A very interesting question about basal insulin (Lantus/Tresiba/Levemir).

[spanishavocado]

Imagine that I have 18 units of Lantus or Tresiba at say 9:00 AM.

I can have the 18 units in one shot, or I could divide these large shot into three shots at the same time, same hour of 6, 6 and 6 units in diferent parts of the body (say belly, left leg and right leg). The three shots given at the same hour: 9 AM. No split afternoon dosing or anything like that. Split dosing is something totally different.

The goal would be to increase the surface of absorption and therefore make the insulin be more stable and work better. I've heard similar theories from Richard K. Bernstein, M.D.

Has anyone tried this technique with success? I may try it tomorrow for my Tresiba dose. Thank you.

 

[robert72]

This was my Tresiba overnight last night. 15u taken at 10pm in one shot. I can't see that I could get it much flatter by splitting it across 2 or 3 doses. No, my Libre is not broken and yes, I did sleep in until 11am

 

[Type1Bri]

This was my Tresiba overnight last night. 15u taken at 10pm in one shot. I can't see that I could get it much flatter by splitting it across 2 or 3 doses. No, my Libre is not broken and yes, I did sleep in until 11am

View attachment 18251

Very nice Rob, was that aided by Dr Merlot in anyway??

 

[robert72]

Very nice Rob, was that aided by Dr Merlot in anyway??

Dr Rioja prescribed 2 glasses

 

[Type1Bri]

He has a great thesis on treating type one diabetics

 

[robert72]

Imagine that I have 18 units of Lantus or Tresiba at say 9:00 AM.

I can have the 18 units in one shot, or I could divide these large shot into three shots at the same time, same hour of 6, 6 and 6 units in diferent parts of the body (say belly, left leg and right leg). The three shots given at the same hour: 9 AM. No split afternoon dosing or anything like that. Split dosing is something totally different.

The goal would be to increase the surface of absorption and therefore make the insulin be more stable and work better. I've heard similar theories from Richard K. Bernstein, M.D.

Has anyone tried this technique with success? I may try it tomorrow for my Tresiba dose. Thank you.

@spanishavocado - it would be interesting to know if it helps you at all. I probably should have tried this when I was on Lantus as I found that it could be erratic at times. I also wonder if smaller doses would be better for injection site/absorption issues.

 

[tim2000s]

Lantus and Tresiba have very different mechanisms by which they operate. Lantus (Insulin Glargine) forms a crystalline precipitate after injection due to its pH, which is broken down by the body slowly. Tresiba remains liquid and it is the use of proteins in a specific way which causes the slow release.

I honestly don't think it matters for tresiba as it could all be curculating in your blood within 15 mins and it wouldn't affect how it acted. It may make a difference for Lantus though.

 

[donnellysdogs]

Lets face it though.. Who in there right mind really wants to faff around adding more injections in?
I don't.
Delighted to start on tresiba Saturday morning... Although levels shot to pices by Sunday morning!!
Increased dose this morn and will see how it goes.

I was absolutely delighted last night at 9pm not to inject.. No way would I entertain adding more injections in!! Having to eat 6 minute meals a day now I have enough to contend with bolusing!! -lol!!

 

[Nuck]

The challenge I have with Lantus is that if I take the full amount I end up with a Hypo at night. If I reduce the Lantus too far then my sugar levels rises both at night and through the day. I then have to use fast acting humalog to keep it down. From fasting I can stay in the zone for about 9 hours before my sugar creeps up. I have had to split my dose and take a large dose at night followed by a smaller dose in the morning. This seems to work for me. Too large in the morning and I start to Hypo after 6 to 7 hours.
From this it would appear that the Lantus peaks after 6-7 hours (not good if I take too much and I am asleep). It lasts 9 to 12 hours (not the 24).
In the morning I do seems to suffer with a sugar spike around 10am. This happens regardless of if I Hypo in the night. This seems to be the way my body works.

 

[Nuck]

This was my Tresiba overnight last night. 15u taken at 10pm in one shot. I can't see that I could get it much flatter by splitting it across 2 or 3 doses. No, my Libre is not broken and yes, I did sleep in until 11am

View attachment 18251

Why does the line start at 4am?

 

[robert72]

Did you fit a sensor at 4am? Looks like the line starts after 3.

Ah no, it's been on for about 10 days. I went to bed at midnight and slept solidly for 11 hours so it only read the data for the last 8 hours from when I woke and scanned.

 

[petepontiac]

At first I was worried that 16u of Lantus before bed would cause a hypo during the night, but it seems to work well and my morning BG is fine. One thing I did learn not to keep Aprida and Lantus next to my bunk, especially when you get them mixed up. 16u of Aprida certainly brings on a Hypo. Arrrgh

Edited to use correct units.

