@Katers87 - I commend you for sticking it out and not changing your dose for 2-3 days. Tresiba takes a good 3 days to level out, so modifying a dose sooner won’t let you dial in the dose. I did find that once I got close, 2u either way would take me from lows to highs (I use the 200mg).
I have opted for the 2u higher dose and running lower bg because I am a “low bg freak.”
Though I haven’t tried it, I have a buddy who split his dose and he says that reduced the high/low peaks.
Yeah, with the pump I have wonderful control. Flatlining all night and through the day… But yesterday I had a bad infusion set and ended up HIGH for six hours. However, for me that’s the one and only downside of pumping (and my own fault since I didn’t have a spare infusion set with me, just an insulin pen).
I also found Tresiba was strongest several hours after injection and seemed to wear off later on. I found splitting the dose helped a lot with that. I don’t understand why splitting the dose would help, nor why timing would matter, because those are supposed to be the two advantages Tresiba has over other basal insulins.
I’m not experiencing that much oscillation in my blood sugar levels (e.g. high & low peaks). They tend to be pretty flat during the day and then begin running low in the evening throughout the night (the last 2 days at least). Maybe if I have trouble with highs when I’m not running low at night then I’ll consider this. Hopefully I won’t have to 
I think the chart in this post Tresiba-how-do-I-calculate-my-daily-dose shows that there are small peaks and valleys, they’re just not as pronounced as you might experience with 1 daily dose of Lantus.
Since I’m not dropping low when I take my dose, this chart actually lines up pretty well with what I’m experiencing. My guess is that some people react differently to the insulin so the peaks or valleys might be more pronounced for them. I’m hoping that won’t happen for me , but we’ll see.
I either get a high point mid-afternoon and middle of the night (~160), or a low in those same areas (~60). I am guessing if I went to the 100mg version of Tresiba, I wouldn’t see this at all. But I’m ok with 60’s.
I second what @kmichel said. When I switched from Toujeo to Tresiba I titered for almost six weeks, a couple units at a time.
I also use the 200u/cc formulation, and, for reasons not entirely related to Tresiba, went from 76u of Toujeo to 44u of Tresiba.
That’s a big drop! I don’t know anything about Toujeo, but that’s a big change. It also looks like Toujeo is 300u/cc? Is that correct? That would make it an even bigger drop.
I wonder if I’ll end up dropping my dose a few more units.
@Katers87 The drop was more due to a drastic dietary change. I went from well over 200g carb/day down to <100g. The high Toujeo dose was causing me to eat to my basal, which is totally bass ackwards.
I did this demo with 22 units because I think that is close to what K is using. I think Jen was using a bit more, but the distro would essentially be the same.
@jen, how does this compare with what you found splitting it?
Mathematically, there is no way to get a uniform distribution of a 40 hour insulin if it is given once every 24 hours. It just doesn’t work out. Just like Lantus lasting 18 hours, it just doesn’t give you flat distro in a 24 hour time period.
If you assume Tresiba is perfectly flat, and lasts exactly 40 hours, how do the numbers look over a 24 hour period with 1 shot versus 2 (given at exactly the same time every day).
If you split the Tresiba dose in half and do it twice a day, the variance (σ2) goes from 0.0672 to 0.0168
Here is what it looks like, assuming shots either 1x day @9:00 AM, or 2x day at 9:00 am and 9:00 pm, 22 units total in each case (this would be after several days of the dosing to let it all get evened out).
If you consider 40 hours of duration, there is an 8 hour gap on once-per-day injections, and two (smaller) 4 hour gaps on twice-per-day.
I don’t think Tresiba is perfectly flat though. I think the close to flat profile comes from the combination of several day’s insulin with each dose having it’s peaks and valleys.
I’m feeling the insulin peak several hours after I’ve given my dose, but it sounds like others feel the peak much more quickly. It doesn’t seem appropriate to assume that each dose of Tresiba will be utilized by the body evenly or at the same rate/hour over the full 40 hours based on the chart Sam provided.
I think the chart is more of a conceptual illustration than an exactly correct mathematical illustration. I also think eric’s Mathematical breakdown is tending toward overthinking it…
I keep it simple… it lasts well beyond 24 hours, and you’re taking it every day, so it’s effectively never in a state of wearing off and recharging, which is the state that Lantus is in a lot lot of the time, which is reduced by taking it 2x daily— why so many people find advantage by taking Lantus 2x daily…
Can try taking tresiba 2x daily, Jen noticed an appreciable difference, which surprised me…
@Katers87 Actually, even though the concentration of the insulin is different, the amount of total insulin units being injected is the same, equivalent to 100u/cc. What’s different is the amount of fluid being injected.
Yes, the chart may be conceptual, but then it shows, conceptually, that each dose of Tresiba does not have a flat profile. The peaks may differ from person to person and may not be exactly as displayed in the chart, but the peaks do exist.
Thanks for clearing that up. I’m not familiar with these different measurements. Still a big drop though!
@Katers87 Yes, it was definitely a big, and appropriate, drop.
The different concentrations of basals like Toujeo and Tresiba is why you can’t get them in a vial, only in a pen. The FDA is kinda sensitive to the fact that most people use a u100 syringe.
Thanks for trying to graph it for us though. I appreciate it
@Katers87, I wonder if splitting might work an amazing change like it did for @Scotteric and @Jen?
I still don’t understand why it did, mind you But it did.
For me, I see two “peaks” in my daily Tresiba usage, but I am not sure if it is the 42+ hour overlap that I personally get. One drop is mid-afternoon, and one drop is about 3am-6am. Because of the stacking, everyone will have a different effect.
According to my buddy who splits his Tresiba, he takes 60% in the morning, and 40% at night. His theory is that splitting the dose adjusts his trend line enough to level him out more. I can’t argue with him, as it works for him. I just don’t see the benefit for me to try it.
Also, the length of action will be different. If I “forget” a dose, I won’t go high until about 2 am the following day - so 42-44 hours before I see a rise. A correction and a basal dose will then bring me back in line, so I have to assume there is residual Tresiba in my system longer than the 42-44 hours I often quote.
Hows the tresiba been working out for the last few days?
Eh, I forgot my dose Saturday morning and didn’t give it until 1 PM. I decided that the delay would likely mess with things a bit (though much less than it would’ve with other basal insulins), and so I’m not making any decisions based on patterns on Saturday or Sunday.
I came down with ANOTHER pretty bad cold on Sunday. This season has been the worst! I generally don’t get sick at all, but nearly everyone is sick in DC. It’s hard to not catch stuff. Blood sugars have been a little elevated, but nothing too alarming. I don’t want to increase my basal insulin yet. This cold is bad enough that it could be the reason.
I don’t have any major complaints on 22 units though. I wouldn’t be surprised if this is my final dose once I can really evaluate my blood sugar levels and feel better able to attribute any highs or incline patterns to Tresiba. I’m no longer experiencing lows on the way home from work at 5 PM. That problem was resolved with the decrease to 22 units.
Overall, I’m really liking this insulin. I think the layering of several days’ doses is a real advantage and creates smoother profiles, and it’s nice that I can just take it once a day.
