Tresiba, Dawn Phenomenon, Split Dosing

LooperCat

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Thank you @kitedoc & @Applenerd81 - I’ve just phoned the DSN answering service to ask if I can have a half unit pen for the Tresiba - I’d like to try 17.5u once a day before farting about with split doses. I’m also going to ask (when they call back) if I can have a Levemir one too, as once a month I get slightly insulin resistant for a week, and need an extra unit of basal. And of course Tresiba being so long acting, any changes I make take 4-5 days to take effect! And try as I might to predict exactly when to start increasing the dose, the vagaries of the human reproductive cycle make this next to impossible. I’ve tried top;OMG up with a unit of the Lantus I have left in the fridge but that takes about three days to kick in, so while better, isn’t as precise as I need.

Ain’t T1 fun?
 
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EllsKBells

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Following this thread, as I never used to have dawn phenomenon, but since Tresiba it is becoming increasingly aggressive.
 

Applenerd81

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By splitting tresiba, it makes no real difference to it being aninsulin that cannot manage DP or waking... so to me, there was nothing else to try but to find an insulin that could be given when I needed the peaks and be out of my body when I needed next to nothing. By switching to insulatard at 3.30 (stupu hour and I do not like doing this, but needs must).... the insulin would be working as and when I needed it but it was too much if I took it all at that time. My consuktant and educator did not want me to split timing of insulatard but they had tried for 2 years and regimes that were standard and awful for me so I ignored them. I split it to 7 or 8am as a 1/3rd because I needed more earlier... by having 2nd dose in morning it too is working when I need it but its actions are less later when I need less.

I need some small background dose overnight but not a lot. Taking in to account that the insulatard was pretty much my always dose... around 17 units.. then I thought, try 2 units but that acted too severely so I have been cutting it down and down by 1/2 units gradually. Then I was down to 1/2 unit. Well for me 1/2 unit by itself does nothing... so I went 3 days clear of tresiba to see if I deginitely need tresiba, and yes, I do. If I dont I wake up high and levels that much higher during day too. So now I'm trying tresiba 1 unit every other day as if it is a flat insukin and stays in my body for 42 hours it should every other day be the dose that is better. Or at least thats my way of thinking...

Tresiba is a flat line insulin. I foubd DP and waking horrendoys with it, increasing dose caused lows other times of day. And still didnt manage the DP.

I dont know anybody else doing this regime but my consultant has now told me that only I can tweak as he has no other alternatives of any other regimes and as I am happy to do so and determined... then he okay with that. I'm still in the top 5% of hba1cs from patients at the hospital despite finding my own way with everything.

I too had tried the levemirs, lantus etc and their actions and peaks didnt suit my body over night...

Sounds like a very complicated regime you have!

The 48 hour duration of Tresiba is based on a dose of 0.4iu/kg of body weight (big dose!) - it’s very unlikely a 1iu dose would cover anywhere near that length of time (unless you weigh around 2kg?

Managing these insulin’s can be a right pain!
 

LooperCat

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Just spoken to my DSN down at the hospital (unlike my GP surgery, they’re thrilled with my latest HbA1c of 43), they’re really not happy about me mixing background insulins for period week, because there’s been zero research done on it, and the two I’m suggesting work so differently. I can kind of accept that, they can’t go smashing the rules, although a little bending (with regard to carbs and ketone levels) seems ok!

I’ve been issued a half unit pen for the Tresiba, anyway with the hope that it’ll stop my raging dawn phenomenon and having to wake up at 4am to nip it in the bud. So we’ll try 17.5u a day and see how that goes. I’m picking it up tomorrow.

But.... if that doesn’t work, they want me to try a pump. Apparently these two issues would make me more than eligible. Now you know how reluctant I am, because of the whole being attached to a machine and tubes thing. But apparently our area prescribes the Omnipod, the tubeless jobbie. So.... time for some research. I may end up going full cyborg :borg:
 
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Applenerd81

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Just spoken to my DSN down at the hospital (unlike my GP surgery, they’re thrilled with my latest HbA1c of 43), they’re really not happy about me mixing background insulins for period week, because there’s been zero research done on it, and the two I’m suggesting work so differently. I can kind of accept that, they can’t go smashing the rules, although a little bending (with regard to carbs and ketone levels) seems ok!

