Frequency of Tresiba dose adjustment?

[brucie75]

Hello everyone

I have always been led to believe that one should not need to adjust basal insulin too often. However, I have to adjust my Tresiba regularly up and down. For instance, since Xmas the dosage has been between 7 and 10 units. I have just returned from holiday abroad when I always have to increase my long and acting insulin doses. Prior to my holiday, I was on 7 units of Tresiba and now I am on 9 units. I was expecting to have to reduce it again now I am back home but no need.

More importantly, is why did my blood sugar shoot up from 4.3 to 24.2 in 3 hours after I went to bed last night and stay at 23/24 all night until I gave myself a correcting dose of short acting? I gave myself my usual 9 units of Tresiba at the usual time last night & had 10g more of snack than usual due to my relatively low BS. Any ideas? It is SO frustrating, especially as my HbA1 has been at 9% (79) for the past 2 weeks.

David

 

[brucie75]

Hello everyone

I have always been led to believe that one should not need to adjust basal insulin too often. However, I have to adjust my Tresiba regularly up and down. For instance, since Xmas the dosage has been between 7 and 10 units. I have just returned from holiday abroad when I always have to increase my long and acting insulin doses. Prior to my holiday, I was on 7 units of Tresiba and now I am on 9 units. I was expecting to have to reduce it again now I am back home but no need.

More importantly, is why did my blood sugar shoot up from 4.3 to 24.2 in 3 hours after I went to bed last night and stay at 23/24 all night until I gave myself a correcting dose of short acting? I gave myself my usual 9 units of Tresiba at the usual time last night & had 10g more of snack than usual due to my relatively low BS. Any ideas? It is SO frustrating, especially as my HbA1 has been at 9% (79) for the past 2 weeks.

David

In addition, even though my holiday was at the same hotel as in the past with similar food, environment etc. my BS was higher than ever even though I was injecting increased doses of insulin.

 

[Hopeful34]

I've never used Tresiba @brucie75 so will leave it for others to comment on it, but I before going on a pump, I had to adjust my long acting insulin on a fairly regular basis.
As to the high last night it could have been due to a few things, eg the insulin may have lost its potency, you could have forgotten to have your evening insulin, given the wrong dose, faulty pen/cartridge, eaten more carbs than you thought/needed at bedtime, be going down with a bug, be stressed etc, etc.
In your situation, I'd start a new cartridge/pen and monitor your levels tonight. Also, if you haven't done a basal test recently, that's probably a good idea to do as well.
Just a thought, do you use a cgm or were the readings from a finger prick test? Faulty test strips/sensor readings??

 

[In Response]

I change my basal most days. This i because I have days when I exercise (I need less basal for the next 24 hours), days when work is more stressful (I need more basal) and normal days. That is without considering days when I am ill or goi g down with a bug or hormonal changes or days when it is very hot or …
Before I changed to a pump, I would adjust my basal a few times each week and was grateful I had one of the shorter basal insulins. The idea of a basal that takes three to four days for a change to take effect would not suit my variable lifestyle.

If you are needing to change your basal frequently, you may find you need something short lasting such as Levemir. This requires an additional jab each day but sounds like it is worth it if you need the variation.

 

[Zhnyaka]

it is not recommended to change the dose of tresiba often because this insulin must cycle and work for more than 24 hours. It takes about 5 days for you to see the effect of a dose change. This does not mean that you cannot change the dose for months.

 

[brucie75]

I've never used Tresiba @brucie75 so will leave it for others to comment on it, but I before going on a pump, I had to adjust my long acting insulin on a fairly regular basis.
As to the high last night it could have been due to a few things, eg the insulin may have lost its potency, you could have forgotten to have your evening insulin, given the wrong dose, faulty pen/cartridge, eaten more carbs than you thought/needed at bedtime, be going down with a bug, be stressed etc, etc.
In your situation, I'd start a new cartridge/pen and monitor your levels tonight. Also, if you haven't done a basal test recently, that's probably a good idea to do as well.
Just a thought, do you use a cgm or were the readings from a finger prick test? Faulty test strips/sensor readings??

I take readings from both CGM & finger prick as my CGM can be inaccurate. However, the readings were very similar on this occasion. I definitely injected the correct dose last night as I am using a recyclable pen which tells you how much you've injected & when. It might have been the carbs but I am struggling to understand how 5-10g extra would result in that much higher a BS. Besides, I had extra carb on another evening last week due to a BS of 5.0 and my BS stayed relatively low that night.

Yes, I was thinking of replacing the cartridge tonight - funnily enough, this current cartridge is nearly empty anyway. So, maybe it is the cartridge.

What's the basal test?

Thanks for the reply.

 

[brucie75]

I change my basal most days. This i because I have days when I exercise (I need less basal for the next 24 hours), days when work is more stressful (I need more basal) and normal days. That is without considering days when I am ill or goi g down with a bug or hormonal changes or days when it is very hot or …
Before I changed to a pump, I would adjust my basal a few times each week and was grateful I had one of the shorter basal insulins. The idea of a basal that takes three to four days for a change to take effect would not suit my variable lifestyle.

