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Splitting Tresiba dose

S

scotteric

Well-Known Member
Messages
312
Location
Canada
Type of diabetes
Type 1
Treatment type
Pump
I'm just wondering if anyone does this, has had success with it and has any tips for how to do it properly. I pumped for 11 years and decided to take a break due to numerous site issues. I was splitting Levemir which worked pretty well for me, but having been spoiled by pumping, I was getting annoyed how inflexible it is with dosage timing and noticeable spikes if I eat around the time my daytime dose was levelling off and nighttime dose hadn't kicked in yet. I've tried Tresiba 2x before but wasn't successful with it. I could not find a dose that would give me consistent coverage for 24 hours. I tried splitting it for the last few days and I seem to finally be getting 24-hr consistent coverage. I know Dr. Bernstein recommends this even though it seems unnecessary. Any help appreciated, thank you!
 
I tried with tresiba 3 times unsuccessfully. Including splitting it.

In the end I have ended up
on the following regime due to my DP and waking phen.

Insulatard 10 units at 4am plus 0.5 to 1.0 unit of novorapid too.

8am 5 units Insulatard plus 4-5 units of novorapid (no breakfast) around 8am but try to do 15-30 mins before getting up.

4pm 1 unit of tresiba.

This regime is about the best I have had since coming off my pump after 5 years. I also tried levemir and lantus.

I found tresiba did not make any difference when splitting as there is just no peak acting time to it that I could time around my rises. Not even with one insulatard or bolus in with it.
 
Hi @scotteric I was using tresiba before the pump and would never consider splitting it - it’s profile is flat and lasts around 36 hours so little point in splitting the dose. Have you tried any basal testing to check your dose is correct ? This would be my starting point if unsure the dose wasn’t right.
 
scotteric said:
I'm just wondering if anyone does this, has had success with it and has any tips for how to do it properly. I pumped for 11 years and decided to take a break due to numerous site issues. I was splitting Levemir which worked pretty well for me, but having been spoiled by pumping, I was getting annoyed how inflexible it is with dosage timing and noticeable spikes if I eat around the time my daytime dose was levelling off and nighttime dose hadn't kicked in yet. I've tried Tresiba 2x before but wasn't successful with it. I could not find a dose that would give me consistent coverage for 24 hours. I tried splitting it for the last few days and I seem to finally be getting 24-hr consistent coverage. I know Dr. Bernstein recommends this even though it seems unnecessary. Any help appreciated, thank you!
Click to expand...


On my pump I found that I needed 3 times my normal basal from 4am increasing to 9am then it gradually dropped down to midday. Then mine went up again around tea time, dropped again and up again at 10pm to midnight.


Itresiba always was going to be a problem for me but 2 different hospitals wanted me to try it.... and try it and try it....

The trouble with tresiba is that even splitting it, if you need more at a set time tresiba extra will jyst work consistently for longer than 24 hours.

I had a photo of my last basals rates on insight pump so I got some tracing paper.. drew the graph out... traved it and moved the graph along 3 hours to allow for tge novorapid peak times. That then gave me the pattern of profile that I needed from any Insulin.
I had some pretty daft suggestions given to me at times from various people... even when I have sent the photo of the graphs to hospital they forgot to take in to the account that novorapid took time to work.....

So, then I worked out times with Insulatard... 1unit of it still knocked me downward from midnight no matter what time I took it. So I changed to adding in 1 unit of tresiba instead over christmas and this is better.
Its pain having so many shots starting at 4am but the peaks and drop offs by splitting insulatard and bolus's works out so much better than suggestions I have been given by others...
Its unusual and totally different to how hospital suggested from text book learning but it is my body and its me that had to find my own way in the end.
 
My understanding of Tresiba is that it's normally a twice daily injection. I tried it for about a month and gave up on it went back to Lantus which I inject in the morning and works fine. I've heard Toujeo is pretty sweet.
 
Juicyj said:
Hi @scotteric I was using tresiba before the pump and would never consider splitting it - it’s profile is flat and lasts around 36 hours so little point in splitting the dose. Have you tried any basal testing to check your dose is correct ? This would be my starting point if unsure the dose wasn’t right.
Click to expand...

Hey, for some reason it just isn't potent enough for the full 24 hours for me. The timing of the injection seems to make a difference too. For example, if I injected before bed I would get great basal coverage until late afternoon the next day and then it would taper off. If I injected in the morning, I would be great for the entire day and then experience horrible DP as it tapered off in the middle of the night. I have a Libre and it's noticeable on the graph how it just shuts off ~16-18 hours after injection and my blood sugar starts skyrocketing. So far the dose splitting has prevented this and I am getting flat coverage all day. What can I say, if it works, it works!
 
TheBigNewt said:
My understanding of Tresiba is that it's normally a twice daily injection. I tried it for about a month and gave up on it went back to Lantus which I inject in the morning and works fine. I've heard Toujeo is pretty sweet.
Click to expand...

I think you're thinking of Levemir - which worked reasonably well for me but always felt like a patchwork solution compared to my pump. I've heard Toujeo is just Lantus x300 and that some people get erratic results with it after a few weeks of using it. My basal insulin dose is under 20 units (and was ~14 on my pump), so I don't think a highly concentrated insulin like Toujeo would be a good fit for me.
 
@scotteric - if you're having problems with spikes around eating, rather than, say dawn phenomenon, then you might want to ask about Fiasp. Whilst I've had problems with it in a pump, most people using it through MDI haven't, and it's speed of onset may help prandial spikes where perhaps Tresiba isn't coping so well, giving you some respite where there might be Tresiba gaps.

Do you have Libre traces to show what's going on?
 
tim2000s said:
@scotteric - if you're having problems with spikes around eating, rather than, say dawn phenomenon, then you might want to ask about Fiasp. Whilst I've had problems with it in a pump, most people using it through MDI haven't, and it's speed of onset may help prandial spikes where perhaps Tresiba isn't coping so well, giving you some respite where there might be Tresiba gaps.

Do you have Libre traces to show what's going on?
Click to expand...

I've tried it in my pump but my biggest gripe with it was its shorter effective duration - I would see large delayed spikes after eating from what I assume is protein/fat that NovoRapid covered better. I'm afraid these will be worse on MDI since there is no way to square wave and at least NovoRapid helps cover delayed digestion by lasting longer. I wish I could just buy one penfill cartridge to try it for a week. I have a vial from when I pumped, but I hate carrying around syringes and only find pens practical.
 
TheBigNewt said:
My understanding of Tresiba is that it's normally a twice daily injection. I tried it for about a month and gave up on it went back to Lantus which I inject in the morning and works fine. I've heard Toujeo is pretty sweet.
Click to expand...

No, it definitely is NOT recommended to inject twice a day.

TResiba due to its lasting time of 36 hours and flat action is not suitable really to splitting..

It also advises to leave 3 clear days between changing doses.
 
scotteric said:
I think you're thinking of Levemir - which worked reasonably well for me but always felt like a patchwork solution compared to my pump. I've heard Toujeo is just Lantus x300 and that some people get erratic results with it after a few weeks of using it. My basal insulin dose is under 20 units (and was ~14 on my pump), so I don't think a highly concentrated insulin like Toujeo would be a good fit for me.
Click to expand...
Sorry I was indeed referring to Levemir not Tresiba. My bad.
 
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