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Tresiba dosing

Levy

Well-Known Member
Messages
312
Location
Leeds
Type of diabetes
Type 1
Treatment type
Insulin
Just wondering if anyone else struggled to get Tresiba to match their body's needs? I used to be on 2x Levemir (18u in the morning and 12 at night). My consultant assured me the different doses wouldn't be a problem with Tresiba.

I started on 22u taken in the evening, but kept dropping a LOT overnight (around 5/6mmol) so I've been gradually reducing it. I'm now at only 14u and my nights are a lot flatter, but I now keep rising between meals during the day.

I'll try a fasting test tomorrow, but in the meantime I was wondering if anyone else had found the same? My A1C has actually increased since starting Tresiba and I'm getting a lot more hypos, so at this rate I would have been better off staying on Levemir!
 
I used to take levemir in 2 doses until i changed to tresiba.I take 16u every morning at 10am,never had a problem with night hypos since.Could you try taking it in the morning instead?
 
nessals946 said:
I used to take levemir in 2 doses until i changed to tresiba.I take 16u every morning at 10am,never had a problem with night hypos since.Could you try taking it in the morning instead?
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Were your two doses very different though?

My consultant told me it shouldn't matter what time I take it because it lasts 32 hours (for me - found out after I'd forgotten it once) and it's supposed to have a very flat profile and shouldn't really "peak" like other basals do?
 
I used to take 10u am and 10u pm.I was told the same thing about tresiba not peaking but i was also told it was best to take it in the morning.I suppose different advice is given depending who you speak to.
 
Levemir and tresiba work very differently... tresiba is a flat working insulin. So you may just need more bolus if your levemir was peaking around the times that you ate etc...
 
nessals946 said:
I used to take 10u am and 10u pm.I was told the same thing about tresiba not peaking but i was also told it was best to take it in the morning.I suppose different advice is given depending who you speak to.
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True, but my two doses were very different (18 and 12) because my nighttime insulin need is a lot lower than my daytime. That's why I'm wondering whether Tresiba would even be able to deal with that
 
donnellysdogs said:
Levemir and tresiba work very differently... tresiba is a flat working insulin. So you may just need more bolus if your levemir was peaking around the times that you ate etc...
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No, I don't think it's bolus related. I will try a full fasting test tomorrow but today for example it was still dropping slightly overnight and then started rising steadily until 1pm when I hadn't had any food or bolus yet. I decided to correct then, and it flattened temporarily, and then started rising again an hour later so I had food and another correction
 
@Levy that's almost exactly what mine were when I was on Levemir (it might have been the other way round, I can't really remember to be honest), and I haven't had that problem. I think @donnellysdogs is probably right, because Levemir is a very 'peaky' insulin, so it could have been almost giving you a 'super-bolus' at times.

The difference between night time and day time needs is my one little niggle with tresiba, because I am so much more sensitive at night than during the day. Also, the one other thing I have noticed is that since going onto tresiba, I get the 'feet to the floor rise', which I hadn't noticed on Levemir, but then I wasn't using a CGM at the time, so it's possible that I just didn't know.
 
I get what you're both trying to say, but the rise is happening even without food/bolus which shouldn't happen when a basal is tweaked properly.

Interestingly I'm the other way around with the feet on the floor @EllsKBells. I used to get it with Levemir but not on Tresiba.
 
I got horrendous rises in mornings from tresiba.

I stil take 1-2 units at 4pm each day but have insulatard at 3.30&8 and another bolus at 8am to counteract the rises but this way nights are beggdr although not always perfect.
 

This was exactly the problem I had with Tresiba when I tried it. When I'm off the pump I stick with a split dose of Levemir now. I use Regular (actrapid) insulin usually with breakfast or dinner since I'm eating low-carb, and it covers any basal gaps along with the protein conversion pretty well.
 

Do you use Fiasp for boluses? The first time I tried MDI with Levemir I was using NovoRapid and it wasn't fast enough to prevent big spikes when I ate during times that my morning or evening dose was fading out. Fiasp seems to work much better, especially at stopping feet on the floor almost instantly in the morning. If Tresiba isn't working for you I'd recommend going back to Levemir with Fiasp, and maybe adding R/Actrapid to cover gaps and protein as well (if you haven't tried all of this already that is).
 

I am on Novorapid. Thanks, I'll keep that in mind!
 
Also, I wasn't actually having any problems on Levemir (apart from feet on the floor). He didn't really change me over for any reason other than that he was doing the same for most other patients.
 
Levy said:
Also, I wasn't actually having any problems on Levemir (apart from feet on the floor). He didn't really change me over for any reason other than that he was doing the same for most other patients.
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You do not have to accept his reasoning, as we are all individual and should be treated as such.
 
donnellysdogs said:
You do not have to accept his reasoning, as we are all individual and should be treated as such.
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You're right! I've got my next appointment in a few weeks so will see what he says.
 
Levy said:
Also, I wasn't actually having any problems on Levemir (apart from feet on the floor). He didn't really change me over for any reason other than that he was doing the same for most other patients.
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I would go back to Levemir in that case and just bolus with Fiasp the second you get out of bed to stop the feet on the floor spike. I was talking to my endo yesterday about Tresiba and asked him if his other patients have had better success than me. He said while he thinks it would be a good fit for me since I split my Levemir into even doses approx. 12 hours apart, he likes that Levemir is more flexible and can be adjusted at will a bit more like a pump, whereas on Tresiba you're stuck with your dose for days and any adjustments won't show until days later.
 

That's another thing I've been a bit annoyed about! I get some days where my BG will run higher/lower for no reason. When I was on Levemir, like you said, I was able to act quite quickly by adjusting my next basal shot accordingly. I haven't found to be able to do that on Tresiba.

I just opened my fridge and realised I haven't actually got any Levemir left so can't really put it to the test unfortunately will see if I can get my GP to do me a prescription without having to wait for my appointment next month
 
That too used to annoy me. My activities vary day to day and tresiba didnt let me have any control on that at all. Heats another thing for me, so not being able to change dose for 3 days of heat then 3 weeks of rain before another 3 days sun really knocked me for a couple years whilst on / off hospitals kept wanting tresiba tried - and tried....

So glad I looked at the action timing for insulatard and could match it to my needs, even then diabetes educator never wanted me to split my dose for 3.30 and 7/8am.
Remember we are the experts with our bodies, consuktants are soecislusts througgh learning from text books... we are all individual....and should be trreated as such
 
I used to be on 12 levemir at night and only 5 on a morning - I now take 15 tresiba on a nighttime. I have been on tresiba probably almost a year now and it’s had it’s teething problems.
I am quite active in my job, 5 days a week, so my tresiba is essentially set up for that. I find it on my days off work I am extra active or extra lazy, I struggle with a day of hypos or a day of hypers! At least with levemir I would just adjust my morning dose depending on the day whereas this isn’t possible with tresiba!
I’m still trying to work out if the benefits outweigh the negatives as I am definitely having less night time hypos but probably more day time ones! I did have to adjust a few times with the tresiba dosage to begin with (started on 17 and now down to 15) but you just have to make sure you wait at least three days in between these changes to fully see the effect!

I think if I took my tresiba in the morning I would be even lower during the day (this isn’t meant to happen due to its ‘no peak’ but I feel that that combined with my fast acting during the day would make me hypo!)
 
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