FUDiabetes

Switch from Lantus to Tresiba not working

Hi All,
I have been a type 1 since the last 5 years. Always been on lantus throughout for my basal, taking it one time in the night. Started off with 19 units and had reached 34 units until last month. Recently my endo asked me to switch to tresiba since it was supposed to be a more “stable and flatter” basal. My time with lantus had its ups and downs but overall kept the morning sugar at an average of 120. Ever since I have started using Tresiba my morning sugar has never gone below 240. No matter what sugar level I end the day with, my cgm shows that the sugar at night keeps rising upto 240 around 2-3am and just stays there flat until the morning. I started off with 34 units as per instructed to keep it 1:1 with lantus. 2 weeks in I am at 44 units with the same result. Morning reading are always above 240. Is this a common thing with tresiba switch? I read about tresiba taking time to adjust but zero changes even with almost 10 units of rise from lantus doesnt seem ok to me. Let me know if someone has experienced this with the switch to tresiba.

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I’ve had T1 for 46 years, and have used NPH, Lantus, Levemir and currently Tresiba. I agree with your doctor that Tresiba is a more stable basal insulin delivery mechanism (for me), but you didn’t say why you were switching in the first place? What time(s) of day were you having instability that the Tresiba was supposed to improve? If you were well controlled with Lantus then there is no reason to change.

If Lantus was working well overnight but not during the day, you may find that two injections a day, spaced about 12 hours apart, would work better for you. I found I needed to take two injections when I was taking Lantus, and definitely also when taking NPH and Levemir. Tresiba is the only basal insulin that has worked for me with a single injection per day.

I found I need less Tresiba than I did Lantus and Levemir, so I am surprised that you seem to need more Tresiba. On the other hand, your basal per day seems rather high, so you may have some insulin resistance going on? If so, that may affect your injection schedule so I would recommend discussing the options with your doctor.

There are a lot of different basal insulins available today, and lots of ways to adjust amount and timing to match your needs, so you should reach out to get some help. Besides talking to your doctor, giving more complete information here would allow us to make better recommendations.

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There were no specific reason for the switch. Ive had some inconsistencies with Lantus during the day especially post lunch and fasting in the morning but it was not any extreme inconsistencies. Hence my doctor suggested I try out Tresiba. But ever since I have started taking Tresiba I just wake up with really high sugars and throughout the day slightest intake of carbs just push the reading upto 200+ as if my body is suddenly super sensitive to carbs and looks like some insulin resistance is going on. But before switching to Tresiba, for a couple of weeks on 34 units of lantus and minimal Humalog along with some help from a nutritionist the sugars were perfectly good with an average of 120.
I agree my basal intake is a little high (last stable was 34 units with lantus), might have to check for resistance.
I’ve read forums where people have said that it took 2-3 weeks for Tresiba to start working, but was just concerned that this high of a dose is still not showing any improvement.

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I did not have to wait any time for Tresiba to start working; I found it active even on the first day and would expect it to be fully operational after taking it for three days at most.

I would switch back to Lantus since you were having success with it. Good control with no severe highs or lows is about as good as diabetes control gets, until you get into micromanaging with sugar surfing (something I recommend but that requires a CGM and more commitment).

But you said one thing that surprised me: “34 units of lantus with minimal Humalog”. How much Humalog were and are you taking per day?

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I was taking on an avg - 2 for breakfast(either with oats or toast), 4 for lunch (with grains and simple carbs), 1 in the evening (with a fruit), 2 in the night (with complex carbs) and then a basal of 34 which worked fine and kept the avg cgm reading at 124.
Currently i have to overestimate to keep things in check. Each dosage has increased by a minimum of 2 units. Breakfast has to be 6 these days since I wake up with 240+

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That is an interesting breakdown from your time with Lantus. i.e. approximately 34 units of basal and 9 of bolus insulin. While I don’t subscribe to the 50/50% basal/bolus rule as anything other than a starting place to try and titrate your needs, I can’t help but believe that you are/were covering some of your bolus needs with basal insulin. Now if this was working great and you weren’t having lows, no problem, please ignore me. And if you switch back to Lantus you may find that you get greater control by giving half of your Lantus to yourself every 12 hours, rather than one shot per day, since in many people Lantus only lasts 22-23 hours. While you were on Lantus did you do any basal testing to see what happened when you didn’t eat?

