Basal regimen with MDI..Tresiba?

All this talk of Tresiba has me thinking about my basal regimen. This is the worst aspect of my diabetes management: usually have a Dawn Phenomenon boost of around 60-80 points, or worse if I sleep in a little. However, it seems to be better if I work out (3x per week). I am currently taking Levemir, 7 units at 6 AM, and 7 units at 830 PM. It is supposed to peak slightly at about 8 hours, so that’s why the 830 PM.

For a long time, I have thought of waking at 4 AM to inject bolus and go back to sleep was the best way to deal with DP, rather than taking a large® dose of basal at bedtime, and risking overnight lows. However, I have had a difficult time putting this into practice:slightly_frowning_face:

Maybe Tresiba will magically make the DP better? It seems I’ve seen others with positive results. I think I’ll ask about a sample at my upcoming Dr. visit.


Have you tried a bit more Levemir at night?

When I am doing MDI, I take a few units of NPH at night. Just a little bit can help. I take it close to the time I go to sleep and it cuts out the 4am spike.

You could try a small amount of NPH, and maybe adjust your nighttime Levemir down if needed.

If you know when you spike, and you usually spike at the same time, you can find some combination of basal insulins that will work.




Good thoughts.

I have taken more Levemir a few months back, but I was waking with morning hypos (especially when more physically active, probably increased insulin sensitivity).

I have kicked around using NPH, but am concerned with using it due to the protamine. (Reference Dr. Bernstein’s Diabetes Solution for a discussion of insulin containing protamine): Google Books Link

In any case, I think I need to test a few times in the night and early AM to get a better picture. However, doesn’t DP start as soon as you wake? or does it kick in at the same time every morning?

I guess I could purchase a freestyle libre to check out my insulin action overnight. Much easier than waking and testing, etc.

Dawn phenomenon starts in the middle of the night/early morning hours while you are sleeping, and accelerates the minute you get out of bed (“feet on the floor” phenomenon). I take a unit of NovoRapid (Novolog) the second I get out of bed to counteract this, or set a temp basal increase when connected to my pump. I find it often continues over the next few hours depending on my stress/activity/coffee level and I need to take more NovoRapid or take a couple units of Regular insulin to control it. I’ve tried Tresiba and found if I took it in the morning my DP appeared predictably and I’d spike to around 12 (216) around 3-4am. If I took it at night I’d have no DP but I kept having to reduce the dose to avoid extreme hypos throughout the night. When I finally reduced the dose enough to stop these, I couldn’t get it to last 24 hours and would skyrocket in the late afternoon as if I had no basal in me at all. Definitely try it, but ultimately I’ve found a split dose of Levemir to be the best MDI solution.


Thanks Scotteric,

I may well need to increase my evening dose and possibly back off my morning dose: it will slightly lower blood sugars around noon, when I delay lunch.

I do wonder how short the action curve is for such small doses as I take: 0.08 units/kg at each dose. If the curve is shortened, the peak action probably moves earlier in the curve as well. I believe most published action profiles are based on 0.4 u/kg or greater dosages. I guess the only way is thru testing in the night or fasted daytime hours… or cgm graph.

Here is a reference link for Levemir duration:
A double-blind, randomized, dose-response study investigating the pharmacodynamic and pharmacokinetic properties of the long-acting insulin analog detemir.

Their description wasn’t worded clearly, so I put it in this table to simplify it.

Dosage amount (units / kilogram) Average duration
0.1 units/kg 5.7 hours
0.2 units/kg 12.1 hours
0.4 units/kg 19.9 hours
0.8 units/kg 22.7 hours
1.6 units/kg 23.2 hours

Wow…I didn’t realize the action was shortened that much for 0.1 u/kg! I understand how Laboratory profiles may or may not correspond to my condition, but they are a good starting point.

By the way, does tresiba have published curves for similar dosages?

For what it’s worth I take somewhere between .1 and .2, often closer to .1, and get about 12 hours, sometimes more or less. If there are gaps they are covered by NovoRapid and/or Toronto (Regular) that I take for breakfast and dinner. If I am eating very low carb or don’t eat late at night I don’t notice any basal gap at all, even if I delay the night dose.

I’ve got absolutely nothing of any value to add other than I’m going to try to get a Tresiba sample at my next appointment, too.

That was it. :grin:

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For what it’s worth, my Libre is fantastic and is very low maintenance. It is better than my Medtronic Guardian, and it looks like there are ways to extend it to make it even more cost effective.

