Split background insulin

Hi, I have just graduated on the Dafne course. We did not cover the impact of split background insulin. I have split mine as my BI seems to run out early afternoon and I seem to go higher as the day goes on even though Im doing corrections at Breakfast lunch and dinner. Can someone please advise how I would know what needs changing should hypos/hypers show thoroughout the day. Would I change the BI if the hypo/hyper is within an hour of eating for instance, or is there any other way to tell? ... Im a bit confused as to whether to change to BI or QA ratios. I hope this makes sense!

Any help would be greatly appreciated. Thanks

Caroline, I think you should talk to yuor DAFNE Educator and/or Diabetes support team ( Diabetes Nurse/Consultant). I don't think you should rely on advice from this site when changing to split doses.
I also don't think there is enough info above to give much advice anyway. You need at least a few more days before a pattern can emerge.
The main thing to remember is that your BI is supposed to keep your blood sugar fairly constant in the absence of food. Therefore you need to look for patterns where it increases either overnight or during they day when you don't have carbs. Your QA is what should take care of food. Therefore if a hypo/hyper occurs within an hour of eating it should be down to QA and NOT BI.
You don't say what type of BI you are taking either, the profiles of all BI's are not the same and they can behave slightly differently. This is another reason for speaking to your Educator. They might suggest switching BI to another type, which again is not something anyone on
here can recommend. We are all happy to help and advise, however you probably need more detailed avice than we can provide.

Thanks for getting back to me. Yes I should have perhaps posted this to the medical staff; being the weekend. Im on lantus. Thanks for your input, I will monitor it closely and see what happens. Think there is alot to take in from the course and maybe im just a bit bamboozled by it all! I will speak to the hosp as I have an appointment on Thursday.

I'm glad to hear you will be seeing the hospital thursday, just because I would like them to confrim what you are doing in case you have
any problems. Not that I'm suggesting you will. I am on Levemir which it now seems commonly accepted does not last 24 hours in a lot
of people and so a lot of people are on a split dose. Less people on Lantus split their dose I think, but I'm happy to be corrected by others.
As I said before, I think you will need to give it a few more days before you can spot any patterns and it will probably take a couple of days
before the changes you have made will have full effect. There is nothing wrong with making changes, thats part of what DAFNE is about.
Its just always a good idea to ensure those that support you at the hospital etc, know you have made these changes. Let us know if
the change works for you, since I'm sure others have considered it but not felt confident enough to do it.

hi, I just wanted to add that I had the same problem when I was on Lantus. The hospital advised me to have lunch and then eat no cps for the next 5 hours(if your on novorapid) and then check your sugars. Check them an hour later still without eating any cps to check what's happening when your QA has ran out and if they've risen you need to split your longacting insulin as it's not being effective at controlling your fasting sugars. I had to do that twice just to confirm that it was definately running out in the evening. I just wanted to suggest it so you'll be able to show it to your dafne team at your checkup.

Even when you've changed insulin type and were already on a split dose before, it can be difficult to work out.

Just this week I've changed from Lantus to Levemir in the hope that things will become more stable but it has been difficult. I've found that I needed a lot more than what I was taking for Lantus so I did start down the path of getting lots of ketones, but applying sick day rules thankfully got me out of it. Not something I needed considering I was still working out my new dose amounts but such is the nature of trial and error.

Keep your chin up - you can work it out and definitely contact your specialist before it gets too much. Good luck Caroline!