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

[staffsmatt]

I've had much flatter results on Tresbida than I ever got on Lantus (I tried Levemir but had a nasty local reaction to it).

There are still things that throw you (illness, eating certain foods before bed etc...) but in general my results have been much better.

 

[tim2000s]

What I've not seen is any feedback from really active people using Tresiba. That's the reason I used Levemir - my need to reduce basal overnight following gym or cycling sessions.

Are there any particularly active people using Tresiba who can speak up?

 

[kzlorenz]

What I've not seen is any feedback from really active people using Tresiba. That's the reason I used Levemir - my need to reduce basal overnight following gym or cycling sessions.

Are there any particularly active people using Tresiba who can speak up?

Hi, an excellent question, was wondering the very same!

 

[donnellysdogs]

I started Tresiba on Saturday.. Still playing with it but not sure it is right for me. Initially my morning readings have been h*ll on waking...
This morning slightly better.
Was having tresiba at 9am but today I have changed it to 6pm.
Got better results today but that was from a stupid accident!! Yesterday afternoon accidentally used 5 units of it instead of my bolus!! Stupid I know. First time I've done that... But readings still high this morning on waking but smoothed out better this afternoon and evening.
Giving a 9am dose for me wasn't panning out good. Fortunately through accident dose yesterday I've decided to increase the tresiba and it allowed me to change to an evening dose to try.
Sat-Monday readings were awful.

 

[robert72]

I started Tresiba on Saturday.. Still playing with it but not sure it is right for me. Initially my morning readings have been h*ll on waking...
This morning slightly better.
Was having tresiba at 9am but today I have changed it to 6pm.
Got better results today but that was from a stupid accident!! Yesterday afternoon accidentally used 5 units of it instead of my bolus!! Stupid I know. First time I've done that... But readings still high this morning on waking but smoothed out better this afternoon and evening.
Giving a 9am dose for me wasn't panning out good. Fortunately through accident dose yesterday I've decided to increase the tresiba and it allowed me to change to an evening dose to try.
Sat-Monday readings were awful.

Sorry if I suggested starting too low - hope it works out soon.

 

[Nuck]

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.

I switched my Homalog for my Lantus and injected 46 units. I had to eat loads of wine gums. Not sure what told me to check but something said it to me and it was right.

 

[steve_p6]

The chap in Oz doing the Afrezza and Coke demos reported back on Tresiba. The relevant comment he made was having to deal with impact of the different activity levels between weekdays and weekends, ie Tresiba dose changes take 3 or so days to show through so really had to run at same level all week.

 

[donnellysdogs]

Perfect !!

Went to bed at 4.3 and just woke to 4.2....

No worries @robert72-since the big C and totally paralysed stomach my bloods can be a bit difficult to guestimate with the insulin qty!

Just wondering if theres any hangover of that 5 units I accidentally gave!!ol
..(should have added dementia in to my ailments!!:)

 

[tim2000s]

The chap in Oz doing the Afrezza and Coke demos reported back on Tresiba. The relevant comment he made was having to deal with impact of the different activity levels between weekdays and weekends, ie Tresiba dose changes take 3 or so days to show through so really had to run at same level all week.

Ah yes, I owe them an update. They sent me some Afrezza and I've not been able to test it due to having Bronchitis. Must give it a go and Easter Weekend seems like the ideal time.

 

[donnellysdogs]

Just done levels.. Was going to be a basal testing day..
Did what used to be my waking bolus correction as normal.. 1.5 units...
Gone from 4.2 to 9.6 in two hours...gggrrrrrr.
Had to do a correction.....

 

[tim2000s]

Sometimes, the Diabeast can be a right pain.

 

[kzlorenz]

See this graph:
https://www.tresibapro.com/clinical-pharmacology/duration-of-action.html

Cheers

 

[tim2000s]

Hi @kzlorenz, thanks for the graph. I think the op is already aware of the duration of the insulin!

 

[kzlorenz]

Hi @kzlorenz, thanks for the graph. I think the op is already aware of the duration of the insulin!

Yes but I just wanted to point out that the casting effect (build up) is not linear i.e. day 2 +25% ca, day 3 +10% (form 0).
This info is quite important to us - btw I don't get why they somewhat put the minimal interval between injection at 8 hrs (I do know that in clinical trials they had not seen a significant hypoglycaemia % increase but this doesn't mean much in real life) that's quite misleading I'm afraid

Cheers

 

[Bluemarine Josephine]

Hello again,
I wish to elaborate on my previous post regarding Tresiba, please.
I do believe that Tresiba is a beautiful stable background insulin, at least, in relation to the other ones that I have tried (Lantus, which is horrible and painful and Levemir, which is the one I am currently using.)