I’ve been issued a half unit pen for the Tresiba, anyway with the hope that it’ll stop my raging dawn phenomenon and having to wake up at 4am to nip it in the bud. So we’ll try 17.5u a day and see how that goes. I’m picking it up tomorrow.

But.... if that doesn’t work, they want me to try a pump. Apparently these two issues would make me more than eligible. Now you know how reluctant I am, because of the whole being attached to a machine and tubes thing. But apparently our area prescribes the Omnipod, the tubeless jobbie. So.... time for some research. I may end up going full cyborg

I’m not aware of a 1/2 unit pen for Tresiba! Hope it works for you
 

porl69

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Hi @Mel dCP. Keep us upto date with the 1/2 unit Tresiba pen. I am stuck between 13 and 14 units at the moment. 14 units and I am hypo in the afternoon 13 and I am high in the morning and going higher in the afternoon!!!
I have looked into the Omnipod and the Medtronic 640G and loved both of them, it's just a waiting game now to see my pump doctor and get on his case
 

LooperCat

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Hi @Mel dCP. Keep us upto date with the 1/2 unit Tresiba pen. I am stuck between 13 and 14 units at the moment. 14 units and I am hypo in the afternoon 13 and I am high in the morning and going higher in the afternoon!!!
I have looked into the Omnipod and the Medtronic 640G and loved both of them, it's just a waiting game now to see my pump doctor and get on his case
That’s exactly the issue I’m having with mine! I’m hoping 17.5u is the magic number...
 
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scotteric

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Hi All,

It's been a long time since I've posted/ been active on the forum! Am in need of some advise regarding Tresiba & dawn phenomenon.

I have always understood Tresiba to be an ultra long acting insulin - and to date I have found its action to be as such, especially at larger doses. However, having revisited Dr Bernsteins Diabetes Solution, I have concerns with regards to bolusing large volumes of insulin at one site.

I am trying to figure out a suitable split dosing pattern for Tresiba, it's not been the most successful yet, especially with dawn phenomenon - my BGs appear to be be rising up from 3am from 4/5mmolL up to 12+ mmol by 6am. This rise wasn't so pronounced with my previous dosing regime and I could get away with 1-4 iu of Humalog upon rising to cover my rise up til I get to work at the office.

I've searched the forums but there is very little on splitting basals (specifically Tresiba) - does anyone else on here use this method? Any advise greatly appreciated. I am using the Libre.

Previous regime: Single shot of 20 units at 6 pm, 1-4iu Humalog upon rising.
Current regime: 2x7iu @ 6pm, 7iu upon waking + correction dose!

Teleseminar on basal splitting:

I found Tresiba only gave me consistent 24-hour coverage if I split the dose. However, it isn't easy to do without significant overlap causing hypos. Have you tried Levemir? I find it a more useful basal for a type 1, especially coming from a pump perspective (I used a pump for 11 years and now when I feel like it). It lasts 12-14 hours on small doses, so it's perfect for splitting without overlap. It's also very responsive to small changes in doses which makes it closer to pump basal. For example, on days I know I will be stressed from work or sedentary, I can take more in the morning. Tresiba can't be adjusted this way since its ultra long profile means dose changes will be seen possibly days later. If your basal needs are consistent every day, I guess this is fine, but I doubt that's the case for most type 1s.
 

Applenerd81

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I found Tresiba only gave me consistent 24-hour coverage if I split the dose. However, it isn't easy to do without significant overlap causing hypos. Have you tried Levemir? I find it a more useful basal for a type 1, especially coming from a pump perspective (I used a pump for 11 years and now when I feel like it). It lasts 12-14 hours on small doses, so it's perfect for splitting without overlap. It's also very responsive to small changes in doses which makes it closer to pump basal. For example, on days I know I will be stressed from work or sedentary, I can take more in the morning. Tresiba can't be adjusted this way since its ultra long profile means dose changes will be seen possibly days later. If your basal needs are consistent every day, I guess this is fine, but I doubt that's the case for most type 1s.

