- advertisement -

splitting lantus

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jan 8, 2016.

  1. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    To keep this simple, my son was getting Lantus at night. More than 2 units made him tend to go low and 2 units didn't seem to help much past lunch. He would rise late after lunch and dinner before his night time shot. Tried 2-3 alone in the morning, but then he rose during the night out of range.

    So I tried splitting it, but ran into this problem: The morning (7:30) dose of 2-3 units seemed to work until around midnight, not sure but somewhere between 10 pm and 2 am before it ran out. The night (7:30) 1-2 units PEAKED around midnight and now was overlapping with the morning dose, so giving a larger morning dose actually gave him the highest basal in the middle of the night when he needs it the least.

    So I was wondering if people had strategies to work with Lantus that worked for them when it didn't seem to work the full 24 hours? Anyone try splitting it but not 12 hours apart, or unevenly like 60% and 40%.

    Basically he needs more in the day and less at night.
     
  2. Sprocket

    Sprocket Approved members

    Joined:
    Mar 6, 2014
    Messages:
    196
    We're working out something similar, but with Levemir twice per day 7am and 7pm. The lower the dose, the shorter the duration we found - likely the same with Lantus. At even doses, we were finding her 7am shot was running around about 3pm and she'd climb steadily higher and I would correct, correct and finally would be back down by AM. I believe we've conquered this by increasing her am dose - she now takes 48 units of Levemir in the Am and 27u at 7pm - so we're far from a 50am/50pm split. Any lower than 27 at night and it doesn't last until 7am and she creeps up higher by morning and any more and it drops her too low. These numbers must seem insane to you, but she is a 14 year old girl, full adult size and 3" taller than me.

    That said, I would back off on the morning Lantus. With two shots per day, I believe the goal is to keep steady for about 14 hours if you're doing shots 12 hours apart. If your 7:30 am shot runs out about 9:30pm, that's what you want - but no later than that. The 7:30pm shot you give him will have then kicked in and will take him through, a few hours past his AM shot. You shouldn't have too much overlap, or he will go low. If there is a gap in coverage, he'll creep high. It takes about 2 hours to start working.

    I think the twice daily method is good (for Levemir especially) because you have more of a chance to fine tune basal than the one dose for the day.
     
  3. nebby3

    nebby3 Approved members

    Joined:
    Jun 5, 2007
    Messages:
    923
    Not sure how much it helps by my dd uses levemir and gets 22u at 8pm and 14u around 7am (though that varies more based on when she wakes up). Definitely not 50/50 though.

    Based on your first paragraph I would have started with 2u at night and 1u in the AM to help tide over that high afternoon.
     
  4. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    Part of the issue is that my son was using 1 unit of Lantus at night, but was approaching 10:1 carb to insulin ratios at breakfast and dinner and was about 15:1 at lunch. It just didn't make sense that he needed 3 units for 30 grams of carbs for breakfast but ran flat at 100 with 1 unit of Lantus. The honeymoon explains the low Lantus, but not the high bolus needs. The endo told me that I could not raise his meal time insulin any more and had to bring up the basal instead and she told me she was sure that adding 2 units of Lantus in the morning would push Lunch and dinner up to 20:1 or 25:1. I added one in the morning for 3 days and it didn't affect anything except that I didn't have to micro correct at dinner as often (I would cut a few grams of carbs but not a half unit worth if he was in range but above 100, or I would add a few grams and give him an extra half unit.

    I went to 2 in the morning and then 3 and the mealtime ratios didn't change. They improved in the sense that he had fewer unexpected out of range numbers particularly at dinner and 4 hours after dinner.

    I also thought it was basal because my son would peak so late. He typically does not even now rise in the first hour after breakfast or lunch, and he doesn't even rise in the first 90 minutes after dinner. He will usually go down 10-20 points in the first half hour, then back to his starting point at the 1 hour mark, THEN he will rise. His dinner peaks are typically around 3 hours out and all of his peaks are moving further and further out.

