FUDiabetes

Tresiba night time lows daytime highs? Go back to Lantus?

Hi all,

Looking for some guidance been on Tresiba for about a year coming from Lantus where I was on that for about 12.

Recently we reduced my Tresiba dose to 18 units from 20 due to night time lows.

I was running low almost every morning unless I didn’t work out the night before. I would be going to bed at 180-200 and still would go low.

If I didn’t go the gym the lows didn’t happen as often but still did.

During the day with the 20 I was pretty good.

Now on the 18 the night time lows better but I am running high 12pm and later.

Is my option to just take Novolog to combat the daytime peaks?

I don’t remember having this much issue with Lantus but I am also using the Freestyle Libre so I have never tested this often before.

Any recommendations on staying at 20 and somehow preventing nightime lows? From everything I looked up Tresiba is hit or miss with people.

Hi airtas, welcome to the site.

I think a better option would be Levemir. It is a basal insulin like Lantus or Tresiba, but it has a shorter lifespan when you take it in small dose.

Since you are only having a problem during the day, if you took Levemir in the morning, and you were using doses in the range of 0.2 to 0.4 units per kilogram of body weight, it would be gone in about 12-14 hours. So for example if you took it at 8am it would be totally gone for the nighttime.

Convert your weight to kilograms and figure out what amount of Levemir puts you in the 0.2 to 0.4 units per kilogram range. If you can land in that range with Levemir, using both Tresiba and Levemir might work for you and fix your daytime highs without screwing you up at night.

Feel free to ask questions, and again, welcome to the site.

Thanks Eric,

Why not replace Tresiba with Levemir all together?

Nevermind, I guess Levemir is more around a 12 hr insulin.

You can do that. Some people use Levemir totally for their basal needs. You can do it in two doses if you want, morning and nighttime. Some people even do it with 3 doses.

I use it sometimes. I like the fact that is is very predictable, and you can adjust with different daytime and nighttime amounts. And also if you are exercising very heavily one day you can cut back on it. Or increase it when you are less active. There are a lot of advantages to it.

The only downside is that you need to take it multiple times a day, and you have to stick closely with the schedule.

If you get into a higher dose amount, it lasts longer than 12 hours. So it really depends on how much you are taking! But it is extremely predictable, which I think is great.

Here is a link that gives some info on the duration based on the dose amount:

I am on day 4 of the lower dose of Tresiba and I spiked 80 points from 12-3 pm and my correction factor didn’t do much.

I know the steady state is around 5 days but do we think it is safe to atleast move up to 19 units or should I wait for the 5th day?

Can also experiment when taking the dose different times of day or 1/2 dose 2x daily… some people have reported good results with this…

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If you were successful with Lantus in the past, why not go back to what you know? Tresiba is only a ruse to keep Lantus like products on patent protection (my opinion). If you had a tried and true that worked for you then why reinvent the wheel just because a Tresiba salesman got your DR to hawk his wares on you?

Hi @airtas! Welcome to the site!

I found that I was having problems with high blood sugars in the morning after about a month on Tresiba. I split my dose (half AM & half PM), and that really, really helped. I’d recommend trying that before switching insulins. If that doesn’t work, then Levemir is a good idea.

I really like how Tresiba lasts for so long though because it’s not an emergency if I forget a shot (especially on the split dose). I like that extra security.

@Eric has a few wiki articles about loading up on carbs after intense workouts. I don’t know as much about this, but he’s mentioned in the past that you can avoid lows after workouts if you replenish your glycogen stores. This may be another way to address this problem.

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Tresiba is a completely different formulation than Lantus. Are you thinking of toujeo? Toujeo, like Lantus, is insulin glargine but in u300 concentration, and it appeared on the market suspiciously around the same time lantus’ patent expired. Tresiba on the other hand is a totally new formulation and works quite differently…

Lantus; glargine insulin is also now available in a generic called basaglar and therefore many insurers are dropping coverage for brand name Lantus, favoring the generic version or other formations for which there is no generic instead.

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did you literally split your daily dose in half 12 hours apart?

Basically, but not exactly 12 hours apart. I take one dose around 8 am and one dose around 4 pm. Those are the times that work well for me.

I think the real advantage is spacing out the small peaks and valleys of Tresiba. By dosing at two times of the day, these will be less pronounced than with just 1 dose per day.

You could also try changing the time of day that you dose. If you’re dosing in the evening, that may be contributing to you dropping low at night because I’ve read thatTresiba is supposed to peak around 9 hours after you dose. I’m sure the peak time is a little different from person to person though. If you’re dosing in the morning, this may not help.

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if I am getting a drop 5 hours after a bolus I am assuming it is a Basal issue? Also does injection site play a role with Tresiba?

I too had difficulties with Triseba and morning lows. It was a real battle to manage because if I took to much in the morning I’d go low the next moring. But if I didn’t take enough I’d be battling highs all day. I could not find a sweet spot between 20 and 24 units. So I switched to Toujeo. For me, that made all the difference in the world. Toujeo is far more reliable and seems to balance out nicely with my Novalog.

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How would this work? I’m trying to envision how this would work. Tresiba supposedly lasts 24 hours. So if someone were to split their 25 units Tresiba unequally, say 15/10 in morning and nighttime, then during the daytime they would have a higher basal rate?

It helped for a bit, but I think some of that might have just been due to my monthly cycle or other variables.

I use Lantus now.

I know who have been over it several times but can you describe again for me the methods in which you are using the Lantus that you feel are equal or superior to using tresiba one times per day…

That’s a sincere question I am looking at potential insurance changes and just want to get a refresher

I used lantus for about 15 years, usually snacking every 6 hours. I injected every 12 hours, but was High all day or low every 6…it felt very similar to nph, however, tresiba works for me. It took about a month before I decided on a constant tresiba dose, but it was worth it. If my insurance stops covering it one day, I’ll be sad, but 2 lantus or levemir shots a day is still better than a pump or a shot every hour. At least for me…I love Cgms, but can’t stand pumps

I think it just depends on your basal patterns and how quickly Tresiba starts working and tapers off for you. Maybe Tresiba has a flat basal profile, but I certainly don’t. I now take Lantus at 9 AM and 4 PM with the latter dose generally being equal to or one unit lower than than former, depending on my monthly cycle.

I need more basal in the evening and less in the morning. I also need to be able to vary my dose during my monthly cycle and when I exercise for a prolonged period of time. Tresiba took a long time to kick in for me. Dose changes weren’t apparent for 12-24 hours- I don’t remember exact timing now, but I’m sure it’s in my prior posts.

It also seemed like I was resistant to insulin in the evening in a way I wasn’t with Lantus, and I kept gaining weight despite lifestyle changes. Much of which I’ve lost since switching to Lantus.

Everyone is different. It’s nice that there are so many options out there.

I agree that dose changes took or takes forever with tresiba…which was why it took a month for me to decide on a dose…my work is pretty active (5-7 miles per shift according to my watch), so occasionally I’ll have to take more fast acting on my days off, but I prefer that to playing with the tresiba dose…I also enjoy 1 shot of basal…2 shots per day can be annoying…I do feel bad for people without access to tresiba. My current insurance covers levemir, tresiba, or basaglar… but if i was stuck with basaglar, I’d be sad

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