Toujeo vs Tresiba!

[Elise Broenlund]

Hello,

I have always used Levemir, but I hated the peak in the middle of the day and it always caused me unstable levels over the night as well as waking up high. I tried Toujeo and was really pleased, for the first time in forever I felt like it was possible to live with diabetes again. Great stable levels, but then about 3 weeks after starting Toujeo I realise it is not the right insulin for me. It causes random highs and lows that I cannot fix. Always there, never goes away.

I only do 15 units of Toujeo as recommended by my doctor. I went to bed with bg 14. 4 hours later I woke up to a bg that was 3. I corrected it, went to bed and it spiked to 16. Then I woke up at 8,4. This was no bolus / rapid acting insulin AT ALL!

Toujeo corrected my food and drops me insanely, but during the day I cannot have a lower dose as I drop low if I even try to take more Novorapid for my meals.

I have heard this happening to other people as well, great insulin in the beginning and then it just messes everything up after a while. I want to try Tresiba.

Is there anyone who have experience with Tresiba and Toujeo, and would be able to write me a comparison please?
Would Tresiba be a better option for me??

 

[GrantGam]

Hello,

I have always used Levemir, but I hated the peak in the middle of the day and it always caused me unstable levels over the night as well as waking up high. I tried Toujeo and was really pleased, for the first time in forever I felt like it was possible to live with diabetes again. Great stable levels, but then about 3 weeks after starting Toujeo I realise it is not the right insulin for me. It causes random highs and lows that I cannot fix. Always there, never goes away.

I only do 15 units of Toujeo as recommended by my doctor. I went to bed with bg 14. 4 hours later I woke up to a bg that was 3. I corrected it, went to bed and it spiked to 16. Then I woke up at 8,4. This was no bolus / rapid acting insulin AT ALL!

Toujeo corrected my food and drops me insanely, but during the day I cannot have a lower dose as I drop low if I even try to take more Novorapid for my meals.

I have heard this happening to other people as well, great insulin in the beginning and then it just messes everything up after a while. I want to try Tresiba.

Is there anyone who have experience with Tresiba and Toujeo, and would be able to write me a comparison please?
Would Tresiba be a better option for me??

I'm sorry to hear that you're not having a good experience with your basal insulin.

What made you decide that Toujeo was not the right insulin for you? You say that things were great and your levels were stable for three weeks, what changed?

I'm afraid to say this, but even if you try all the basal insulins in the world, you'll likely have poor success unless you have the fundamentals of BG management dialled in. 15u is what was initially recommended by your Dr, as a starting point, and it's clearly not working for you. Do you understand how to adjust the dose to compensate for overnight lows - or have you gone back to your Dr with your BG logs to see if he/she can advise on an amended dose?

Have you ever conducted a basal rate test?

https://mysugr.com/basal-rate-testing/

 

[himtoo]

Hi @Elise Broenlund
in your profile it says you are on a pump -- is this correct ??

 

[DaftThoughts]

I only do 15 units of Toujeo as recommended by my doctor. I went to bed with bg 14. 4 hours later I woke up to a bg that was 3. I corrected it, went to bed and it spiked to 16. Then I woke up at 8,4. This was no bolus / rapid acting insulin AT ALL!

Toujeo corrected my food and drops me insanely, but during the day I cannot have a lower dose as I drop low if I even try to take more Novorapid for my meals.

15 units may be way too high for you. Toujeo takes a while to settle in your system before it reaches full potential, so you may have experienced a lag before it was working at 100%. The fact it's taking care of your food to a point where you don't need your Novorapid is a very good indicator that your dosage is way off. Background insulin should keep you stable, not cover your food. I recommend doing the basal test linked in another post above.

You can also discuss with your DSN whether you could lower your dosage to 10 units, give it a few days to settle, and then work from there, upping 1 unit every 3 days until your levels are even (that's how I adjusted mine). You may even need to start lower if Toujeo is giving you a hypo of 3 mmol/L actually, though discuss it with your DSN first.

Before you consider switching to Tresiba, I agree with @GrantGam that it won't change anything if you don't understand how basal insulin works and how to adjust the dose to find the one right for you. Doctors make educated guesses on where to start us off, but most of the time we have to fine tune our dosages ourselves. Learning how to do that properly will give you the best control over your diabetes and you'll be able to differentiate between wrong dosage and ineffective insulin type.

 

[Elise Broenlund]

I'm sorry to hear that you're not having a good experience with your basal insulin.

What made you decide that Toujeo was not the right insulin for you? You say that things were great and your levels were stable for three weeks, what changed?

I'm afraid to say this, but even if you try all the basal insulins in the world, you'll likely have poor success unless you have the fundamentals of BG management dialled in. 15u is what was initially recommended by your Dr, as a starting point, and it's clearly not working for you. Do you understand how to adjust the dose to compensate for overnight lows - or have you gone back to your Dr with your BG logs to see if he/she can advise on an amended dose?

Have you ever conducted a basal rate test?

https://mysugr.com/basal-rate-testing/

It`s completely fine that you say that even though it sucks, I thought the same thing myself. I have tried everything from 8 to 15 units of basal insulin nothing is working. When I lower it I need a hell of a lot more bolus insulin, but then whenever I do more bolus insulin I get my level to be normal for a while and then I go low. When I increased my basal I have the same problem. I need less bolus insulin, my levels don`t go as high as they used to anymore, but I still drop low all the time no matter what I do. There`s nothing in between.

