in afternoon but am lower and within range at bedtime. What I don't want to do is have to do two injections before bed, i.e. BI and a correction dose of QA. Not much fun.

I don't deliberately go to bed high to avoid a night time hypo but my nurse told me not to go to bed any lower than 8.

I normally inject about 9am and at 11pm (before bed) so that's 14 hours and 10 hours. I am not working, but if I was and was injecting at say 7am there is no way I could then leave the next dose until bed.

But thanks Garry it is very useful as you are on a similar BI to me. I will persevere and if get back to my nurse if it's not working out.

Regards
Diane

May 25, 2012 15:38

Garry DAFNE Graduate
North Lincolnshire and Goole NHS Foundation Trust 328 posts

My recent dinner time results are a disappointment to me but I'll get them back under control in a few days.
Have a think about changed timings though.
I genuinely believe that a practical way to get a good time split is to use meal times. I don't know why some nurses say take BI at bedtime.....can't see the rational and anyway you are the expert about your body needs so do what works for you.
By the time I go to bed all I want to do is sleep....not think about taking another injection.

Regards
Garry

May 27, 2012 10:55

thebatoutofhull DAFNE Graduate
Sheffield Teaching Hospitals 60 posts

I split my lantus as well. 17 in the morning. 13 in evening14 hrs later. My lantus lasts 18 hours max not 24. When you can find out how long your lantus lasts for you will be able to work out how to overlap the two injections. I am more interested in how lantus rolls off when it runs out. This has caused me to go high later in the evening. Lantus does not start working for approx. 1 hour. Then it rises from 4 hours to 8 hours. It then shelves for a further 2hours reaching max efficacy at 12 hours with a glucose infusion rate (mg*kg-1 min-1) of 1.8. (The peak of lets say insulatard is 3.1 - nearly double). Lantus then tails off over 12 hours between 0.5 and 1.0 G.I.R. It is this tail that is awkward. When you overlap how do you know when to have the second jab if you don't know when the first BI is ending?
I spent 2 months experimenting eating no carbs and background testing.
When over lapping my lantus I have to supplement the resulting trough with a little QA . Bloomin tricky to get right.
All the best.

May 24, 2012 14:30 DianeW DAFNE Graduate South West Essex PCT 115 posts	I've recently started splitting my Lantus to morning and bedtime instead of all in the morning. Wonder if anyone can give me advice. If my BG is high at bedtime, will the Lantus bring it down at all or will it keep my BG at approx the same level it was before bed? If I'm high at bedtime, should I be doing a correction of QA as well as my Lantus. I don't like to go to bed any lower than 8, so say I'm 12 for example. Are you supposed to take roughly equal levels of Lantus morning and bed? My morning dose is for 16 hours and my bedtime dose 8 hours. I am getting confused!
May 25, 2012 10:57 Garry DAFNE Graduate North Lincolnshire and Goole NHS Foundation Trust 328 posts	[Shared diary only visible when logged in] Have split my Lantus for just over 2 years. Personally I only use equal doses and try to get the timings 12 hours apart. Seems the simple way to get an 'even' BI always available for your body to use. Like you I can't see 16 hours versus 8 hours being helpful and going to bed high to avoid hypoing during the night can't be good long term. Need get BI right so you can go to bed at a BG in range and get up in the morning in range. Lots of things get in the way of that....but that's what we must try and achieve. Lantus dose changes, for most of us, seem to have a long reaction time - up to 3 days to see any resultant BG change. Some other people use BI doses with a small differential of 2 or 4u....depending on your BI resistance of course. I normally take QA and BI insulin before breakfast at 06:45 and before dinner at around 19:00. So for me it works. At weekends, or on holiday, when getting up later.....dinner tends to be later too.....so it still works. Here are the last few days diary included for your consideration DianeW. Regards Garry
May 25, 2012 11:35 DianeW DAFNE Graduate South West Essex PCT 115 posts	This is very helpful Garry. My nurse said to take it breakfast and bed at 28 units each time and I have always thought, well I sleep for 7-8 hours but I am up for 14-16 hours so how can that work. Surely I will be overloaded with BI during the morning and I have had a couple of hypos just before lunch. I am generally at a good figure before breakfast, 6-7, which suggests the overnight BI is ok? From looking at your diary I am similar to you in that I go a bit high in afternoon but am lower and within range at bedtime. What I don't want to do is have to do two injections before bed, i.e. BI and a correction dose of QA. Not much fun. I don't deliberately go to bed high to avoid a night time hypo but my nurse told me not to go to bed any lower than 8. I normally inject about 9am and at 11pm (before bed) so that's 14 hours and 10 hours. I am not working, but if I was and was injecting at say 7am there is no way I could then leave the next dose until bed. But thanks Garry it is very useful as you are on a similar BI to me. I will persevere and if get back to my nurse if it's not working out. Regards Diane
May 25, 2012 15:38 Garry DAFNE Graduate North Lincolnshire and Goole NHS Foundation Trust 328 posts	My recent dinner time results are a disappointment to me but I'll get them back under control in a few days. Have a think about changed timings though. I genuinely believe that a practical way to get a good time split is to use meal times. I don't know why some nurses say take BI at bedtime.....can't see the rational and anyway you are the expert about your body needs so do what works for you. By the time I go to bed all I want to do is sleep....not think about taking another injection. Regards Garry
May 27, 2012 10:55 thebatoutofhull DAFNE Graduate Sheffield Teaching Hospitals 60 posts	I split my lantus as well. 17 in the morning. 13 in evening14 hrs later. My lantus lasts 18 hours max not 24. When you can find out how long your lantus lasts for you will be able to work out how to overlap the two injections. I am more interested in how lantus rolls off when it runs out. This has caused me to go high later in the evening. Lantus does not start working for approx. 1 hour. Then it rises from 4 hours to 8 hours. It then shelves for a further 2hours reaching max efficacy at 12 hours with a glucose infusion rate (mg*kg-1 min-1) of 1.8. (The peak of lets say insulatard is 3.1 - nearly double). Lantus then tails off over 12 hours between 0.5 and 1.0 G.I.R. It is this tail that is awkward. When you overlap how do you know when to have the second jab if you don't know when the first BI is ending? I spent 2 months experimenting eating no carbs and background testing. When over lapping my lantus I have to supplement the resulting trough with a little QA . Bloomin tricky to get right. All the best.