Tresiba split dosing question

Damian1991 said:

My question is, although perhaps not neccessary because of the long acting profile of Tresiba, would i get the same benefit from Tresiba by splitting my dose 15/15 or even 10/10/10 or would this mess things up?

This potential split is purely out of fear for a single 30 unit injection going wrong, whereas a 10 or 15 unit injection I feel would be more manageable.

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I moved to Tresiba from Lantus for the same reason as you, a Lantus low where I eventually passed out for two hours after eating a ridiculous amount of glucose and carbs. Thankfully I woke up again, I didn't expect I would when I couldn't fight the urge to close my eyes for just a second anymore.

The way Lantus (abasaglar, Toujeo) works makes those lows possible. It shouldn't be possible with Tresiba or Levemir.
If you dig far enough, you'll find stories about anything, maybe they are correct, maybe they are cases of the wrong insulin pen, maybe those sudden lows on Tresiba were caused by other factors.

However, the Tresiba will work just as well taken in a split dose, and if this makes you feel better, I don't think there is any reason not to. It's a very forgiving insulin when it comes to timing.
I've been on Tresiba for 5 or 6 years, on more than triple your dose, and haven't experienced any issues. I sometimes inject all in one go, often take out the needle halfway through and inject the rest a couple of inches away from the first injection.
Splitting morning and night shouldn't be an issue, even if I don't expect it will make a difference, physically. Mentally it might though, which is as good a reason as any!

Damian1991 said:

Hi all,

I recently changed long acting insulins from Lantus to Tresiba. I did this due to experiencing 2 'Lantus lows' which dropped me low dramatically within 20-30 minutes of the injection with no fast acting left in my system at the point of taking the lantus and with a very steady level for the previous 6 hours. My understanding is that this is much less likely to happen with Tresiba, however if you go digging on google you will find stories of people adamant this has happened on Tresiba also.

I feel like I am on quite a large dose of long acting, 30 units a day (100kg in body weight, Male, 6ft 3"). This used to be split 15/15 on Lantus but is now just 1 dose of 30 on Tresiba. My levels during the day and night (Libre 2 fitted) are very steady on 30 units so i dare say the dosage is correct.

My question is, although perhaps not neccessary because of the long acting profile of Tresiba, would i get the same benefit from Tresiba by splitting my dose 15/15 or even 10/10/10 or would this mess things up?

This potential split is purely out of fear for a single 30 unit injection going wrong, whereas a 10 or 15 unit injection I feel would be more manageable.

I appreciate any thoughts, suggestions or experiences.

Thanks,
Damian

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Morning Damian,
I have been T1 46 years.
I can understand your apprehension regarding one 30 unit dose.
I have not used either of your background insulins .
I have been on Levemir twice daily for about 15 years (12 before bed 12 at breakfast) , works perfectly for me, only have to adjust for illness
Don't know if this has any bearing but we are almost identical in height and weight .

Damian1991 said:

It's just that the lantus low was so scary its hard to convince myself that this one will be different, it took 10 years for me to have that 1st Lantus low. After the lantus low happened to you, did you have any apprehension with the Tresiba to begin with?

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The Lantus low was the scariest thing that has ever happened in my 7 years of diabetes, much scarier than mixing up basal and bolus.
I was absolutely convinced that I wouldn't wake up again if I closed my eyes, but I couldn't fight the urge anymore. When I woke up again some two hours later, I was still below 3, but at least I was awake to treat.
It never dawned on me to call 112 (the Dutch 999) or even a friend or neighbour, isn't it lovely that our brains don't work properly during a hypo?

It took me 3 days of googling before I finally found out what the cause of this ridiculous hypo was.
This was the article that finally made it clear, and it even led back to some ancient threads on this forum. I have the article bookmarked (and thanks for that, @tim2000s !): https://www.diabettech.com/diabetes/lantus-lethal-or-lifesaver-doc-gbdoc/

Reading up on it, I was very sure I never wanted to inject a form of insulin glargine again, but no, I wasn't apprehensive of other insulins, I saw (and still see) no reason to.
My main concern was getting rid of the Lantus. My first insulin of choice was Tresiba, followed by Levemir, and I even would have accepted NPH if this would have been my only choice.

I called my GP's practice nurse for a very urgent appointment (I was still misdiagnosed as a T2 at the time), and made it very clear that I wasn't going to use the Lantus even one more day, I still had some of the old NPH in the fridge, only slightly past it's use by date.

I don't think she believed the Lantus was the cause of my low, but she definitely believed I was not going to take the Lantus ever again.
I was very relieved she managed to get me the Tresiba right the next day.

Damian1991 said:

I'm reluctant to change anything with it, even the split dose, because my levels are so steady with it, especially through the night.

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What I found with Tresiba is that it's ridiculously forgiving when it comes to timing.
I take it last thing before turning off the light, no matter if this is 11 PM or 7 AM (after a rare party). I'm usually very stable, and it doesn't seem to matter if there's up to 6 hours difference in injection time from day to day.
On the other hand, if your levels are so steady without splitting the dose, I don't see a reason why you would, except for sleeping better because of the fears.

What about splitting the dose into two different spots but at the same time?
Or moving your dose to morning instead of night, so if a funny reaction should happen, you won't be half asleep?
While it's not a thing with Tresiba, you still have to live with your fears, no matter if they're realistic fears or not.

I live with anxiety over many things, most of them not realistic.
But I have learnt that sometimes it's much more effective to adjust some things to accomodate the anxiety than trying to fight it all the time.

You've had a traumatising experience with the Lantus low, and it takes time to get over that. If some objectively unnecessary accomodations are helpful with this, why not?

I was tresiba before the pump and would never contemplate splitting it, it's profile is 36 hours and you can miss a dose in the morning and take it in the evening without any issue, it's profile is as flat as a pancake.

I'd check the dosage though by doing some basal fasting tests if you feel the cover isn't working effectively: https://www.mysugr.com/en/blog/basal-rate-testing/

Levimir was good for many years but over time & needing ever increasing amounts I was professionally advised that I was no longer responding to it so switched to Tresiba several years ago - this turned out to be a game changer in my control.
- I initially injected once a day but experienced lows after several hours so split 50/50.
I personally take 12 units at 7am and 12 units at 6pm and my levels have been consistently in range ever since.
Note: I also split levimir (back in the day when it worked for me) and found this to work much better …… as certain biographers & specialists report it makes sense to keep a consistent level of Basal in your system rather than administer all in 1 hit over a 24hr period

@LWA I am not sure the Tresiba/Levemir comparison is valid with regard to split dosing - depending up on your dose, Levemir can only last 12 hours whereas Tresiba lasts 36 hours. If you are splitting the Tresiba dose, you are overlapping your doses by at least 24 hours.
The usual reason for splitting doses is where we (commonly) need different basal at different times of the day - this is the biggest advantage of pumping. By splitting your dose 50/50 you are not allowing this.
Biographers and specialists (whoever these are) who suggest keeping a consistent level of basal, will not be referring to Tresiba which has an incredibly flat profile over its life - so providing the consistent level they suggest. They are more likely to be referring to the older basals such as Lantus/glargine which has a far from flat profile.

Thanks for your comments
I, as everyone can only go on personal experience and my comments were merely to suggest that splitting Tresiba works better for me …. When i initially moved onto Tresiba several years ago I experienced lows several hours after injection if I took all in one go.
Ever since I have split (as I did previously with Levimir) and control has been excellent ever since

When I was on tresiba I was on about 30u and there was no benefits to splitting the dose.. there is pretty much no spike with tresiba and it works for upto 72 hours

The only benefit would be if you get pain from a large dose