I do understand how to adjust doses to compensate for all things that can happen, but nothing is working for me anymore. I just have an impossible diabetes to manage well enough to avoid hypos or DKA. The first 4 months after diagnosis I did everything my self, no help from doctors, I adjusted everything and was 110 % confident in every decision I made. Nothing went wrong. Then I tried an insulin pump for 3 months and as stupid as I am to not give up when things go bad, I kept being on it for 3 months before I went back to injections. Back on injections, food does`nt rise my bg until an hour after eating, insulin does`nt kick in until 2 hours after eating causing it to maximise the lowering effect between 2 and 4 hours rather than before the 2 hours like it`s supposed to. Some have suggested I may not even be a type 1, I may be type 1 LADA...

 

[Elise Broenlund]

15 units may be way too high for you. Toujeo takes a while to settle in your system before it reaches full potential, so you may have experienced a lag before it was working at 100%. The fact it's taking care of your food to a point where you don't need your Novorapid is a very good indicator that your dosage is way off. Background insulin should keep you stable, not cover your food. I recommend doing the basal test linked in another post above.

You can also discuss with your DSN whether you could lower your dosage to 10 units, give it a few days to settle, and then work from there, upping 1 unit every 3 days until your levels are even (that's how I adjusted mine). You may even need to start lower if Toujeo is giving you a hypo of 3 mmol/L actually, though discuss it with your DSN first.

Before you consider switching to Tresiba, I agree with @GrantGam that it won't change anything if you don't understand how basal insulin works and how to adjust the dose to find the one right for you. Doctors make educated guesses on where to start us off, but most of the time we have to fine tune our dosages ourselves. Learning how to do that properly will give you the best control over your diabetes and you'll be able to differentiate between wrong dosage and ineffective insulin type.

 

[Elise Broenlund]

No, I have never conducted a basal test, because it is dangerous to do so. My diabetes is so out of control (has been for 5 months), that every time I start fasting I get dangerous ketones.

 

[GrantGam]

It`s completely fine that you say that even though it sucks, I thought the same thing myself. I have tried everything from 8 to 15 units of basal insulin nothing is working. When I lower it I need a hell of a lot more bolus insulin, but then whenever I do more bolus insulin I get my level to be normal for a while and then I go low. When I increased my basal I have the same problem. I need less bolus insulin, my levels don`t go as high as they used to anymore, but I still drop low all the time no matter what I do. There`s nothing in between.

I do understand how to adjust doses to compensate for all things that can happen, but nothing is working for me anymore. I just have an impossible diabetes to manage well enough to avoid hypos or DKA. The first 4 months after diagnosis I did everything my self, no help from doctors, I adjusted everything and was 110 % confident in every decision I made. Nothing went wrong. Then I tried an insulin pump for 3 months and as stupid as I am to not give up when things go bad, I kept being on it for 3 months before I went back to injections. Back on injections, food does`nt rise my bg until an hour after eating, insulin does`nt kick in until 2 hours after eating causing it to maximise the lowering effect between 2 and 4 hours rather than before the 2 hours like it`s supposed to. Some have suggested I may not even be a type 1, I may be type 1 LADA...

Sounds like you're having a really tough time @Elise Broenlund. Have you reached out to your Dr and DSN for extra support? I'm sure they'd be more than happy to accommodate, if that means phone consults, more frequent appointments, etc.

No, I have never conducted a basal test, because it is dangerous to do so. My diabetes is so out of control (has been for 5 months), that every time I start fasting I get dangerous ketones.

It's not dangerous to conduct a basal rate test with the method outlined in the link I provided. It's especially designed to keep the fasting periods to a minimum as to avoid liver dumps and such like. You should not see dangerous levels of ketones simply from fasting for 6 hours.

 

[Elise Broenlund]

I don`t mean to be rude, but for me it is. I have had ketones in my blood 3 months even if I eat regularly. My a1c was 13 %. My levels have been anything between 10 and 25 mmol for 5 months straight. Whenever I give myself more insulin I go low, even if it is just 1 unit more. So I keep my levels high. Because of the insulin pump giving me dangerous doses, I have had 3 seizures (lows) and one episode of DKA in February. Since then I have always had ketones in the blood. I have been to so many doctors appointments, but no one can help me. They all say my diabetes is particularly hard to control compared to other patients...I do realise the only thing that could solve it is the insulin pump, but it completely took away my freedom as I went low all the time every day, because they simply can`t figure out what I need.

 

[GrantGam]

I don`t mean to be rude, but for me it is. I have had ketones in my blood 3 months even if I eat regularly. My a1c was 13 %. My levels have been anything between 10 and 25 mmol for 5 months straight. Whenever I give myself more insulin I go low, even if it is just 1 unit more. So I keep my levels high. Because of the insulin pump giving me dangerous doses, I have had 3 seizures (lows) and one episode of DKA in February. Since then I have always had ketones in the blood. I have been to so many doctors appointments, but no one can help me. They all say my diabetes is particularly hard to control compared to other patients...I do realise the only thing that could solve it is the insulin pump, but it completely took away my freedom as I went low all the time every day, because they simply can`t figure out what I need.

You're not being rude at all

Diabetes is entirely individual, and because of that, the condition can often demand a lot more from one individual compared to the next.

Have you read any diabetes books? These two are really worth their weight in gold; especially the first:

https://www.amazon.co.uk/d/cka/Thin...naging-Diabetes-Insulin-Completely/0738215147

https://www.amazon.co.uk/Pumping-In...coding=UTF8&psc=1&refRID=6340BBJMKB322MNCMRCK

because they simply can`t figure out what I need.

The beauty of the literature that I've linked, is that you can figure out what you need (to a certain degree of course) to manage your diabetes correctly, efficiently and safely. There is no denying that Dr's and DSN's offer a vital service and critical resource to us diabetics. But no-one will ever be able to manage your condition as well as yourself.