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Surely not everyone’s will look like this, right? I have my basal rates set to counter dawn phenomenon, with a jump in my 4:00 am rate, but until I add some coffee, my blood sugar steadily drops in the morning. Does this mean that what you’re describing is not true for me, or does it mean that the one increase in basal is enough to counter everything past 5:00 am?

Sorry to butt in. I have a friend who describes this, and he says he’s never found a doctor who could address it. I always thought he was making stuff up. :grin:

It’s hard to say, we’re all different! I just know on pump or MDI the minute I get out of bed I skyrocket unless I take insulin immediately. There are people who say going hypo causes a counter-regulatory reaction that makes them go hyper for hours after. Ive never experienced this, if I’m hypo I’ll just stay hypo until I treat it, and only go high if I over-treat, but we really are all different!

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There are a lot of different hormones that are secreted when you sleep. Different for everyone, like luteinizing hormone and prolactin for women. And there are some hormones that are related to the stage of your sleep and your circadian rhythm. Or the hormone leptin, which keeps you from feeling hungry while you sleep! Or growth hormones. Or cortisol and adrenaline. These hormones are different for everyone, and can affect people’s BG differently, or not affect it at all if they do not have as much of the hormones secreted.

The main point is - it’s just different for everyone.

Then when you wake up, your liver recognizes that you are moving about and believes that you need fuel for that, and since you have not had breakfast yet, it gives some of it’s stored fuel, liver glycogen, and that can also raise your BG.

So these things can be different for everyone. Some may be flat when sleeping and only spike when they wake. Others may have it the opposite way, or spike both times, or not spike at all.

If you need a higher basal rate set at night, then you are probably seeing some of this. But it sounds like the higher basal is more than enough to cover you, which is why you drop in the morning.

But…once you wake up and have coffee, that sends a signal to your liver to provide more fuel, which is what raises your BG.

Sorry, is that the question you had?

Thanks for the thoughts, everyone.

I definitely plan to ask my GP for a Libre prescription, hopefully he’s heard of it.

Given all this talk of variation: hormones, differences in activity and diet, difference in peak timing, difference due to dosage, etc, it reinforces with me the need to look hard at what my BG is doing ovenight and tweak my dosages accordingly.


So that’s what I assumed… that we’re all different. And even though we have our own patterns, they’re subject to change whenever they dang well please. But I was looking at that statement up there, and I’ve always thought of myself as having “dawn phenomenon”, therefore the need for the half unit increase in the wee hours of the morning, but the second part doesn’t fit. But it appears that the accelarating upon getting up is part of dawn phenomenon. Am i making any sense here? I’ve heard of dawn phenomenon since diagnosis, but I’ve only just heard the term “feet on the floor” phenomenon and thought it was referring to something else…

And now I’ve made myself dizzy and am not even sure for what purpose.

Never heard of this… wish I could make it while I was awake and in the pantry.

But again… this refers to a spike with physically getting up… I think I understand your point, but…

And these are all just different variations of dawn phenomenon? [quote=“Eric, post:13, topic:4463”]
If you need a higher basal rate set at night, then you are probably seeing some of this. But it sounds like the higher basal is more than enough to cover you, which is why you drop in the morning.

Drop, like, over the course of hours. I could get up and sit in one place, not do insulin, not have coffee, and I’d be on the slightest decline that would take hours to lead to a low. If I get up and get kids ready for school, I crash in minutes. If I have coffee and don’t get insulin on board in time, I spike. But that’s the caffeine… I thought.

I can’t remember now. That is all very interesting stuff, and I’m trying to apply it, but I’m stuck… that’s okay. I’ll take another look at it when I can think straight…

“When 22 Japanese patients with T1DM received subcutaneous administration of insulin degludec at 0.4 units (U)/kg once daily for 6 days, the duration of action was reported to be over 26 h.” ( If this is accurate, it explains why Tresiba has never lasted 24 hours for me, as I could never take close to 0.4 u/kg without being hypo all day.

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I hear you. I just bumped up my evening dose of Levemir, but I’m only at 0.1 U/kg

Does the study also say that for lower doses, the duration is shorter?

I haven’t gone through the whole report yet, it’s a bit long. Was wondering if you noticed if it mentioned a duration for lower doses.

It doesn’t, it was just a passing comment I thought was interesting but the paper isn’t really about insulin duration.