Lantus not lasting full 24 hours

[pixelgirl]

Hi,
I am new and just registered for the forums. I am going to be posting in the introductions forum next :)
The reason why I skiped that and went straight to asking my question is because I have been having a horrible time getting my sugars under control. It seems that no matter what i do, they are either too high or else down in the ditch (very low).
Now I take lantus (15 units) in the morning and humalog with meals. I had heard that one could split their lantus dose in 2 shots--one in evening and one in morning. in my case would be 7.5 in morning and 7.5 in evening. I am going to have to do something because every morning when i wake up my sugars are in the 350 range. When I go to bed they are fine.
Has anyone successfully split the dose and done fine since?
Thanks and now I'm going to go post to the introductions board:D

[Brian23]

If your numbers are good before you go to bed, your liver may be dumping glucose into your system. Try eating a few crackers with peanut butter before bed. You may want to also try waking up a few times at night and checking your BG level to help to determine what is going on.

[xMenace]

15 is on the low side, so perhaps extra units could be added. Check with your Doc first though.

Google Dawn Phenomenon and the Symogi Effect. IMO the DP is the likely cause. Almost all of us have it to some degree.

[JuneR]

My doc had me divde my dose 2 x day. I found that taking just a couple units of Humalog before bed along with my lantus and now novolin N ( have some to use up) made a big difference in my dp. Fun trying to figure things out, huh? Good luck!

[WAMB00]

When I started Lantus a few years back I was on a single shot at bedtime (I used Novolog for meal coverage). My sugars ran high in the late afternoon and evenings. When I tried to increase the dosage of the single shot Lantus, I had lows in the night. So splitting the shot worked really well for me.

[Gary_W]

Hello and welcome :)

Have you done a fasting test to see if your basal rate is set correctly? Look it up on here if you're not sure how to do it. This technique was instrumental in me getting my contol right.

Lantus doesn't last the full 24 hours in me either, but it's less of a problem as I whack it in at midnight or thereabouts each night. As you are doing yours in the AM, the time you are without insulin cover is the early hours of the morning when sugars tend to rise in most of us anyway due to the old DP... For me, the single night-time injection works. The time that sugars can start to rise a little is mid evening, but I always test 2-3 hours after my evening meal and correct with rapid if needed. That takes me up to the next shot of Lantus and works nicely.

Good luck

Gary

[grace girl]

I agree with Gary. First you must do basal testing. Lantus doesn't last 24 hours for me, either, but I was able to confirm that through basal testing.
Taking it at night, I was high in the late evening, about 20-22 hours after the last lantus shot.
It can be successfully split, I did it about a year ago and it made a huge difference.
I split it 50/50, taking it 12 hours apart and did lots of testing. I went from 24 units in one dose to 16 in the AM and 4 at night. But I'm odd...LOL
I strongly suggest you get a copy of Using Insulin by John Walsh. Not only does it thoroughly cover basal testing, but there is also some discussion about splitting lantus.
That book was THE tool that finally helped me get my blood sugar under control.

[TenderVittleS]

350 in the morning is definetely not good. Increase your Lantus at night and you should be okay. If you're taking 15 units, try 25 units before bed.

[Isometric]

I just started a Lantus/Novolog combo myself. I'm finding that my highs are post-breakfast, and my lows are about 6 hours after my morning Lantus shot. My fastings have been on the high side of OK, but still OK, so I've been heavily considering injecting the Lantus at night. I'm asking my endo about it, and I've already ordered that Using Insulin book, so I'm basically just trying to learn as much as I can about it. I recommend the same for anyone. Knowledge is a powerful weapon for us - so even though I'm not real fond of war metaphors, I'd say arm yourself to the teeth!

On a side note, while I'm still waiting for my book to arrive - what's a good method for switching Lantus to an evening dose without overlapping and putting myself at risk for a hypo?

[Scratch]

350 in the morning is definetely not good. Increase your Lantus at night and you should be okay. If you're taking 15 units, try 25 units before bed.
Yipes, this is not good advice.

First off, the information we've been given in the opening post was too limited. We don't know enough to say with any certainty why pixelgirl is waking up at 350. It could be her basal dose is too low, it also could be she's bottoming out overnight and her liver is giving her a rebound effect. We don't know if she's done overnight tests to monitor her blood sugars while only her basal insulin is active.

If it's a situation being caused by going hypo with a liver rebound, increasing to 25 units, approx 1 u/hr basal, from 15, approx .625 u/hr will be no good at all.

Now if she does overnight testing and finds that her blood sugars are steadily climbing, then she should begin increasing her dose, but I certainly wouldn't do so by increasing it 67%. A more cautious stepwise approach would be better, making changes at around 10 to 15% per change, or in her case 1 to 2 units of change as indicated by testing.

[Gary_W]

Yipes, this is not good advice.

First off, the information we've been given in the opening post was too limited. We don't know enough to say with any certainty why pixelgirl is waking up at 350. It could be her basal dose is too low, it also could be she's bottoming out overnight and her liver is giving her a rebound effect. We don't know if she's done overnight tests to monitor her blood sugars while only her basal insulin is active.

If it's a situation being caused by going hypo with a liver rebound, increasing to 25 units, approx 1 u/hr basal, from 15, approx .625 u/hr will be no good at all.

