FUDiabetes

Action Profile of Tresiba at Lower Doses?

I’m currently using Levemir for my basal needs on MDI therapy. It has worked pretty well dosed 2x daily.

Given others success with Tresiba, I’m curious if it could be an improvement over Levemir for my situation. However, I take a fairly low dose of Levemir daily: 12U morning and night, which adds up to 0.27 U/kg total daily dose. All of the studies I’ve seen show action profiles for a minimum of 0.4 U/kg with Tresiba. I suspect that at lower dosages, the duration of action will be less than 24 hours, similar to other basal insulins.

For those using Tresiba in lower doses (less than 0.4 U/kg), how has it worked? Have you needed to move to 2x daily injections?

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Following bc I have the same question for if I ever try Tresiba…

So my dose is .18 u/kg. It definitely seems to work at least 24 hours—I do notice that I do not find the same flexibility in dosing timing that some folks report though, and I never considered that as a possibility as to why. Variation in dosing time of up to +/-4-5 hours seems ok for me; more than that and I start to notice it. I’ve never been sure whether that is due to the tail action that extends into the next day or what though, since it’s complex. I take mine before bed, and if I forget, I’ll see it (though mildly) in my morning blood sugars 7ish hours later.

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Also, fun unrelated fact that I’d never calculated before—my dose was about .25 u/kg before I started taking metformin (adjusted for both dose difference and weight difference, pre-metformin, but all but .01 u/kg of that change is because of change in dose).

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Ok, so my math is rusty, but we’re talking calculate this by taking your current dosage and dividing by your weight in kg? Just double checking…because I am on a teeny, tiny dose (LADA and still have some insulin production), and that would come out to 0.07u/kg for me. It’s a perfect dose for my current goals (I go to bed around 100 most nights, and wake around 80-100 with relatively flat lines). Before that, I was waking in the 110-130 range. I haven’t noticed any issues with it sputtering out before the 24 hrs - I was on Levemir during pregnancy, and I remember that happening then - but not sure how much I would notice on such a small dose?

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My Tresiba dose varies a bit during the month, but it’s generally not higher than .32 U/kg.

Tresiba generally works well for me. Every basal insulin has its pros and cons. My basal needs are higher in the evening, and that’s been a challenge on Tresiba. I tried taking Tresiba 2x a day. At first I thought it was helping, but eventually I realized that it really wasn’t solving the problem for me.

Tresiba seems to take much longer to kick in for me than others. I can be as late as 12 hours on my dose before I begin to notice bg values trending slightly upward. If I’m really late or miss a dose, I won’t really feel it until almost 24 hours later. Over time I’ve realized that while Tresiba is marketed to be flexible on timing, it’s much better to take it at nearly the exact time every day (within 1-2 hours at least). Otherwise, I will have upward trends 12-24 hours after the time it should have been taken. I’m not sure if I’m the only one that experiences this; it seems like other people report a lot more flexibility on their timing. Sometimes I wonder if they’re just not attributing upward trends at the 24 hour to a late Tresiba dose.

I generally don’t notice a dose change of 1 unit until 1.5-2 days after I’ve changed it. My doctor has suggested that I switch back to Lantus or try Levemir so that I can handle exercise and monthly hormone variations more easily. I’m trying out a couple of other things first, but if those don’t work, then I will switch at my next appointment.

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Yep.

If I could take Levemir (allergic), I would likely switch to it for this reason. I think it’s probably superior for anyone on MDI with changing basal needs to Tresiba. However, my only other option is Lantus, and Lantus sucks in my experience (inconsistent action day to day, split-dosing helps but doesn’t entirely fix its 20 hour duration issue, etc), so for now anyway, I’d rather deal with some difficulty adjusting my basal. If I had more frequent and more intense variation (say if my activity levels very regularly varied day to day), I’d probably need to either go back to Lantus or a pump to manage though.

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@cardamom, would you mind sharing how you came to find that you are allergic to Levemir? This is a new concern of mine with insulin lately…

I get localized raised red circles of around 1/2-1 inch maybe in diameter around injection site when I tried it. Happened a number of times, so I stopped and went back to Lantus. I had already had this happen before way back in the day with my Lente insulin, which is when they switched me to NPH. I suspect it is not truly an allergy per se (which would be systemic) but rather a mast cell mediated reaction, which makes sense as I likely have a mild case of mast cell activation disorder (MCAD, also known as MCAS), which is linked to my hEDS. I had no further testing to confirm this. Haven’t had the issue with any other modern insulins.

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I think I read a prior post of yours about this combination. I’m curious if you think that Metformin helped flatten your basal needs profile?

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It definitely reduced my dawn phenomenon. I’m still dealing with what I’m pretty sure are cycle related changes—I don’t think it affected those much.

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I’ve taken doses as low as that and not had any problems

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Mike, I have used Tresiba once daily in the AM for over a year at roughly 0.25U/kg pf body weight. Recently, for unknown reasons, I experienced nighttime BG higher than I wanted. I switched over to half of my daily basal twice daily (8AM and 8PM) and it has knocked those nighttime BGs back down to satisfactory levels.

I am not sure if this nighttime BG issue was caused by the Tresiba duration (I have heard 42 hours), the timing of the Tresiba peak (which I interpret to be at 4 +/- hours for me), or possibly I was developing some insulin resistance due to less activity? Before trying the AM/PM basal, I gradually increased my Tresiba AM dose by 20% with no improvement at night but more lows in the day so I gave that up. At any rate, twice daily basal works well for me.

I like the fact that Tresiba’s basal action is pretty mellow…I switched over “cold turkey” one evening without ill effects. Sunday AM, Monday AM I took 20U, Monday PM, Tuesday AM, Tuesday PM and onward I took 10U.

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I’ve had t1 for 43 years. NPH then about ten years dual dose Lantus, then about eight years dual dose Levemir. Started Tresiba about a month ago. Once a day in morning, still fine tuning dose and timing but pretty close now. Currently .28 unit/kg. I take it when I wake and that can vary by a couple hours from day to day.

I see a small rise early in morning (dawn phenom) of about 30,40 points just before and after waking, easily handled with small fast acting injection on waking. I also need to be very careful to have handled all evening meal carb and protein before sleeping else see slow rise while asleep - but that should be true of any properly adjusted flat basal.

So short answer - it is working well for me at your dosage level and I see no reason to consider twice a day injection.

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