FUDiabetes

Split Tresiba basal

About 2 weeks ago I decided to split my Tresiba basal into a morning and evening dose (I am MDI). Before that, I tried increasing a single morning Tresiba basal with limited success, trying to knock down some persistent highs that were causing some havoc with my BG control and generally ruining my attitude.

For a long time since I started with Tresiba, I had been on 19 units daily, at 8AM plus or minus about an hour. Not sure if it was inactivity, change in diet, or ??? but my nighttime BG’s seemed to be creeping up starting around midnight and I often had to either wake up for a correction bolus or sleep through it and wake up at 160 or so. I usually have dinner at 5-5:30 PM so I did not consider that meal to be a contributor (but maybe it was?). At any rate, I tried increasing my single Tresiba basal for about a month and got it up to 24 units with little improvement at night but more lows in the day and evening. Then I made a cold turkey switch to 9 units at 8AM and 9 units 8PM. My theory was that maybe I am not getting a true 24 hour basal out of the Tresiba. The results have been satisfactory but not awesome, with my average nighttime BG dropping to 123 from about 155. Further tweaking of the basal dose is planned.

Does anybody have other ideas for dropping this nighttime BG on MDI? I’m hesitant to drop off to sleep lower than about 120 because of some 3AM lows I experienced when I used Lantus. I often nudge the BG up a little with about 10g carbs if I am below about 120 and falling when I hit the sack. Perhaps I should not do this and go ahead and let it ride and rely on the Dexcom to alert me if I get too low in the pre-dawn hours? Not sure, looking for ideas.

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I have the exact same problem with nighttime creeping highs. The solution that was given to me was a bedtime dose of NPH. I haven’t yet tried this but it sure makes a lot of sense.

This sounds like a pretty substantial improvement for such a simple adjustment

Based on this I guess I’m not understanding how you’re not feeling you’re already at your goal levels?

Might have to give that NPH a shot. When I was having trouble I tried Humalog for dinner bolus and evening corrections (rather than Fiasp which is my normal bolus) with no success. In the back of my mind I think maybe an after dinner brisk walk would help and will try that too.

Sam, You read it right. My head is spinning thinking about nighttime goal levels. I guess my ideal would be to fall asleep at 105 and wake up at 95 with no dawn phenom. The closer I can get to that the less tweaking I will do. The carb nudge at bed time is an old habit that is starting to feel like a security blanket and maybe I’m just ready for a change of pace.

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