Advice for starting on Tresiba

[Allyee]

I have been on Lantus since diagnosis (about 15 years) and use a dexcom ONE CGM. I currently experience night time lows most nights at about 3-4am which is very disruptive sleep-wise. I have always split my Lantus dose as it only ever had about 18-20 hours duration for me. I have tried to adjust my Lantus dosing for about 6 months to stop the night time hypos but have not managed to do this effectively.

I am thinking of approaching my GP to switch on to Tresiba as this has a much flatter profile and longer duration of action. I wanted to ask advice of people who had made this switch:
- pros/cons,
- starting dose, would this be roughly 1:1 or at least a good place to start (e.g. Lantus daily dose of 15iu would be a daily dose of 5iu as Tresiba is a 72 hour duration, taking 3 days to reach optimum basal), and
- any good arguments to persuade a cash-strapped CCG to prescribe me a more expensive insulin.

Thanks for your thoughts.

 

[eventhorizon]

Hi.

I switched from Lantus to Levemir then finally to Tresiba. From what I remember the Lantus to Levemir switch was 1 to 1. The Levemir to Tresiba required slightly less overall insulin once things had settled.

Probably best to start with a little less than what you've been using and work slowly increasing the dose. Giving 2 or 3 days between each change.

 

[Zhnyaka]

my doctor reduced my dose by 20% and forbade changing it for 5 days until tresiba was in a loop, and then increased the dose until a normal profile was reached. It turned out to be less than 1:1. Anyway, I think you should ask your doctor and not us, because people are different. Of the disadvantages, I can only note that Tresiba is inflexible insulin and it takes at least 3 days to see the effect of a dose change

 

[EllieM]

I have tried to adjust my Lantus dosing for about 6 months to stop the night time hypos but have not managed to do this effectively.

If you are already splitting your dose to flatten the profile have you considered that the issue might be that you just need less basal insulin at night? (Assuming these are real hypos, as measured by a glucometer and/or hypo symptoms, rather than a compression low caused by lying on your cgm.)

It might be worth seeing if your endo will put you on a waiting list for a pump??? (And as regards the cash strapped NHS, a change to tresiba would certainly be cheaper than that.)