It’s been 10 months since I went back to managing my diabetes with multiple daily injections and Lantus.  For most of that time, I gave myself one injection of Lantus daily, at bedtime.  Figuring out how to manage dawn phenomenon was one of the main issues I faced when going off the pump.  Also, I didn’t feel that the Lantus actually lasted a full 24 hours, at least not at the same strength. 

So, several weeks ago, I took my endocrinologist’s advice and tried splitting the dose into two daily injections.   Instead of giving my entire daily dose at 10:00 p.m., I injected half the dose at 7:00 a.m. and the other half at 7:00 p.m.  The hardest thing was remembering to give those injections at all!  I had to set my cell phone alarm to remind me.  However, once I settled into the routine (which actually corresponds nicely with breakfast and dinner), it turned out to be a welcomed change.

I’ve found that my dawn phenomenon is not as dramatic as it was before.  I theorize that the Lantus takes awhile to peak, so the timing works better by giving a dose at 7:00 p.m. rather than 10:00 p.m.   

One issue I quickly addressed was that my big dose of Lantus must have been helping to cover my postprandial blood sugar at breakfast. By giving the entire dose at 10:00 p.m., it would peak at mid-morning, therefore I need more fast acting insulin at breakfast now that my dose is split in two. 

A big improvement has been my blood sugar control when exercising in the late afternoon.  Previously, it seemed that I had little active insulin in my system by 5:00 p.m. which led to high blood sugars after running, (if I didn’t give myself any fast acting insulin and therefore snacked too).  Now, I can run with more steady blood sugars without needing to bolus or snack, if I don’t want to.

My endo was pleased with this change and noted that I didn’t have to be very strict about the timing of these two doses.  If I wait until 8:30 or 9:00 p.m. to inject, it’s okay.  Since the insulin is long acting and my half dose is pretty small, the overlapping doses allow for more flexibility, which I like. 

Overall it feels like my basal insulin is now acting just like basal insulin should: remain in the background and not cause unnecessary fluctuations in my blood sugar.