I would definitely recommend Tresiba as a background insulin under the following condition: Your diabetes has to be “consistent” and predictable.

During the DAFNE course, I saw other diabetics whose diabetes and insulin needs where so stable and predictable, one day after the other, that it was becoming annoying. Literally, nothing (and I mean NOTHING) changed! Their basal needs were exactly the same, their ratios exactly their same, protein/fat intake did not alter their ratios, exercise affected their diabetes as described by the DAFNE rules.

If your diabetes is like this, then Tresiba is an excellent choice!

However, if your diabetes is like mine, then Tresiba might not be a good idea.
Exercise and delayed onset hypoglycemia, stress, menstrual cycle/ovulation, a rain in Tibet and my diabetes develops a completely different profile.
No one day is similar to the next.

Same basal, same food, same ratios, same timing of injections, same activity during the day and I hypo.
Next day, same basal, same food, same ratios, same timing of injections and activity and I hyper…

During the last 4-5 months my background insulin needs were of 22 units overall.
1 month ago, my diabetes decided that my basal needs would change to 16 units overall.

I have thought many times “thank God I am on Levemir, I can do a basal test and adjust easily… If I was on Tresiba, I would have to run after my hypoglycemias for 2-3 days before my reduced basal dosage worked."
That would have been unpleasant…

Therefore, I do believe that Tresiba is a wonderful insulin depending on the behavior that your diabetes demonstrates.
In my case, Levemir is not as stable but, its flexibility is something that I value as useful.

Regards
Josephine

 

[AndyS]

It seems to me that what we are really saying is making sure you use the right tool for the job.

In this case the tool is your choice of basal insulin.

I must admit that I find that I see quite a bit of variation and change fairly often to agree with Josephine when it comes to how quickly you can react with levemir. Yes it is not quite as quickly as you could change things with a pump but since I fail to qualify for a pump on all but one of the points they look at this is as good a second as I am likely to get until the cost of pumps come down (probably halve I would say).

So essentially what Josephine says, if you are super stable and predictable then Tresiba or Lantus otherwise Levemir (or something else) is you aren't on a pump and not eligible.

/A

 

[Nuck]

Hello again,
I wish to elaborate on my previous post regarding Tresiba, please.
I do believe that Tresiba is a beautiful stable background insulin, at least, in relation to the other ones that I have tried (Lantus, which is horrible and painful and Levemir, which is the one I am currently using.)

I would definitely recommend Tresiba as a background insulin under the following condition: Your diabetes has to be “consistent” and predictable.

During the DAFNE course, I saw other diabetics whose diabetes and insulin needs where so stable and predictable, one day after the other, that it was becoming annoying. Literally, nothing (and I mean NOTHING) changed! Their basal needs were exactly the same, their ratios exactly their same, protein/fat intake did not alter their ratios, exercise affected their diabetes as described by the DAFNE rules.

If your diabetes is like this, then Tresiba is an excellent choice!

However, if your diabetes is like mine, then Tresiba might not be a good idea.
Exercise and delayed onset hypoglycemia, stress, menstrual cycle/ovulation, a rain in Tibet and my diabetes develops a completely different profile.
No one day is similar to the next.

Same basal, same food, same ratios, same timing of injections, same activity during the day and I hypo.
Next day, same basal, same food, same ratios, same timing of injections and activity and I hyper…

During the last 4-5 months my background insulin needs were of 22 units overall.
1 month ago, my diabetes decided that my basal needs would change to 16 units overall.

I have thought many times “thank God I am on Levemir, I can do a basal test and adjust easily… If I was on Tresiba, I would have to run after my hypoglycemias for 2-3 days before my reduced basal dosage worked."
That would have been unpleasant…

Therefore, I do believe that Tresiba is a wonderful insulin depending on the behavior that your diabetes demonstrates.
In my case, Levemir is not as stable but, its flexibility is something that I value as useful.

Regards
Josephine

I seem to have the same challenge where I yoyo between hypo and hyper eating the same food at the same time even weighing the food out. I have changed health authorities so I will see what can be done.

