My 2c worth: the rise could have been due to chicken, not necessarily due to too low basal. For basal testing overnight, a low-carb ,high-protein, high-fat dinner is in my experience not the best choice because of delayed protein/fat-related spikes can be easily confused with any basal-related effects. If circumstances allow, I’d choose an early and small carby dinner instead, which hopefully would be all gone with bg back to range before going to sleep. In any case, wish you best luck and success with the Tresiba experiment.
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I actually think my basal overnight—at least the latter half—is too high rather than too low. Out of the seven nights of Tresiba I’ve had so far, I’ve dropped during that latter half of the night without a bolus for four of them. The other three nights I’ve fallen slightly then stayed pretty flat.
It’s during the day that I tend to run high (five of the seven days so far, the other two days were running low).
I agree with you that some of the overnight rise could be from protein. On the pump I’d sometimes try an extended bolus for three or four hours to help deal with that, which I’m obviously not doing with MDI. I eat low-carb because carbs spike me to a ridiculous degree, and so the nights I’ve eaten carbs I’ve ended up with insulin on board at bedtime from correcting, which screws up the overnight stuff. And the carbs thing is not from a too-low carb ratio…I can use a 1:4 ratio and still spike to 15-20 mmol/L, even though my usual ratio for lower-carb meals is 1:8 - 1:14 and results in little to no spiking. So, I’ve found low-carb eating gives me far, far better control than eating carbs in the past few years.
I figure that changing from pump to MDI is a big change, and if I change up my diet to a high-carb diet and rework all my ratios so they’re really high like 1:2 or whatever I need to stop carb spikes, that’s just going to make things more complicated and I think I’d have less of an idea of what dose might truly work for me.
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I was not suggesting any kind of high-carb diet or any diet change at all. Just skip a dinner or have a small carb bite for the purposes of testing how basal works overnight - that’s all.
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I’ve been talking metformin for about five years and started Tresiba about four months ago. I noticed no difference in the way metformin behaved with Lantus, Toujeo or Tresiba. All I noticed really was that my Bg never went over 300 anymore.
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I haven’t had that effect. Just that my DP has disappeared and (at least when I was pumping) I was using a lower basal rate.
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I know I’ve only been using it for 3 days, but still waking up with DP. The problem is this makes sense if it is working exactly as intended, since a) it is supposed to be a perfectly flat 24-hour basal (but not some insulin with magical properties) and b) DP is real! I’ll keep trying but I don’t see how this can be a long-term solution or a step forward from pumping. It’s backing up my theory that people who do best with it have residual insulin production that compensates for when they need more basal.
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For what it’s worth, I definitely do not have residual insulin production, and I do well with it, but I added metformin to the mix, which took care of my dawn phenomenon beautifully (and lowered my TDD). I don’t know that it would work for me without metformin—probably not.
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So I flatlined last night…at <3.0 mmol/L. For seven hours.
The two times I tested I was 2.3 mmol/L and, several hours (and glucose tablets) later 2.9 mmol/L.
I’m wondering if I screwed up by forgetting Tresiba one night and instead taking it at 5:00 AM the next morning, and then taking my normal dose at 11:00 PM last night. I didn’t think that mattered, though, but maybe it did since I basically took two doses within the same waking hours period.
Otherwise, I think this might be the massive drop I was worried about, where my basal rates and ratios drop by 25-50% over a 24 hour period. I was running borderline high all day yesterday, but it really wasn’t bad considering the high-carb junk I was eating.
It’s too bad I already took 36 units. Otherwise this might be a time I’d jump back to 30 units or even more (on the pump I was taking 22-25 units).
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I’m sure the dose timing was a factor… how much of a factor is unfortunately impossible to know
But doesn’t it say on the product packaging (and I’m sure I’ve seen you say in other posts) that if you forget a dose you can just take it as soon as you remember? My dose was about seven hours late. I was under the impression that as long as doses were spaced eight hours apart (mine were spaced 31 and 16 hours apart, respectively) it didn’t matter that much.
I’m much more inclined to believe this is “the drop” I’ve been wondering how I’d handle, especially given the timing (I’ve been saying one to two weeks since my first post…which was eight days ago).
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For what it’s worth, I do not find Tresiba to have nearly the level of dose flexibility advertised. I think of it as ideally taken +/- 4 hours from 24 hours from your last dose. If you have to deviate further, you can, and it probably won’t be terrible, but at some point you will see effects. For example, if I was supposed to take it right before bed and forgot, and woke up 7-8 hours later, I’d like realize it because my blood sugar would be slowly creeping up (but not as bad as if I’d made the same error with Lantus).
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Yeah the package does say that… I’ve never skipped an entire dose until the next day… And it’s timing is super flexible, but I’d still wonder-/logically when you do this and get a different result it makes me think there must be some effect
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Thanks for that information. I debated skipping the dose, but I was afraid then I’d go high. But I was remembering multiple threads I’d read on TuD where people had forgotten Tresiba doses and had just taken the dose when remembered and then the next scheduled dose with no reprecussions.
I’d agree, except I’ve been saying for the past week that I’m expecting a huge drop to occur within the next week or two, and the timing fits perfectly for that. Maybe it’s a combination of both. I’ve also been running low overnight for the past several days, so maybe it’s also that that’s just gotten much worse.
I’ll see what happens today and I’m tempted to just take the same 36 units and seeing if I run low all day today and all day tomorrow before adjusting. But I’ll admit, I’m getting burned out from running high and low constantly, and the thought of running low for another two days is not appealing. I haven’t had more than a few hours of staying in range over the past week. So at this point I’m a little unsure of what my body even wants with regards to the dose.
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This is exactly what I did. Excpet when I woke up seven hours later, my BG was fallling (and had been falling for the past few hours) rather than rising. So the insulin still seemed to be active and effective even though the dose ws seven hours late. If I forgot Lantus, I’d wake up at 14-20 mmol/L in the middle of the night (almost as bad as a pump being disconnected).
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So it is definitely still in my system and working 8 hours after when I “should” have taken my shot, but it seems to not be at full force. I wonder if that will be the same for you when you get to a stable dose (could be that it’s still driving you low bc it’s too much altogether), or you may have better flexibility with it (certainly YDMV is a theme here!). It’s absolutely more flexible than Lantus, which is great. When I do delay a dose significantly, my strategy is to then shift my dose time, so that say I’m usually aiming for about 10p-12a, and instead I take it at 8a, then I will not go back to 10p-12a, but instead do my next shot around 11am say the next day maybe, and if I want to get it back to the evening, keep moving it up by a few hours until it comes back around to where I want it. Part of why I find my timesulin cap essential!
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Not exactly related to Tresiba, but something that can be useful for a lot of different basals. You can put your pen needles in a pill container with the days-of-the-week on it and that can help you remember to take it. Just get one big enough for the needles to fit.
They also make some pill containers with alarms! This would probably work well for you. Looks like the needles would fit in here.
And of course the timesulin cap cardamom suggested could help.
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Wow! I didn’t know these timesulin caps existed. This is awesome. I need to figure out how to get one.
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I got mine on Amazon—was much cheaper at the time than the retail price, but someone mentioned the price may have gone up to the full amount since.
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Nice. They’re not too expensive on amazon either.
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Thanks for the suggestions for remembering. I don’t think I would typically forget…it was just Christmas evening after dinner, and I was sequestered away from my family because my allergies were bothering me so much (we had two dogs there), and just fell asleep by accident. But I’ll keep them in mind if I do find myself forgetting. 
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