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Tresiba Issues

Discussion in 'Type 1 Diabetes' started by StewM, Mar 17, 2021.

  1. StewM

    StewM Type 1 · Well-Known Member

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    Hi, I was wondering if any of you could help. I've been having some issues with my Tresiba recently.

    Some days, I take it and it absolutely hammers my Blood Sugar and I'm going Low after every meal. Other days, it's like there's hardly any there, and I'm having to take 150% doses of Bolus to fight the fire.

    I've tried switching to a new Pen, switching Injection Sites, but none of these things have helped. I'm always using fresh needles on every injection.

    Two abnormal factors may or not be related. I had my Covid Vaccine two weeks ago, but my Blood Sugars have seemed to have returned to normal. Also, just over a month ago, I switched from Humalog to Fiasp. Part of me wonders if the Humalog was covering up this problem because of its extremely long tail. Cause 1) on the higher days, the Humalog helped a lot more covering the deficit and 2) on the 'highly effective' days I was mistakenly blaming the Humalog for Lows occurring long after eating.

    Has anyone encountered any such problems with Tresiba?
     
  2. Juicyj

    Juicyj Type 1 · Expert
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    Hello @StewM

    Going low after a meal would indicate the quick acting is to blame rather than the basal, it's best you start with doing basal fasting tests first to really identify if the basal is indeed at fault, have you tried doing this at all ? Also can you see a pattern to these lows comparing day to day ?

    Tresiba's profile as a basal is very flat, it lasts around 36-48 hours, of all the basal insulins this was the least problematic one for me despite taking me around 3-4 weeks to get my dose adjusted but as it was so flat it didn't cause me to go low around mealtimes.
     
  3. StewM

    StewM Type 1 · Well-Known Member

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    Thanks Juicyj, poor word choice on my part there. "Going Low long after eating" is what I should've said, as you're quite right.

    The last basal test I did was about three weeks and that saw my blood sugar dropping 1.4mmol/l across a four-hour period. I reduced my Basal 10% and found for the next week, by Blood Sugar would rise and keep rising from 3am until I took lots of Bolus (more than would typically be required) to bring it down.

    I've found consistently* since I started using Tresiba that the dose I'm currently working on keeps me flat. So I was quite surprised to see the results of the last Basal Test.

    The main pattern I see is I get two days worth of going low at the 4/5 hour mark after eating. And then I get two days worth of steady blood sugars after eating, but horrible rises in my Blood Sugar overnight.

    *When I do Basal Tests, however, I've found my Insulin/Carb ratio has almost constantly been in flux.
     
    #3 StewM, Mar 17, 2021 at 1:35 PM
    Last edited: Mar 17, 2021
  4. Juicyj

    Juicyj Type 1 · Expert
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    Hi @StewM

    My immediate thought is your 1.4 rise isn’t overly concerning, I tend to view anything over 2 mmol/l as something to review, a few other factors to consider are: exercise/stress and fat content of meals, do you exercise much ? What’s your average meal look like - also what levels are you rising to overnight and are you using a CGM to monitor ?
     
  5. StewM

    StewM Type 1 · Well-Known Member

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    Hi Juicej, thanks again for your help. I think I’ve discovered a possible answer.

    The extreme insulin resistance I developed after the Corona Virus Vaccine returned today. So I don’t think I’ve kicked whatever that it is. So that’s at minimum skewing my results.
     
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  6. donnellysdogs

    donnellysdogs Type 1 · Master

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    I had horrendous highs for 4 days after covid jab with Astra Zeneca. Nothing with shift bloods downward. I was hugely correcting and nothing for 4 days. Reported to MHRA.

    However, I have 2 basals... tresiba and insulatard as tresiba could not handle myriads that started at 3am until midday. I asked my consultant to add in insulatard aswell. I take both around 10pm at night. I also take insulatard in the morning aswell as fiasp.

    I also have two bolus type insulin’s. Fiasp for getting up (before my feet hit the floor) as I get huge rises that neither basal insulin’s manage. So have 1 or 1.5 of fiasp just before getting up, then novorapid for any food.
    Ido only eat one meal a day at around 6pm.

    Arise of1.4 isn’t too worrying... it depends what your level was before dropping.. and not huge worrying quick drop.

    I have had to hugely increase my tresiba from 2.5 units to 5.5 and still need to increase them from looking at my basal testing. If I take insulatard at 7.30am it’s worn off 12 hours later but it keeps my bloods good in the mornings & afternoons. When it finishes at 7.30 I then need to increase my tresiba to stop more rises though.

    I’ve just found that since covid jab 4 weeks ago it has increased my insulin’s needed. Normally I do change though around BST starting at end of March so may just be this kicking in a bit earlier..

    Hope you can fathom out what is going on.. but if you aren’t rising or falling 2-3 hours after your bolus, then it’s the basal that needs changing.
     
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  7. StewM

    StewM Type 1 · Well-Known Member

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    It’s interesting that you say 3am, because it’s 3am precisely I’ve been getting my rises. Even though, I wasn’t experiencing them prior to the Vaccination. I also take my Tresiba at 10:30pm. So our Tresiba’s on a similar schedule (ten units in my case).

    I suspect (with my limited experience) the “general” Insulin Resistance I encounter post-Vaccination ups my Basal requirements, just not quite sure how to approach increasing as it takes Tresiba awhile to settle and whatever this may have passed by the time it does.
     
  8. donnellysdogs

    donnellysdogs Type 1 · Master

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    As you are just on tresiba it’s May be a case to firefight with the fiasp for a few more days.

    That’s the reason I Am on insulatard aswell as tresiba . Flexibility for things like stress, illness, etc.
    The trouble is with tresiba is the long time for adjustments to kick in.. if I get anything like stress I need it to work straight away.

    I’ve had 3am rises for all my nigh on 40 years diabetic life. Did have a pump that worked well for 5 years, then my ski started to block the cannulas. Back to insulin via injections.

    With tresiba only, I had to wake every morning at 3am for a quick acting. Knew I couldn’t cope with that and tresiba is a flat insulin.. and insulatard says it lasts18 but it kicks out of me at 12.... so a pain managing at work...

    See how you go for 3am rises. Hopefully you aren’t like me permanently but if you are tresiba will not be good.

    As far asI know I am the only person in the country on 2 basal/4 insulin’s so you would need to really research what you think may be the way for you..
     
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  9. StewM

    StewM Type 1 · Well-Known Member

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    Two nights on. The overnight rises have calmed down significantly without increasing my Tresiba (so glad I didn’t jump the gun)

    The one curious thing is that sensitivity to Carbs is sky high. My blood sugar was dipping pre-bed last night. So had a five gram pick me up. This should my blood sugar from 4.9>7.9 (when usually I’d see a 1-1.5 jump from such a small snack). Also my corrections are now working totally normally, but I still require Large doses of Bolus to handle any meal.
     
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