Some people with type 1 diabetes have split the Lantus dosage with success. The recommendation I read was 25% in the morning and 75% in the evening. What are the indications to split the Lantus dose and once it is split, how do you decide which dose to adjust? The support for making insulin adjustments using a pump is vast, but I am unable to find equal sources on how to best use Lantus. All the information I see is general with very little on how to fine tune the dosage. Do you know of any sources on best practices with Lantus?

There are no hard and fast rules. Our practice has always been to let the blood glucose levels be our guide. We generally start with bedtime-only Lantus plus prandial fast acting insulins. If there is a large afternoon snack, not so much afternoon activity and higher blood sugars at dinner and afternoon, this is a good indication that the Lantus is not lasting 24 hours, but waning. Therefore, add a few units of Lantus in the morning. Our ratio is usually about 80 to 90% Lantus in the evening and 10 to 20% in the morning, but this also is very individualized. Some of our youngest kids need the reverse, more morning Lantus and very little at bedtime. As my friend and colleague Professor Harry Dorchy in Brussels always says/writes: no dogma.

SB