 

[kzlorenz]

Hello again,
I wish to elaborate on my previous post regarding Tresiba, please.
I do believe that Tresiba is a beautiful stable background insulin, at least, in relation to the other ones that I have tried (Lantus, which is horrible and painful and Levemir, which is the one I am currently using.)

I would definitely recommend Tresiba as a background insulin under the following condition: Your diabetes has to be “consistent” and predictable.

During the DAFNE course, I saw other diabetics whose diabetes and insulin needs where so stable and predictable, one day after the other, that it was becoming annoying. Literally, nothing (and I mean NOTHING) changed! Their basal needs were exactly the same, their ratios exactly their same, protein/fat intake did not alter their ratios, exercise affected their diabetes as described by the DAFNE rules.

If your diabetes is like this, then Tresiba is an excellent choice!

However, if your diabetes is like mine, then Tresiba might not be a good idea.
Exercise and delayed onset hypoglycemia, stress, menstrual cycle/ovulation, a rain in Tibet and my diabetes develops a completely different profile.
No one day is similar to the next.

Same basal, same food, same ratios, same timing of injections, same activity during the day and I hypo.
Next day, same basal, same food, same ratios, same timing of injections and activity and I hyper…

During the last 4-5 months my background insulin needs were of 22 units overall.
1 month ago, my diabetes decided that my basal needs would change to 16 units overall.

I have thought many times “thank God I am on Levemir, I can do a basal test and adjust easily… If I was on Tresiba, I would have to run after my hypoglycemias for 2-3 days before my reduced basal dosage worked."
That would have been unpleasant…

Therefore, I do believe that Tresiba is a wonderful insulin depending on the behavior that your diabetes demonstrates.
In my case, Levemir is not as stable but, its flexibility is something that I value as useful.

Regards
Josephine

Hi Josephine.
I am currently giving a go to Tresiba since I had your very same problems; My needs use to change quite a lot without any apparent reason.
This actually might be due to changing in absorption rate, see this paper http://onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2012.01627.x/epdf

I am worried too about the limited reaction level of an ultra-long insulin to physical activity induced insulin sensitization (i.e. the muscles and other tissue Glucose transponders expression in response to insulin) but it seems that from this (small) trial (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136489 ) that it can be well controlled.

I'll start training more next week and we'll see...
I'll let you know how it goes if interested.

Cheers

 

[tim2000s]

I am worried too about the limited reaction level of an ultra-long insulin to physical activity induced insulin sensitization (i.e. the muscles and other tissue Glucose transponders expression in response to insulin) but it seems that from this (small) trial (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136489 ) that it can be well controlled.

I'm afraid a trial that contains 7 participants is statistically useless by pretty much any measure. If you read it, It also maintained the participants at bg levels that I would not be comfortable resting at. Even in the 24 hours post exercise, they maintained the participants at what most of us would consider to be abnormally high levels:

Mean glucose levels during 24 h post-exercise were found to be 9.94 ± 2.00 mmol.l-1 (A), 8.77 ± 2.78 mmol.l-1 (B), and 8.55 ± 1.94 mmol.l-1 (C) in HIIE. Mean values for CON were 8.21 ± 1.39 mmol.l-1(A), 9.82 ± 1.67 mmol.l-1 (B), and 9.38 ± 3.27 mmol.l-1 (C). No significant differences were found in mean values between HIIE and CON (p = 0.833).

And the variance on these numbers (± a range from 1.39 to 3.27) would almost certainly push anyone trying to maintain a level of 6 mmol/l into hypo territory.

This study is great for showing us data, in what I consider an abnormal position, but clearly demonstrates that the variation experienced post exercise when using Tresiba would cause issues for just about anyone trying to maintain a level between 4 and 8 mmol/l.

The statement that terrifies me in this entire document is in the conclusions:

The revealed data allow the calculation of required BG baseline concentrations in T1DM patients for different mean exercise intensities, durations, and methods to avoid hypoglycemia and to minimize additional carbohydrate ingestion during exercise.

Basically, they identified that if you use Tresiba and run your blood glucose at a level that will never get you into the NICE recommended Hba1C level, then you'll avoid Hypoglycaemia. Well, yes you might, but you then won't avoid the onset of complications and I know which one bothers me more.

 

[kzlorenz]

I have collected a few more papers on the topic of Degludec and exercise.
If anyone wants them just drop me a line please.

Cheers