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No I did not do any basal testing on Lantus. I did try getting close to the 50/50 rule some time back but always somehow found lacking insulin in terms of morning sugar. I had to increase the basal in the past to keep a good fasting reading. Which of course resulted in sudden lows during the day, hence I started cutting back on the bolus which kind of helped me keep things in uniform line throughout the day.

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Also one other thing that concerns me, especially with Tresiba, my sugars are pretty high at night. And somehow it keeps increasing according to my libre. The rest of the day with a little addition to my bolus keeps the readings in check. But somehow, the night time graph just keeps going up.

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The whole night, or just in the few hours before waking? It might be you never find a happy place with Tresiba, fortunately there are a number of choices now!

I don’t see any reason to stick with Tresiba. I don’t think it’s superior in any way to Lantus or Levemir for a type 1. There are certain people who it works great for, and the more choices the better. I don’t think it’s possible to get perfect basal coverage with the tools we have. All we can do is try to cover our insulin needs as best we can with the least amount of hassle, and it sounds like you were accomplishing that with Lantus.

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I’d question whether these are even related to basal coverage. I have inconsistencies every second of every day, but it has nothing to do with which basal I’m using. Stress hormones, activity level, quality of sleep, the weather, what time it is in Japan, a trillion variables affect blood sugar. That’s why looping pumps are such a big deal. I can wake up at the same time every morning to very different blood sugars, eat the same breakfast and have completely different results after, but it has nothing to do with what basal I’m using. Sometimes you might need more or less basal on a given day, but this is even less of a reason to switch to an inflexible basal like Tresiba.

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The whole night. Though based on last few days looks like Tresiba is acting a little stable at 44. But that is a huge increase in insulin from lantus. I really don’t think tresiba is that superior to lantus to consider this trade off. Might just switch back to Lantus

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Totally agree. By inconsistencies I meant inconsistent morning sugars even with the same food schedule at night. Which like you explained may not entirely point to basal. The reason for the switch was more of my endo’s idea who believes in his words ‘Tresiba is a far more stable insulin in the long run’
But unfortunately I have only experienced rise in my basal and bolus insulin intake with no real betterment in terms of stability.

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Hi Hidan123, I have been following this thread and agree with Chris about his concerns that you are covering some of your bolus needs with basal insulin especially that you mention that you are hypoglycemic in the afternoon. I am also thinking that your insulin to carb ratio may not be correct if your blood sugar is going high after eating a complex carbohydrate meal before bed. I would definitely start with basal testing by doing an 8-10 hour fast starting at 8 pm to look at your BG trend. Once you have determined the correct basal dose, it is likely that you will need to adjust your carb ratio. I tend to adhere to a 40-45% basal dose compared to your TDD of insulin.

There are a number of reasons that might be raising your blood sugar at night. First, are your taking enough of a bolus dose of insulin to cover your
meal before bedtime? What is the composition of that meal before bed? If protein and fat are part of that meal, then you may see a rise in blood sugar initially for carbs and then again 5-8 hours afterwards for the protein and fat.

Secondly, when Chris asked when you were having the rise in blood sugar overnight, he was alluding to the Dawn Phenomena when the body releases hormones (cortisol and catecholamines) causing the liver to release stored glucose and cause insulin resistance which is a normal physiologic response. A new study was published that showed eating a late meal before bedtime increases cortisol levels. I am wondering if you did not have a meal at bedtime that you would become hypoglycemic overnight given your high basal dose.

My suggestion is to do a simple basal test. Also, remember that you will not see the effect of a dosage change with Tresiba for maybe 3 days. They recommend that any dosage change not be made for 4 days. Once you have the correct basal dose, then you can determine which basal insulin is good for you.

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