I haven’t tried Levemir yet, but Tresiba has been much better than Lantus for me. I understand Levemir can work for up to 12 hours - but again this will likely be based on relatively high doses?

I’m genuinely amazed at the difference splitting the dose has made. The liver wiping out a lot of the basal during the dawn hours makes a lot of sense (as per the teleseminar) as such, my morning Tresiba is more effective and late afternoon early evening bgs are far more stable (much less variability).
 

scotteric

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I haven’t tried Levemir yet, but Tresiba has been much better than Lantus for me. I understand Levemir can work for up to 12 hours - but again this will likely be based on relatively high doses?

I’m genuinely amazed at the difference splitting the dose has made. The liver wiping out a lot of the basal during the dawn hours makes a lot of sense (as per the teleseminar) as such, my morning Tresiba is more effective and late afternoon early evening bgs are far more stable (much less variability).

Levemir will only last 24 hours on very high doses, but you should be able to get 12 hours out of it unless your dose is extremely minimal. I take between 8-10 units at morning and night and get pretty good 24-hr coverage without overlap. It is not the same as Lantus. The advantage of Tresiba I guess is that you don't have to be as particular about the time of day you take it, but again this adds additional flexibility if you want to induce an overlap to cover a stressful morning or have less at night if you're active or have been drinking.
 
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Brendon.Dean

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If you're struggling with that stuff try fasted cardio at moderate to high intensity in the AM
 

LooperCat

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Hi @Mel dCP. Keep us upto date with the 1/2 unit Tresiba pen. I am stuck between 13 and 14 units at the moment. 14 units and I am hypo in the afternoon 13 and I am high in the morning and going higher in the afternoon!!!
I have looked into the Omnipod and the Medtronic 640G and loved both of them, it's just a waiting game now to see my pump doctor and get on his case
Picked up the pen from the hospital today, and the prescription from my surgery in the magic half hour between them closing and the pharmacies being shut. I’ll be hopefully gettingnthe cartridges tomorrow; if not Monday.
 
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Applenerd81

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Levemir will only last 24 hours on very high doses, but you should be able to get 12 hours out of it unless your dose is extremely minimal. I take between 8-10 units at morning and night and get pretty good 24-hr coverage without overlap. It is not the same as Lantus. The advantage of Tresiba I guess is that you don't have to be as particular about the time of day you take it, but again this adds additional flexibility if you want to induce an overlap to cover a stressful morning or have less at night if you're active or have been drinking.

IMG_3352.jpg


I’m trying to replicate a profile similar to that shown in the picture (my old pump profile) with my split basal, hence the 2/3:1/3 split. Just haven’t quiet got the timing right for each shot. Just know I need around 18-20iu per 24 hour period...
 

Applenerd81

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If you're struggling with that stuff try fasted cardio at moderate to high intensity in the AM

Fasted/high intensity work drives my blood sugars higher. That plus now I’m back at work - I prefer to train in a fed state!
 

donnellysdogs

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Sounds like a very complicated regime you have!

The 48 hour duration of Tresiba is based on a dose of 0.4iu/kg of body weight (big dose!) - it’s very unlikely a 1iu dose would cover anywhere near that length of time (unless you weigh around 2kg?

Managing these insulin’s can be a right pain!

I thought that, so it is ideal just for my sleeping up to 3am...

I Changed this week to taking 1 unit of tresiba in mirning and levels have now been too high at night.. so will be going back to my 4-6pm 1 unit dosing again next week. I have had change to routines this past week so need a few more days to double check.
 
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Brendon.Dean

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Fasted/high intensity work drives my blood sugars higher. That plus now I’m back at work - I prefer to train in a fed state!

Sorry I said cardio, I meant to say exercise, something that gets your muscles going like weighted squats for example.

So you tried fasted cardio and it raises your blood sugar?
 
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Applenerd81

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Agreed. Even walking my dog in the morning requires a bolus!

My (fasted) commute which includes a half mile walk needs 2iu bolus just to keep me level! Wish things were easier, as always!