tips for splitting basal dose

[REDLAN]

Hi, was hoping for some advice.

I'm on Levemir 21 units at the moment taking it at 5pm (has been as high as 23 over xmas when I was getting fat and lazy)

I've got this problem with lows at night/early morning 3am-7am, followed by what I think is a rebound, so I tend to get a high lunch time, and then a hole starting around 4pm where basal and my lunchtime bolus insulin run out together - sometimes annoyingly preceded by a mild hypo. Although if a 20 hour duration is right maybe it's running out around lunchtime hence the high, and I'm actually only covered by the dregs of my bolus from 4pm onwards, hence the feeling that it seems to take an hour at least for my basal injection to fire up and start working.

To smooth this out I was thinking of splitting the dose.

2/3 evening time
1/3 first thing in the morning

does this sound about right? or do I want to go for a 12 hour split? Or would a 50:50 split be better? And are there split times that would work better?

might have to do a properly test my basal - I hate going hungry (",)

[Stuboy]

when i split mine, i split it 50:50 to start with, and after 3 days when i knew what needed to be adjusted in which ever direction, i adjusted for... i now take 7 at night and 6 in the morning. (10pm and 10am) i do notice changes in FBS when i adjust my evening basal.

so I would go 50:50 on a 12hour gap to START with... then work from there and see what works best for you :)

Good luck! You'll hopefully be amazed at the difference it makes! I was...

[Emm]

You'll have to find what suits you, but I would suggest that you take off just 2 units of your usual jab, and have them in the morning. Wait a day or two, then take off another two so that you're having 4 in the morning. Same again after another day or two. Once you've got to 6 or 8u hold tight for at least 3 days (gives it a chance to settle without overlap so you can really see how it's working). Then if you need to, fiddle with another 2/3 units. At some point you'll find a good balance and stick with it.

I'd suggest writing it down as you go so that you remember what your dose is :D Also aim to keep your jabs as close as possible to the same time every day, and if possible 12 hours apart. For some people it's not that important, but it can help to keep things smooth.

I think the basal testing is a great idea. One afternoon of hunger is worth it for months of settled BG levels :) It's even better if you can arrange a couple of days beforehand where you eat regularly and exercise as usual, with some sort of routine, so that you can be a little more that other factors aren't changing your results.

[grace girl]

I split my lantus back in October....I, like Stuboy, started at 50/50...and adjusted from there. I now take 16 units in the am and 7 at night. It made a huge difference. I always take the shots 12 hours apart.

[DanG]

You'll have to find what suits you, but I would suggest that you take off just 2 units of your usual jab, and have them in the morning. Wait a day or two, then take off another two so that you're having 4 in the morning. Same again after another day or two. Once you've got to 6 or 8u hold tight for at least 3 days (gives it a chance to settle without overlap so you can really see how it's working). Then if you need to, fiddle with another 2/3 units. At some point you'll find a good balance and stick with it.

I would suggest following the advice given above.

As a caution about split - I began my experiment with split at holiday a month ago. And, 26DEC I had the shock low at 3AM that made me see paramedics... again. Haven't seen them in a couple years, but the split experiment was not as carefully managed as suggested above.

I would suggest do it very carefully as suggested above. The above suggestion will be the way I do it next time I try. Just be careful... I say, based on recent split experiment.

[BlueSky]

REDLAN,

Because you are not getting full coverage over the 24 hour cycle from 1 Levimer shot a day, there is no way of knowing what split would work best for you. You will have to do some testing-and-measuring. And the logical starting point would be to split the total amount into two equal shots about 12 hours apart.

Once you have done that and given it a few days to settle down, you can test your basal rate by skipping a meal. I find it easier to skip only one meal at a time, and rotate them. You will then be able to tweak the split to get the best results.

The actual transition to a split dose is pretty simple. On the day you want to do it, have 10 units at 5pm and 11 units as soon as you get up in the morning (or vice versa). You might go a bit high during the night. But that's ok. You definitely won't go low! :wink:

[REDLAN]

seems like the consensus is 50:50 split - and then adjust from there.

Yeah the basal testing is definitely going to be needed - and the skip one meal at a time sounds like a good idea - I can cope with missing just one meal...

...it's a funny thing, I've had this disease for what 24 years and the meals I've missed you can count on the fingers of one hand - kinda got used to eating really regularly.

thanx for the advice everyone (",)

here goes...

...now where is that pen?

[JasonJayhawk]

I found that I need to take more basal insulin at nighttime (~9 PM) than in the morning (~7:30 AM). The nighttime dose, if basing on time alone, would seem to need to be higher to last longer, but it's just the opposite.

The gosh-darn Dawn effect and the food digesting slowly from the day helps.

My best tip for you is to be patient with adjustments, and make sure to take the dose at the same time every day. Within a couple weeks, you should be at something that you only slightly deviate from. If you find yourself still playing with the doses of basal after a couple weeks, then come back and report so we can offer more dieas. :trytofly: