Confused after switching from Lantus to Tresiba

Maybe your basal needs are higher during the night?
Depending when you took Lantus, it had a bit of a kick after something like 5 hours which may have been the night time hypos.
Being a flatter profile, the first 5 hours or so of Tresiba may be lower than you are used to with Lantus.

You don’t mention how long you have been using Tresiba. Given its longer profile, it may not have built up to its optimum level yet. I understand it lasts something like 3 days(?)

If you have not been using it for long, I would see how it goes for a bit longer.
Otherwise, you may want to look at something more flexible like Levemir but this requires two doses per day.

michael_n said:

Hello everybody!

I've managed to finally change my basal insulin, a thing I've been planning for the last two years. I made the switch a month ago while I had covid since I already had high readings and the time needed for adapting wouldn't make much of a difference.

The dosing I use is 24 units, the same as I did with Lantus. The strange thing is, while on Lantus I was worried about hypos at night, with Tresiba I wake up with high readings (180-200 mg/dl) and all this while decreasing my Fiasp doses and having perfect control during the day. None of this makes sense to me and I'm not sure about increasing the dose, so any advice is useful.

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Hi @michael_n

Sometime ago I switched from Abasaglar (a Lantus biosimilar insulin) to Levemir. I found I had to increase my basal by 2 units (2 x day) to get my levels down and like you I often wake up with high readings unless I've had a zero (or very low) carb evening meal.

I've kind of given up trying to control this now and just include a correction dose with my breakfast bolus.

If you're not comfortable with adjusting your own doses then please speak to your doctor or endo'.

Hi @michael_n before the pump I switched from Lantus to Tresiba, took a bit of tweaking (well, doesn't everything diabetes-related), but I was having highs in the mornings like you, which I was frustrated abut as this was the reason why I switched. I ended up moving to an evening dose of tresiba, eventually did the trick, as it lasts a lot longer than 24 hours and adjustments take time to bed in. So perhaps the timing of your injection may be something to consider?

I've had similar experiences to what you (and others in this thread have decscribed). The problems first appeared when I was on Levimir. I'd had good control with Levimir for about ten years, when suddenly in the morning I had relentless highs. I was frequently shooting into the 20s post-breakfast, but if I increased my Bolus or added a correction I ended up crashing low by Lunch.

My Basal was switched to Tresiba and things improved. Unfortunately, in my eagerness to control the spikes I initially set my dose high. So here's what I did. Tresiba whilst an extremely flat Basal, does still have a very soft peak at 8 hours post-injection. So I timed my injection so that peak occured when my bloods started to creep up in the morning (in my case dosing at 10pm, because my Bloods started to climb at 6am). I would also do a Blood Test the second I woke up, and if I was above normal range I would get a correction onboard, before even getting out of bed (basically the earlier the better with such a correction, because of my reduced Basal needs later in the day). On top of this, I found I'd need a marginally higher ratio for breakfast (literally the smallest increase I could tolerate). This worked quite well, but it was far from flawless.

Since using the pump, this has given me further insisight into what was happening. I have a 'normal' rate of Insulin which lasts between 11am and 2am. However, between 2am and waking my Basal needs creep up until by the time I wake they've almost doubled, and then by 11 they come crashing down to normal again. As such, it was always incredibly difficult to match this profile with 1/2 injection a day Basal, but it's no problem for the pump. Which is a roundabout way of saying a Pump might be something worth thinking about if you continue to have problems.