New to Tresiba - Flexibility?

[victry77]

So, I started Tresiba (previously on a split dose of Levemir for years) four days ago. I was switched by my consultant and prescription was done by the DSN. Basically, the consultant said it was a better, much flatter insulin that can last for up to 42hrs and the DSN told me to take 20% less than my usual Levemir dose. That was all the information I was given.

So, by day three I was being hammered with hypos non-stop. It's only since browsing the forum that I've realised it takes about three days to settle in. I think it's worth me reducing by another unit at least and see how that goes.

But my main issue is regarding flexibility. I told the consultant that my levels are starting to get much higher and erratic with PMS (and likely effects of starting peri-menopause). It's unpredictable and happens some months but not others, but I could at least up my Levemir to meet my needs.

Also, I do some theatre/performance work. Nerves and adrenaline would shoot my sugars up, so I would need to up the Levemir again.

But, with Tresiba, how do I accommodate this? From what I describe does this sound like a suitable insulin for me?

OK, I was starting to get a lot of ups and downs with Levemir, and I did feel that perhaps it wasn't working as well for me anymore. But I'm just a bit a concerned about the lack of flexibility.

Any advice?

 

[searley]

Your best bet in uncertain cases is not to adjust the tresiba as all changes can take 48 to 72 hrs to take effect.. you best bet would be micro doses of you fast acting to control your levels

 

[victry77]

Your best bet in uncertain cases is not to adjust the tresiba as all changes can take 48 to 72 hrs to take effect.. you best bet would be micro doses of you fast acting to control your levels

Thanks, yeah, it appears that increasing the basal isn't an option now for the instances were I would normally need it increased.

I've been taking it between 9-10AM but want to try and move it to the evening as my BG tends to spike as soon as I wake up.

 

[victry77]

Well, 8 days in and I'm still spiking pretty much the same times of day as I did with Levemir andthen just chasing hypos the rest of the time

 

[searley]

Well, 8 days in and I'm still spiking pretty much the same times of day as I did with Levemir andthen just chasing hypos the rest of the time

With tresiba time of day doesn’t really matter as there isn’t really a spike in its profile.. but I always took my basal at night

 

[In Response]

Well, 8 days in and I'm still spiking pretty much the same times of day as I did with Levemir andthen just chasing hypos the rest of the time

What time of day do you get your spike?
If it is predictable, I know some people give themselves a bolus shot to accommodate their predictable spike. Then you could lower your basal to avoid the hypos.
I used to get spikes when I went climbing. I suspect it was a combination of resistance training and a bit of adrenaline fuelled liver dump. I would account for this with a bolus dose as I started climbing.

Another though: I assume you have done a basal test and are confident that the problem is not a need to adjust your insulin to carb ratios. Bear in mind, it is not uncommon to need different ratios for different times of the day.

 

[victry77]

What time of day do you get your spike?
If it is predictable, I know some people give themselves a bolus shot to accommodate their predictable spike. Then you could lower your basal to avoid the hypos.
I used to get spikes when I went climbing. I suspect it was a combination of resistance training and a bit of adrenaline fuelled liver dump. I would account for this with a bolus dose as I started climbing.

Another though: I assume you have done a basal test and are confident that the problem is not a need to adjust your insulin to carb ratios. Bear in mind, it is not uncommon to need different ratios for different times of the day.

I was constantly going hypo after about two days of using it, so I have reduced it. Now I'm still going quite low late morning.

Then I always used to spike about 4pm, however, I found I was also crashing then, too, since using Tresiba. I've reduced my lunch bolus, but the past two days I've spiking higher than ever at 17!

I originally took it at 10am, but have gradually changed it to 10pm. I thought that might help with my usual morning spikes. I think it might have, but afternoon/evening seems problematic now.

 

[In Response]

Have you done a basal test to check the problem is the Tresiba?
It should have a long flat profile do not affected by taking morning or night unless your liver dumps different amounts of glucose at different times of the day. If that is the case, it would seem to me that Tresiba is not ideal and Levemir (or a pump) would give you more flexibility.

 

[EllieM]

it would seem to me that Tresiba is not ideal and Levemir (or a pump) would give you more flexibility.

I would have thought that a pump would be the best option for someone with varying basal needs. I'm not in the UK but my team suggested it to me when I was having issues with dawn phenomena but I've managed to improve my situation by splitting may lantus dose. If I couldn't make lantus work for me I would ask for a pump. (Lantus is the only basal available where I am)

@victry77 is a pump something you would like or that your team would be prepared to give you?

 

[victry77]

Thanks.

I've tried a pump in the past (medtronic) but had terrible problems with cannulas and found it difficult to wear.

 

[In Response]

Thanks.

I've tried a pump in the past (medtronic) but had terrible problems with cannulas and found it difficult to wear.

Did you try different cannula? There are a few 0eople on the forum who had problems with the "standard" cannula but trialed other types of cannula ("sure-t" is often mentioned ") and found one more suited to them.
I am not sure what you mean about "difficult to wear". Are you referring to the cannula issue or not knowing where to put it. I had problems finding somewhere to attach (or hang) my pump when I had a tubed pump and never became one of those people who could forget they had a pump. This was resolved when I got a patch pump. However, one limitation of patch pumps is you cannot chose the cannula as the needle is part of the pump.

Sorry, 9 am rambling. What I meant to write was not to let your previous experience of a pump to put you off trying again.

 

[In Response]

Another random thought: have you recently attended a DAFNE course? I wonder if a refresher of how to calculate basal and bolus doses, especially when things change such as stress and exercise, may help adjust your doses to suit you more.
If there is no course available near you, you could try the Bertie 9nline course.

 

[victry77]

@In Response

Thank you for your advice. Yeah the cannulas kept bending and not delivering the insulin properly. I tried the steel ones but they also gave me problems. They hurt and I woke up one morning bleeding from the cannula site.

I also found it really cumbersome to wear and it sort of upset me. I was constantly aware of it and it got me down.

I think I'm fine with carb counting. I've been doing it for years. I think a lot of the problem now is my age and fluctuating hormones. I told the consultant this and that I was having difficulty controlling it now. That's why she suggested Tresiba. I honestly think I'm worse on it.

I had one perfect day last Sunday. Even though I was out all day and eating out (this would raise my BG) everything stayed perfect on just a small amount of bolus. I thought I'd had a break-through but it's just been all over the place again the remainder of the week, esp the last 2/3 days.

I've been 14-16 from 4pm yesterday afternoon. Settled a little this morning and now back up to 16! Correction doses are doing nothing. This comes after days of chasing hypos and going through more glucose shots than I care to remember.

 

[JanetMargaret]

With tresiba time of day doesn’t really matter as there isn’t really a spike in its profile.. but I always took my basal at night

 

[kimberleyanneb]

So, I started Tresiba (previously on a split dose of Levemir for years) four days ago. I was switched by my consultant and prescription was done by the DSN. Basically, the consultant said it was a better, much flatter insulin that can last for up to 42hrs and the DSN told me to take 20% less than my usual Levemir dose. That was all the information I was given.

So, by day three I was being hammered with hypos non-stop. It's only since browsing the forum that I've realised it takes about three days to settle in. I think it's worth me reducing by another unit at least and see how that goes.

But my main issue is regarding flexibility. I told the consultant that my levels are starting to get much higher and erratic with PMS (and likely effects of starting peri-menopause). It's unpredictable and happens some months but not others, but I could at least up my Levemir to meet my needs.

Also, I do some theatre/performance work. Nerves and adrenaline would shoot my sugars up, so I would need to up the Levemir again.

But, with Tresiba, how do I accommodate this? From what I describe does this sound like a suitable insulin for me?

OK, I was starting to get a lot of ups and downs with Levemir, and I did feel that perhaps it wasn't working as well for me anymore. But I'm just a bit a concerned about the lack of flexibility.

Any advice?

 

[kimberleyanneb]

About 5 years ago I was in your situation and switched from split dose of Levemir to Tresiba and can honestly say when it's all settled it's amazing! My consultant once told me the optimum time to take it is 6pm butI take mine at 9pm and have a small snack with it to help prevent nighttime hypos but still occasionally get them. It is flexible; I take anything from 10u to 16u depending on what my sugar is before I take it, if I fancy an aero lol or what I'm doing the next day. If I'm doing an exercise class I'll take a lower dose whereas if I've got nothing planned other than totally crashing as I've got MS as well then I take a higher dose. If I'm stressed I find I need a higher dose whereas if I'm hormonal I tend to need a lower dose. It may be worth speaking to your DSN to help but if they're as much use as mine have been over the years then you're probably better off listening to your own body. As your settling in with it only ever reduce or incease by 2u (1 click) at a time and give it 2 days before adjusting again. I hope this helps, please let me know how you get on

 

[Smallsdiabetes]

So, I started Tresiba (previously on a split dose of Levemir for years) four days ago. I was switched by my consultant and prescription was done by the DSN. Basically, the consultant said it was a better, much flatter insulin that can last for up to 42hrs and the DSN told me to take 20% less than my usual Levemir dose. That was all the information I was given.

So, by day three I was being hammered with hypos non-stop. It's only since browsing the forum that I've realised it takes about three days to settle in. I think it's worth me reducing by another unit at least and see how that goes.

But my main issue is regarding flexibility. I told the consultant that my levels are starting to get much higher and erratic with PMS (and likely effects of starting peri-menopause). It's unpredictable and happens some months but not others, but I could at least up my Levemir to meet my needs.

Also, I do some theatre/performance work. Nerves and adrenaline would shoot my sugars up, so I would need to up the Levemir again.

But, with Tresiba, how do I accommodate this? From what I describe does this sound like a suitable insulin for me?

OK, I was starting to get a lot of ups and downs with Levemir, and I did feel that perhaps it wasn't working as well for me anymore. But I'm just a bit a concerned about the lack of flexibility.

Any advice?

It does seem to work better and last longer but I had to halve my normal dose and switch to taking it when I get up then it does not impact my daily activities

 

[IanA123]

Ah Tresiba, the wonder drug that will help us all, NOT.
3months on it now and was told by consultant I would be taking less tresiba than I was insulatard, well that was a lie as currently on 54u of Tresiba and was 28 of Insulatard. Control was stable with Insulatard and humilin s, yet erratic is and understatement at the moment. Was on tresiba and aprida, changed nhs trust as previous were ignoring me. New trust told me apidra wasn't working so changed to humalog, yep 1 month on and still erratically high 2hrs after eating. Spoke with DSN and it looks like I shall be returning to human based Insulins as analog simply do not work for me. Proof woth hba1c which has risen from 44 to 62 since the switch.

 

[steve_p6]

My experience was 54u on Levemir split. Went onto Tresiba at 35u ( hypo city). Ended up at about 20-24u and split that twice daily as I found it hypoed 9-10hrs after injecting otherwise. You need to tune dosage to your own experience of how Tresiba acts.

On subject of pumping did you consider Omnipod as alternative to tubed?

 

[golden oldie]

I was told by the diabetic nurses that Tresiba doesn't flatline, it goes up and over in a loop, then down again. I'm having problems with going low at bedtime and high first thing in the morning, which bears that out. I have it before breakfast. Going to talk to someone about it asap