    Again, I never would have split the Lantus except the endo literally told me not to raise mealtime insulin anymore. Right now my son looks like he may need 9:1 at breakfast and dinner, and maybe 13:1 at lunch though it may be part of the stress of going back to school. He has trended higher throughout the week and needed corrections after dinner and at lunch today (with a 10:1 ratio for breakfast).
     
    Last edited: Jan 8, 2016
  5. GChick

    GChick Approved members

    Joined:
    Nov 9, 2013
    Messages:
    213
    All I can suggest is figuring out percentages (how much is needed for which time slot).

    I used to take 17 units total of Lantus:
    10 units @ about 9:00pm (sometimes as late as 10:00pm)
    7 units @ about 5:00-6:00am

    Why I think it worked is that the shorter time segment but larger dose was given at night and the "peak" of it would be at about the same time I gave the smaller dose for the longer time segment, so in fact the larger night time dose and a small part of the small morning dose would both be working at breakfast.... the most insulin-needy time of day for me.

    All I can suggest is don't expect a 50/50 split nor a 50/50 time segment and play around with it.
     
  6. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    Thanks. My first impulse was to give one dose at breakfast (before 8:00 am) and the second around 5:00 pm because we seemed to get a peak around 2-6 hours. This peak would help a little with the late dinner bump (I think that it seems a lot of kids his age get a hormone surge around 8:00 pm or so) and the peak would be over by 11:00 so as long as he wasn't low by then I knew he would not be likely to go lower. Unfortunately it helped less with breakfast at 5:00 than at around 7:30 pm (he peaks very late from breakfast though, like 2 hours after eating).

    I also think that his small doses make the lantus less predictable in a way. A large dose can only enter the system so fast, but a small one like 2-3 units is just so small that sometimes it leaks out early and sometimes it leaks out late.

    I think this is basically the issue that will get me pumping, though I like a recommendation someone gave that while pumping you can still cover 50-60% of basal with Lantus and then just adjust the top end with the pump. We are at one year post dx next tuesday. We got dexcom at just the right time (his doses increased 250% in the first month on dex).
     
  7. dpr

    dpr Approved members

    Joined:
    Dec 17, 2013
    Messages:
    399
    Time for a pump?
     
  8. mom24grlz

    mom24grlz Approved members

    Joined:
    Mar 30, 2010
    Messages:
    1,799
    Ashleigh splits her Lantus. 21 units at 7AM and 18 units at 8PM.
     
  9. forHisglory

    forHisglory Approved members

    Joined:
    Jan 26, 2015
    Messages:
    382
    Our one year is Tuesday as well! I just wanted to make a quick comment on using Lantus with the pump. We considered this too but there are times when we need very little basal...I think the maximum fine tuning and ability to suspend basal if necessary could be complicated by Lantus on board. Also, it adds another variable when you're trying to figure our profiles or it may slightly mask a site failure. With Dexcom, I can't see how a high number or bad site would go unnoticed long enough to worry about ketones. Now, I know some are extremely sensitive and develop ketones quite easily. The rationale for the Lantus and pump (unless going untethered) just hasn't made sense to me with a reliable CGM. IMO for what it's worth. Plus- what kid likes that sting?
     
  10. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802

    thanks. Do you notice a drop in blood sugar during the overlap period say 10 pm to midnight?
     
  11. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    piggy backing to the other thread, I agree with the endo that giving a higher Lantus in the AM will most likely change the lunch and dinner ratio. I think you still might have a strong first meal of the day ratio. Both of my girls do and DX at totally different ages.

    Also both ofmy girls have a spike about an hour after the fall alseep, sometime much more than expected but we runn a higher basal at night.
     
  12. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    Do they go to sleep within 4 hours of dinner?
     
  13. mmgirls

    mmgirls Approved members

    Joined:
    Nov 28, 2008
    Messages:
    6,030
    Yes, dinner at 6-7 pm and bedtime at 8:30 on a school night. School starts at 7:30 am and I try to get them there around 7am, so they usually have an larger after school snack between 2:30 and 4pm.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice