Switching from Levemir to Tresiba

Type 1 & LADA
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Hi All - I’m a 37 yo woman, recently diagnosed (six months ago) as Type 1, suspected LADA. I’ve been using Levemir as my long acting insulin since my diagnosis, and decided it was time to give Tresiba a try. Hoping to document my personal experience with the transition here in case it will be helpful for others.

My BG at diagnosis was 325 and my A1C was 14%, I’m now down to a 6.0% A1C and try to stay between 70-160 mg/dl. I use a Dexcom G6 and MDI with Humalog as my short acting insulin. I flex my Levemir dose between 6-8U once a day at night (usually around 9pm) depending on my menstrual cycle and activity levels. Humalog is usually 1:20 carb ratio in the morning and 1:15 for lunch and dinner, which I suspect is due to the Levemir not lasting the full 24 hours. I typically eat breakfast at 8am, lunch at noon, and dinner between 6-7pm. I generally don’t snack between meals to avoid extra injections.

The past week I’ve been injecting 7U nightly of Levemir. Last night I took my first dose of Tresiba, 6U at 9pm. I ate about 30 g of carbs with dinner, but it was a high fat, high protein meal, so I took 5U of Humalog at 6:50pm, a few minutes before eating. At 9pm my BG was at 115, and was around that level until I fell asleep. I woke up very dehydrated, needing to urinate around 3am to a BG of 140. Based on my symptoms in the middle of the night, I was surprised that my BG was not higher. I took 0.5U of humalog as a correction dose then went back to sleep. This morning I woke up at 115, went for a run fasted at 7am, and then saw my post workout BG creep up to 148. I took 1U of Humalog at 8am as a correction dose. Currently hanging out at 130.

Given my higher sugars today, I’m not very hungry this morning, so planning to skip breakfast.

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@Marblejane First, welcome to the outfit. I hope you find the folks here as helpful as I have! Second, like you, I’m relatively new to T1, diag’d Nov last year (misdiag’d as T2 8 years ago), so I may not have the best answer, but am sure others will advise. My comment is it may be best to keep to whatever your “schedule” or “norm” would be vice skipping a meal. My rationale is there are enough factors to consider with T1 without adding to the list. But that given, whatever works for you! I’d appreciate knowing how the transition to Tresiba goes and the impacts to your BGs. My Lantus seems to wear thin in the evening and I understand Tresiba lasts a bit long (discussing with my Endo later this week).

Again, welcome to the group!

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Hi @Marblejane. Welcome to FUD!

It takes a few days to get Tresiba titrated up. What you are used to - being able to change your amounts - with Tresiba the longer-lasting profile means that everything takes days for it to be brought up or down.

So you will have to stick with an amount for a few days to know if you need more or less.

And if you were taking only 6-8 units of Levemir in a day, then it was definitely NOT lasting 24 hours.

Convert your weight to kilograms, and this is the way of figuring out how long Levemir was lasting. What I like about Levemir is that it’s easy to adjust for different days, and for different amounts during different times of day. Tresiba is basically the same amount every day, every hour. So it depends what you are looking for.

Levemir dosage (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
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Interesting! I was at just above 0.1 U/kg. However, in my personal experience, my Levemir seemed to last much longer than 6 hours. But it’s tough to say - I’m taking so little insulin, my doctor thinks that I still have some pancreatic function.

The last few days have been rough. I have taken 6U of Tresiba every night since Sunday.

Monday, I did skip breakfast, and ate a bigger than normal and slightly earlier lunch. I covered with my usual ratio and all was fine.

Unfortunately, I ate some take out pad see ew for dinner, and covered with my normal dose (5U of humalog, which is the most that I usually take at one time). I had the biggest blood sugar spike since starting insulin about 2 hours later. I noticed my sugar climbing around 8:30pm. I took the 6U of tresiba at 9pm, and then at 9:45pm, I took a correction unit of Humalog. I was at 225 then, and 45 minutes later, I was up to 292. I took another 1.5U at 10:30pm. I tried to stay awake a little longer to see if my sugar would go down, but finally went to sleep. I woke up at 3am at 180, and took another correction unit. Guess what happened then?

I got a low blood sugar alarm at 4:45am, and ate a granola bar with 20 g carb. It’s now Tuesday morning, yay no sleep. I ate my normal breakfast and took my normal dose with it. I had a bigger than normal sugar spike after lunch, so I dosed my dinner (homemade tacos) higher than normal…and got low after dinner. Ate some skittles and bottomed out at 57 before bouncing back.

Today was better, having finally gotten a good night’s sleep. I woke up a bit higher than I like, around 120. Normal breakfast tacos (20g carb) and normal dose of 1U plus a correction 0.5U. Lunch was fine. Dinner, I bolused for the chili (2U) and a few bites of dessert (bread pudding, another 2U) all upfront, about 15 minutes before I started eating. Spiked to 175 and then dropped suddenly down to 105 (this was planned, it was dessert time).

Before I wrote all of this out, I had convinced myself that I needed to increase my Tresiba dose to 7U tonight. But after writing everything out, I think I just had some extra evil takeout that screwed me up for a few days. Going to stick to 6U again tonight and see how it goes.

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