 

[slip]

At first I was worried that 16ml of Lantus before bed would cause a hypo during the night, but it seems to work well and my morning BG is fine. One thing I did learn not to keep Aprida and Lantus next to my bunk, especially when you get them mixed up. 16ml of Aprida certainly brings on a Hypo. Arrrgh

The thought of realization just when the pen clicks as you've fully depressed the plunger............I sure we've all been there and done it. One way or another you're in for a 'treat'

 

[Dillinger]

This was my Tresiba overnight last night. 15u taken at 10pm in one shot. I can't see that I could get it much flatter by splitting it across 2 or 3 doses. No, my Libre is not broken and yes, I did sleep in until 11am

A) Brilliant bloods, you lucky b*&^%$%!!
B) 11 hours sleep!!? You lucky b*&^%$%!!

Now after my jealous outburst could you let me know about the Tresiba? Do you feel that it is responsible for those great levels? What is the benefit of having a basal with such a long action? Doesn't it mean that it stacks up or risks staking up? Is there something else about it that you like?

Thanks

Dillinger

I'm still jealous...

 

[petepontiac]

The thought of realization just when the pen clicks as you've fully depressed the plunger............I sure we've all been there and done it. One way or another you're in for a 'treat'

I stared sweating with anticipation as soon as the plunger was depressed whilst looking at the Lantus pen on the bedside cabinet. Then it was just a case of waiting for the shakes

 

[robert72]

A) Brilliant bloods, you lucky b*&^%$%!!
B) 11 hours sleep!!? You lucky b*&^%$%!!

Now after my jealous outburst could you let me know about the Tresiba? Do you feel that it is responsible for those great levels? What is the benefit of having a basal with such a long action? Doesn't it mean that it stacks up or risks staking up? Is there something else about it that you like?

Thanks

Dillinger

I'm still jealous...

Hi @Dillinger - I'm sure it's responsible for the flat basal. Obviously that depends on getting the dose right and of course you need to get the boluses right too. I think the benefit of having such a long acting insulin is that it doesn't run out. I used to see that with Lantus at around the 20 hour mark. Understand about the worry of stacking but I'm not seeing any effect from it. I can't think of anything else about it that I like other than it does the job very well and is just one shot a day.

 

[Bluemarine Josephine]

Hello everyone, I hope that you are all very well!
My two cents here regarding Tresiba. (and irrelevant to the topic, I know... I am sorry).

I LOVE this basal insulin, it is so flat and smooth with a wonderful, totally flat and stable profile. I cannot stress enough how comfortable I felt with it.

Unfortunately, my physicians switched me to a split dose of Levemir during DAFNE course (which is still okay and certainly far better than the temperamental Lantus.) They said to me it is because I need a different dosage of insulin in the morning than in the evening (and I cannot split Tresiba.) However, I believe that this is a fabricated excuse just because Tresiba is an expensive insulin and the council at the hospital (where I live) has not approved the cost for Tresiba.

If anyone can get their hands on Tresiba just go for it.

Regards
Josephine.

 

[smag3]

Why is it a lottery as to whether you can get the Trisiba or not? I have been told NO even though I am sure it would reduce the amount of actrapid I use, and give me a much flatter profile. Can I appeal against a decision that is not in my best interests?

 

[tim2000s]

Hello everyone, I hope that you are all very well!
My two cents here regarding Tresiba. (and irrelevant to the topic, I know... I am sorry).

I LOVE this basal insulin, it is so flat and smooth with a wonderful, totally flat and stable profile. I cannot stress enough how comfortable I felt with it.

Unfortunately, my physicians switched me to a split dose of Levemir during DAFNE course (which is still okay and certainly far better than the temperamental Lantus.) They said to me it is because I need a different dosage of insulin in the morning than in the evening (and I cannot split Tresiba.) However, I believe that this is a fabricated excuse just because Tresiba is an expensive insulin and the council at the hospital (where I live) has not approved the cost for Tresiba.

If anyone can get their hands on Tresiba just go for it.

Regards
Josephine.

I suspect that they put you on Levemir for that and another reason. The DAFNE evidence base shows that DAFNE is most effective with the use of Levemir and not Lantus. They don't have enough data to argue either for or against Tresiba at this stage.

If you weren't having Hypos as a result of Tresiba not working well with exercise, and you found it better than Levemir , then I'd certainly consider saying that you wanted to go back.

 

[AndyS]

The challenge I have with Lantus is that if I take the full amount I end up with a Hypo at night. If I reduce the Lantus too far then my sugar levels rises both at night and through the day. I then have to use fast acting humalog to keep it down. From fasting I can stay in the zone for about 9 hours before my sugar creeps up. I have had to split my dose and take a large dose at night followed by a smaller dose in the morning. This seems to work for me. Too large in the morning and I start to Hypo after 6 to 7 hours.
From this it would appear that the Lantus peaks after 6-7 hours (not good if I take too much and I am asleep). It lasts 9 to 12 hours (not the 24).
In the morning I do seems to suffer with a sugar spike around 10am. This happens regardless of if I Hypo in the night. This seems to be the way my body works.

I was seeing exactly the same behaviour on Lantus, moving to a split Levemir dose pretty much solved this behaviour for me as I can now apply different basal for day and night.