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Tresiba

Peppergirl

Well-Known Member
Messages
211
Location
Ellesmere Port
Type of diabetes
Type 1
Treatment type
Insulin
Hello

Still early days with tresiba, on my third daily dose of 30-34u. I was on lantus x 2 doses of 18u. BGs much better as I am now on LCHF but I wanted to tweak things to get my BGs better especially in the morning. It was a bit hit and miss in the morning and I'm sure I experience DP. I split my lantus for years as I didn't want to take a lot of insulin at once, that was the only reason TBH. My BGs have been stable throughout the day, although I found I had some small correction doses to keep them down, so for example a BG of 7.5mmol for over three hours, I would correct. This worked OK, but I felt the basal was wrong.

Anyway, the DSN said that the consultant would want me to try tresiba before even looking at a pump. She told me to reduce the dose to 30u initially and I've had one dose in the evening the last three days. BG was 6.1mmol on rising on Wednesday, but last couple of days it's been 3mmol. I did have 34units last night, as BG was high most of the day yesterday, despite corrective novorapid, between 8-10mmol. Before bed, it was 8.8mmol. So I thought I would increase the tresiba a bit.

What I wanted to find out was whether tresiba should be split doses? I thought it lasted about 36 hours and was "flat" so didn't have peaks...seems that it drops me a few hours after taking it (about 9.30pm) and then higher throughout the day. Although, I've still got a lot of testing to do. But the morning lows suggest taking it all at once is incorrect.

Thanks
 
Hi @Peppergirl Tresiba is a great background insulin, it doesn't need to be split as it lasts 36 hours and is a flat profile, you only split your dose if you feel that your background is not supporting you over a 24 hour period and even then you would need to do some basal testing to see this, so I would be wary about making any changes within 3 days as it will take a week or so for your dose to settle down when you first start taking it. It's best to leave it be as suggested by your DSN rather than trying to rush into making any changes, as you have now increased your dose then you will need to watch it very carefully, when I was using Tresiba before the pump I was using probably about 20% less than my total daily levemir dose and I would always wait about 3-4 days before making any changes.

In regards to your lows, I wouldn't point the finger immediately at your background if you're eating the same thing and taking the same dose of QA then your carb/ratio may of changed, but I suggest you speak to you DSN today to go through this with them and also advise that you have adjusted your Tresiba dose also
 

Sure I've read it's meant to last up to 42 hours, so wouldn't have thought it's a basal where you would split-dose.

There's a member who currently uses Tresiba and always offers up some good advice, I'll tag him in the hope he replies to your thread @robert72
 
hi @Peppergirl - I don't think splitting Tresiba would help as it is not peaky and lasts well over 24 hours. If you are concerned about the volume of insulin that you take in one shot, then it would be worth asking your DSN about using the 200u strength version (stronger, so only comes in Flexpens) so you would only need half the volume for the same dose. Agree you should also talk to your DSN about your waking lows.
 
Hi Peppergirl.
I also take Tresiba and rather oddly I find I get a much flatter profile if I take it once in the morning rather than once in the evening. Don't ask me why as its a very long lasting insulin but it worked for me and so it might be worth thinking about changing the time of day you take it.

I'd also second what juicyj said. I think because its related to the equilibrium concentration in your system it can take 2-3 days to see the changes from altering your dose.
 
I'll just disagree slightly. There is some peaking if you look at the action profile for a single shot, (http://images.rxlist.com/images/rxlist/tresiba2.gif). The reported effect from Novo is that when you overlap consecutive days of jabs the combined effect is flat throughout the day though I don't see that from a simple overlay of the graph referenced.

I am not entirely convinced it is fully flat for myself, ie a dropping BG overnight and bolus not working as well as expected later in the day. I have seen mention of splitting the Tresiba elsewhere and I am giving that a go at the moment, ie 50:50 split 12 hrs apart, which does appear to be addressing the behaviour I was seeing on a single daily jab.

I will just add that any peakiness I have seen with Tresiba is still a huge improvement on the issues I was having with Levemir.
 
Not sure about that graph - it can't possibly start that fast
 

Hi Steve,

Useful information - however as the OP has only been taking Tresiba 3 days it's still too early to consider making any insulin changes without prior consultation from her DSN
 
robert72 said:
Not sure about that graph - it can't possibly start that fast
Click to expand...
@robert72, You are right, onset of action is 60-90 minutes. The graph I referenced assumes that the subject has been on Tresiba a few days and therefore has reached steady state insulin concentration at hour 0 and then plots out the action profile over the subsequent 42 hours.
 
So, only showing half the story
 
As I understand it tresiba is series of monomers and dimers linked together and it's these monomers and dimers rather than the long chains which are adsorbed by the body. It has such a long acting profile as it gradually breaks up the longer chains over time. I wonder whether this graph is more of a description of the rate at which the longer chains break up therefore become available rather than it's action profile? ??
 
The axis is for glucose infusion rate which I assume mirrors the insulin action to maintain a constant BG. I can aee how your question would relate if this were instead a graph of serum insulin concentration though.
 
steve_p6 said:
The axis is for glucose infusion rate which I assume mirrors the insulin action to maintain a constant BG. I can aee how your question would relate if this were instead a graph of serum insulin concentration though.
Click to expand...

Ah ok couldn't quite see that on my small image I opened.
Sorry peppergirl for taking over the thread but I think it's of interest to all tresiba users to understand the mode of action

I think the overlap is important too as I know the timing of taking tresiba is much less stringent than other basal insulins. For example I take it every morning which means week days that's about 6:15 and weekends more like 9:30
and it doesn't impact my levels.
 
I'm a morning tresiba giver.

It is much smoother for me over night. I do keep to only altering by small amounts and doing these changes every 3 days. I am on on 2/3 less insulin than you, but even if in your scenario I would not change by more than 2 unit and give it 3-5 days.

I've gone from needing 3 or 4 insulatard shots a day to just one tresiba. It's not always perfect but actions of it are much smoother..
 
well at least I have a pattern, as BG low again this morning, libre shows hypo about 8 hours after 30u tresiba which I've been taking at 9.30pm. not as low as yesterday morning though. Had 5 glucose tablets to correct a 2.4 at 7.45am, shot up to 8.1, so I'm sure DP kicks in as usual.
 
I had issues with hypos when I first switched from Levemir (10u night/5u morning) to 15u of Tresiba at night.

At first, I was on the fence about switching (and even debated switching back) but after about a month it was very clear that Tresiba works much better for me.

It's important to note that I now only take 11u of Tresiba compared to the split 15u I took with Levemir.
 
I went from pump to tresiba.
Pump was 16.3, tresiba somewhere between 101/2 and 91/2. Levels dropping with adding cinammon and turmeric!!
 
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