Now if she does overnight testing and finds that her blood sugars are steadily climbing, then she should begin increasing her dose, but I certainly wouldn't do so by increasing it 67%. A more cautious stepwise approach would be better, making changes at around 10 to 15% per change, or in her case 1 to 2 units of change as indicated by testing.

Ditto

Making any large change in insulin (especially upwards) without having an idea why you're doing it is not a good idea. Basal testing will tell the OP what she needs to know so she can make the needed changes in a safe manner.

[DanG]

Ditto

Making any large change in insulin (especially upwards) without having an idea why you're doing it is not a good idea. Basal testing will tell the OP what she needs to know so she can make the needed changes in a safe manner.

Yes, ditto.
However, if you are like me, you rarely see the doctor, nor do you depend on his knowledge - they only practice, you know, medicine.
You are the expert in your diabetes. Realize that, and live with it.
DO NOT make any large changes to lantus, especially if you switch to night time lantus. It was a year ago I tried the split dose, and that put me in a severe low, i.e. we had the paramedics here at 3:30 AM - no fun!!

So, enuf with the split for me, sez I.

I switched from bedtime lantus to breakfast lantus - on my own. Doctor listens to me - he has nothing to tell me but experience of others. My thinking is this: if you have low bloodsugar on lantus during the day, you at least have an opportunity to correct yourself. If you go low while asleep, the only hope you have is that you wake, or your liver pushes enuf glucose to your system to wake you. Whereas, during the day, you can probably tell if you are approaching a low - presumeably you do know what a low blood sugar is like? - i.e. sweaty, nervous, shakey, disoriented.

However, even knowing this, sometimes things go whako. A month ago while at work, I realized I should eat, but was busy and kept working (CAD). About 4 PM, I became sooo disoriented, I could not even do simple computer clik someone told me to do. Really embarassing!! A bit of a soda and 10 minutes later, I realized I had made a fool of myself. I tell nobody I am diabetic, not even my wife... just kidding. My wife knows, and so do my kids, but not many others.

[TenderVittleS]

Yes, ditto.
However, if you are like me, you rarely see the doctor, nor do you depend on his knowledge - they only practice, you know, medicine.
You are the expert in your diabetes. Realize that, and live with it.
DO NOT make any large changes to lantus, especially if you switch to night time lantus. It was a year ago I tried the split dose, and that put me in a severe low, i.e. we had the paramedics here at 3:30 AM - no fun!!

So, enuf with the split for me, sez I.

I switched from bedtime lantus to breakfast lantus - on my own. Doctor listens to me - he has nothing to tell me but experience of others. My thinking is this: if you have low bloodsugar on lantus during the day, you at least have an opportunity to correct yourself. If you go low while asleep, the only hope you have is that you wake, or your liver pushes enuf glucose to your system to wake you. Whereas, during the day, you can probably tell if you are approaching a low - presumeably you do know what a low blood sugar is like? - i.e. sweaty, nervous, shakey, disoriented.

However, even knowing this, sometimes things go whako. A month ago while at work, I realized I should eat, but was busy and kept working (CAD). About 4 PM, I became sooo disoriented, I could not even do simple computer clik someone told me to do. Really embarassing!! A bit of a soda and 10 minutes later, I realized I had made a fool of myself. I tell nobody I am diabetic, not even my wife... just kidding. My wife knows, and so do my kids, but not many others.


I've had the D since I was young so I pretty much do my own adjusting. Rarely do I need a doctor to tell me, they can only offer experience from what they heard, but everyone's different. Lows with Lantus are not like NPH so they are easy to correct for me. Dan I would tell your coworkers or at least one worker that you are diabetic. You may realize there's plenty working with you! It makes life alot easier and they will most likely understand why you zoned out for a little while.

[Scarlett]

I split w/15 & 15 almost 12 hours apart exactly- i was shooting at 10 am and 10 pm and found sugars almost always off-started easing back to 6:30 am/pm and got better control
it seems like I could almost live on just the lantus alone
my endo started me at 25/25 and i moved it down after 2 days of constant near death experiences! I'm approx. 145 lbs and i'm T1 for 34 yrs. -GOOD LUCK and BE CAREFUL!!!!! go slow with adjustments and stay on the same routine during the adjustments you'll never get that "great" control unless you have some kind of baseline where to start.

[pixelgirl]

Cannot thank you all enough for the replies, much useful information. Ok, I found out yesterday and the day before that that 15 units is too much for me. I had lows scattered throughout the day. The reason why is because I have dropped 15 pounds in the past 2 months. Now I agree about the basal testing. I think I will read up more on what you all have said and do that in the next day or two. This is what I did this morning:

started this morning taking 7 units of lantus at 8:00 am. At 8 pm tonight I will then take 7. So far, so good. I will report back how this turns out too but definately a basal test is in order.

[Real4]

Has anyone successfully split the dose and done fine since?

I'd say most "pro"s split their dose. By "pro" I mean somewhat who knows something about insulin medically and they themselves take insulin.

Lantus just often does last for 24 hours.

A doctor, per se, doesn't know from Adam on taking insulin unless they've had a particular reason to learn.

I personally have had good result splitting my dose. Morning readings under 100.