Diabetesnet.com
12-14-2009, 07:45 PM
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My doctor has asked me to start dividing my dose of lantus in a.m. and p.m. I'm only taking 4 units a day, so that is 2 units a.m. and p.m.
I don't understand how dividing a basal insulin will improve anything, and she couldn't explain it...only that studies are showing that dividing the dose keeps patients from having "dips" in blood sugar. Can you explain how it would work?
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I usually encourage that Lantus and Levemir doses be split into two injections for my patients. Although it is an extra injection per day, there are advantages.
Lantus is actually an "18 to 26 hour" insulin. This means that many people (probably at least a third of all users) do not get a full 24 hours of action from it and many more do not take their Lantus at exactly the same time each day. Many people notice a peak in Lantus activity at about 6 hours after the injection and if this peak occurs Lantus won't last a full 24 hours (more peaking = shorter action). Small doses like yours often have a shorter duration of action (no studies done on this to my awareness but commonly seen with other insulins). Smaller doses often mean more insulin activity at 6 hours with less at 16 hours and beyond.
Thus your background insulin may "wear out" before the day is done, creating unexplained highs before the next dose is given. It can also result in lows during its peak activity. For instance, if Lantus is given only at bedtime, night lows can be more likely. If Lantus is given only in the morning, high readings before breakfast may occur. Splitting the Lantus evens out dosing gaps and minimizes peaking. After splitting, most people find they have better readings.
Another reason to split is that most people don't have consistent schedules where they give their one dose of Lantus at the same time every day. If someone gives Lantus at bedtime but goes to bed later on Fridays and Saturdays, a gap in coverage occurs on the first night and some doubling of action occurs when they return to their usual schedule. Splitting the dose greatly minimizes these timing issues even when the two doses are not given at exactly the same time of day.
Most people who need only 4 units of Lantus a day have Type 1 diabetes and are fairly sensitive to insulin. If this true for you, you may want to think about an insulin pump for precise, steady dosing.
Let us know how it goes,
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (https://www.diabetesnet.com/ask_john/?p=63#respond).
My doctor has asked me to start dividing my dose of lantus in a.m. and p.m. I'm only taking 4 units a day, so that is 2 units a.m. and p.m.
I don't understand how dividing a basal insulin will improve anything, and she couldn't explain it...only that studies are showing that dividing the dose keeps patients from having "dips" in blood sugar. Can you explain how it would work?
----------
I usually encourage that Lantus and Levemir doses be split into two injections for my patients. Although it is an extra injection per day, there are advantages.
Lantus is actually an "18 to 26 hour" insulin. This means that many people (probably at least a third of all users) do not get a full 24 hours of action from it and many more do not take their Lantus at exactly the same time each day. Many people notice a peak in Lantus activity at about 6 hours after the injection and if this peak occurs Lantus won't last a full 24 hours (more peaking = shorter action). Small doses like yours often have a shorter duration of action (no studies done on this to my awareness but commonly seen with other insulins). Smaller doses often mean more insulin activity at 6 hours with less at 16 hours and beyond.
Thus your background insulin may "wear out" before the day is done, creating unexplained highs before the next dose is given. It can also result in lows during its peak activity. For instance, if Lantus is given only at bedtime, night lows can be more likely. If Lantus is given only in the morning, high readings before breakfast may occur. Splitting the Lantus evens out dosing gaps and minimizes peaking. After splitting, most people find they have better readings.
Another reason to split is that most people don't have consistent schedules where they give their one dose of Lantus at the same time every day. If someone gives Lantus at bedtime but goes to bed later on Fridays and Saturdays, a gap in coverage occurs on the first night and some doubling of action occurs when they return to their usual schedule. Splitting the dose greatly minimizes these timing issues even when the two doses are not given at exactly the same time of day.
Most people who need only 4 units of Lantus a day have Type 1 diabetes and are fairly sensitive to insulin. If this true for you, you may want to think about an insulin pump for precise, steady dosing.
Let us know how it goes,
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (https://www.diabetesnet.com/ask_john/?p=63#respond).