I started Tresiba 3 nights ago, after finally getting a prescription from my doctor. I’d like to share my experience because I was looking for threads from anyone with LADA on MDI just getting started on basal, and I didn’t see one (I would happily be pointed in that direction if I just missed it). Technically I am not new to basal insulin, as I was on Levemir during my last pregnancy, but my babe is now 18 months old(!), so it’s been a while, and I have never taken Tresiba.
My fasting levels have been sitting around 100-130 the past month or so (and around the 100 place for months before that). So far on Tresiba I’ve seen 95, 105, and 107 first thing in the AM. I’m currently doing 4u, so tonight or tomorrow night I will bump up to 6u and see how that goes (haven’t decided yet with my husband’s work schedule which day would be worse to potentially have lows while home alone with the kids). The bad thing is the timing of those lower fasting numbers could also just be a hormonal influence, so it’s hard to tell yet whether or not the Tresiba at this dose is doing anything at all. On the other hand, even if hormones are in play, this is the lowest insulin resistance portion of my cycle, so it’s not like I’m getting up to max dose when I’m also at max insulin resistance, which would then of course be too much when that dropped later in the month.
The main interesting thing I’ve noticed so far is that, while my numbers have been higher pre-basal, most nights I still maintained a relatively flat line, even if that flat line was sitting around 120. Now that I’m taking Tresiba, though, I do not have a flat line at all, day or night. I experienced this when I began Novolog, too - my beta cells were straining so hard to maintain decent BG levels (and they couldn’t), I introduced exogenous insulin, and the beta cells suddenly just stopped doing anything for a short period of time until I guess they’d had a sufficient break. It’s always really “cool” to see, even if I’d prefer that flat line.
Thank you! I’m certainly open to suggestions - the bump up was based off of what my docs NP said (every 3-4 days). Just curious, why would you go a full two weeks?
ETA: doc’s NP also wanted to start me @10u. I chose a conservative route…
I usually give it a week, but I don’t have a monthly cycle and @Pianoplayer7008’s other health issues to contend with, so maybe a pattern is more obvious over two weeks?
@Pianoplayer7008, I tend to agree with @Thomas on suggesting to go slow on moving basal up (I mean in how high a step). Imho it is harder to deal with too high a basal, since you may have to eat every hour or two, day or night. With Tresiba, it may take you more than one day to be able to go back down (since it remains active more than one day). So I would also suggest going up slowly—but I am not a Tresiba user. Possibly @Sam or @cardamom might want to make a suggestion?
At the same time, I am not you, and I figure you may know best what you need My advice may be too overly cautious.
I think at least a week is probably a good call, and small adjustments, mostly because these numbers are still very good, so there’s really not urgency to tweak it. Tresiba does take about 3 days to adjust*, and they usually suggest 5 to be safe, but a week or even two gives you a chance to observe how the dose functions over time so you can be sure you aren’t reacting to other variability. Again, if you were seeing numbers that were way off, I’d say change faster potentially (3-5 days), but you aren’t.
*Unless you do something fancy with it (which I would definitely not recommend to a beginner with it, more for someone making a change they know they need for a specific situation) like initially overcompensate for the change then slightly underdo the change, and then settle on the intended dose.
I’m not a Tresiba user, but I agree with others that with those numbers I would wait. I used Tresiba for a month at the beginning of this year, and I think I changed the dose every three days, but my numbers were also crazy high and low. I never could settle on a dose and I think in that month I had about three days where I actually spent more than half the day in range, and I feel like a lot of that was because I was changing the dose so often, but for me it was overall a very frustrating experience. I think your numbers look fantastic, and as long as they aren’t going crazy high or low, I wouldn’t do anything since that’s far harder to stop once it gets started than making small tweaks after a couple weeks of stability.
A couple, enough to suspect it works, but not enough to recommend it, beyond suggesting it as something someone else could experiment with (but again, for someone very familiar with Tresiba and making a change they feel confident about).
Thanks for all of the advice - I’m waiting; not sure how long. My fasting numbers are ok, but my meal spikes are absolutely ridiculous at times, and I think the underlying basal is part of the issue (spiking from 120 vs spiking from under 100), so my temptation is to rush things, and so far I’m resisting. The whole reason I started @4u vs the 10u my NP told me to was because I’m trying to take it slow and be careful. Rushing would just undo that.
So interestingly, today was a very good day in terms of basal (hovered around 95-110 when not eating), but my meal spikes when I eat any larger amount of carbs (more than 30) are much faster than normal the past few days (regardless of whether I’m using Afrezza or Novolog). Today I had a lower carb lunch but higher carb breakfast and dinner, and it shows below. Maybe just an adjustment thing with the new basal…? Right now I’m planning to wait to see if it balances itself out once I get settled in with my basal rate before I try to adjust anything with my boluses. Pic of my graph today, though again, as usual my Libre is running ~20 below actual BG, so all those lows aren’t actually low…I keep thinking of adjusting my target range down but have been wary of trying that in case the Libre works itself back to normal and then I end up missing a low until it’s really low. I might still adjust the top of the range so I can catch highs more quickly…or just to drive myself more crazy.
With basal and bolus it’s really helpful, conceptually, to completely separate the issues of what your bg is doing when you’re eating vs fasting.
At a glance of your chart I see downward trends (regardless of the number— down is down, and up is up) clearly separated by meal spikes. I would not interpret that, myself, as needing more basal whatsoever. I could actually argue that less might be justified.
Why would you do less? I’m thinking of staying where I’m at with my basal dose with what I’m seeing - I’m comfortable sitting around 100 for the time being.
The adjustments I referred to were to my mealtime doses (or maybe timing…or combination of both…), but I want to wait and make sure I’m not dealing with something I’ve seen before: that introducing more exogenous insulin gives my beta cells enough of a break that they take a little vacation before coming back with renewed vigor. Basically, I’m not sure if the spikes I’m seeing are indirectly related to the basal (not caused by insufficient basal, but perhaps caused by the newness of having that extra insulin) or are unrelated and another sign of disease progression in that my ICRs need a change, if that makes sense.
This is what I’m saying needs to be conceptually separated. If your IC ratios need adjustment, consider that as a separate issue in your mind… it’ll be impossible to untangle the intracadies otherwise… I agree that the basal looks pretty ok particularly given that your meter reads consistently higher than the libre…
Also might recommend skipping lunch or breakfast one of these days and watching the trend on the libre…
In my experience, you don’t really ever need to fast for a whole day, just skip the meal in the time of interest. That gives you about 3-4 hours of time past the 4 hours where you last meal insulin is active. That is enough time to see if you are holding a flat line or going up/down.
Good point…snacked @11p last night (that late night snack urge got me…), and I was using Afrezza, so it would’ve been long gone by 2a…so right before that big dip.
My advice may be too overly cautious.
My fasting numbers are ok, but my meal spikes are absolutely ridiculous at times, and I think the underlying basal is part of the issue (spiking from 120 vs spiking from under 100), so my temptation is to rush things, and so far I’m resisting. The whole reason I started 
Basically, I’m not sure if the spikes I’m seeing are indirectly related to the basal (not caused by insufficient basal, but perhaps caused by the newness of having that extra insulin) or are unrelated and another sign of disease progression in that my ICRs need a change, if that makes sense.