If you are needing to change your basal frequently, you may find you need something short lasting such as Levemir. This requires an additional jab each day but sounds like it is worth it if you need the variation.

I was on Levemir 2 years ago before I went onto Tresiba. This was because Tresiba is longer-lasting but to be frank, I've not really noticed a difference. Everyone's different though. I have been thinking of maybe asking to go back onto Levemir.

Thanks for the reply.

 

[brucie75]

it is not recommended to change the dose of tresiba often because this insulin must cycle and work for more than 24 hours. It takes about 5 days for you to see the effect of a dose change. This does not mean that you cannot change the dose for months.

I decided to increase my Tresiba by 2 units on Sat 9th, 8 days ago. This has not made much of a difference. I will change cartridges tonight as my current cartridge is nearly dead.

Thanks for the reply.

 

[EllieM]

I will change cartridges tonight as my current cartridge is nearly dead.

I find that sometimes my lantus appears to "go off" when I'm near the end of a cartridge..... I know most insulins are supposed to last 28 days out of the fridge but I am not personally convinced that this is always the case. However, I haven't used tresiba and have no idea how long you've been using your current cartridge so this is wild speculation.

 

[becca59]

I find Tresiba to be much less effective after 4 weeks. I only use small amounts so usually dump about 1/3. Seems wasteful, but I know my levels will start creeping up.

 

[Juicyj]

Hi Brucie,

What was your evening meal ? fat delays the absorption of carbs so this could easily cause a delayed spike. I personally wouldn't change a thing without a succession of repeat patterns, from one day's events alone is not enough information to change a basal dose, also as said earlier it's profile is 36 hours so can take 4-5 days to see any effect from an adjustment.

If you're unsure that the basal is offering enough coverage, do some basal fasting tests first: https://www.mysugr.com/en/blog/basal-rate-testing/

 

[brucie75]

Hi Brucie,

What was your evening meal ? fat delays the absorption of carbs so this could easily cause a delayed spike. I personally wouldn't change a thing without a succession of repeat patterns, from one day's events alone is not enough information to change a basal dose, also as said earlier it's profile is 36 hours so can take 4-5 days to see any effect from an adjustment.

If you're unsure that the basal is offering enough coverage, do some basal fasting tests first: https://www.mysugr.com/en/blog/basal-rate-testing/

Hi

I do not think it was the evening meal as I had had the same food for the previous 2 days. I also doubt it was the insulin but hey, you live and learn. My overnight BS levels have spiked a lot for a week or so apart from the odd day. They have been at very high levels (>15) and do not come down until I take a correcting dose of quick acting. It is frustrating as I was having relatively normal overnight BS levels with 2 fewer units of Tresiba until recently with the same lifestyle and food. I have been on holiday to Lanzarote and am often left wondering (irrationally, maybe!) if my diabetes 'resets' itself after a change in environment etc.

 

[Juicyj]

Hi @brucie75

BG levels are affected by so many factors, such as hormones, stress, infection, sleep, hydration, heat, exercise, other medication etc etc, coming back from a holiday is bound to affect your levels, it's also important to note that basal insulin is there to cover the background functionality of managing type 1, it's role is to keep you stable during periods of fasting such as sleep, I always look at how my body responds during periods of fasting with basal first, hence why I suggested basal fasting tests first and foremost.

I wouldn't jump in with any adjustments until you've done this and settled back into your routine, it's typical to see times where levels rise and insulin turns to water, changing insulin/sites too is important when this happens to rule out bad sites or insulin too.

Gotta take the rough with the smooth but trust your gut too - also get yourself a copy of 'Think like a pancreas' highly useful read.

 

[brucie75]

Hi @brucie75

BG levels are affected by so many factors, such as hormones, stress, infection, sleep, hydration, heat, exercise, other medication etc etc, coming back from a holiday is bound to affect your levels, it's also important to note that basal insulin is there to cover the background functionality of managing type 1, it's role is to keep you stable during periods of fasting such as sleep, I always look at how my body responds during periods of fasting with basal first, hence why I suggested basal fasting tests first and foremost.

I wouldn't jump in with any adjustments until you've done this and settled back into your routine, it's typical to see times where levels rise and insulin turns to water, changing insulin/sites too is important when this happens to rule out bad sites or insulin too.

Gotta take the rough with the smooth but trust your gut too - also get yourself a copy of 'Think like a pancreas' highly useful read.

Thanks Juicyj - still having problems with overnight sugar levels. I increased my Tresiba by another unit to 10 on Wed night but have not noticed a difference yet although I do realise there's a few days' lag with Tresiba.

I'll look into 'Think Like A Pancreas'.

 

[CANL]

For me, my doctor said: increase Tresiba by 1 unit every 5 days if needed.
Down 2 units if needed.

 

[Zinadane]

My tresiba can be stable for a month or more. Then suddenly out the blue it can be way too much or little. Sometimes up to a 20% adjustment is needed so it can take few days to settle out. I usually go 0.5 increments on my novopen untill I feel it is correct again.
I like to get my basal as perfect as I can, it can dramatically reduce the need on my bolusing, when I get it just right.
Can't always explain, but usually stress or exercise routines play a big part.