Adjusting Tresiba Dosage

I’m in the process of trying to figure out the BEST tresiba dosage for me. I had been taking 18 units daily and found I was having lows early in the morning and at bedtime. I decreased to 16 units and now am finding that I am running high from about 10:00 a.m. to early evening (without eating carbs), so no need to question bolus insulin for meals. I’ve even run high in the middle of the night/early morning. I am not eating carbs because I am trying to get an accurate basal rate before tackling my carb to insulin ratio (baby steps).

My question…has anyone tried one dosage one day (ex 16 units) and then a higher dosage the next day (18 units) to even/balance sugars out? I know the obvious solution may be to take 17 units a day but my pen comes in even dosages. After spending loads of money to transition off of pump to MDI, I would like to avoid getting the pen that gives odd dosages, afraid that won’t solve my issue.

Any suggestions would be helpful.

You may never find a precise dose which fits. In truth, many of us deal with needing more insulin overnight. Since Tresiba is so flat and lasts 42 hours you can be caught in a no win situation. Enough insulin to deal with your worst part of the day and you go low at other times. And then if you adjust to your lowest basal needs then you end up high at times. My suggestion is to choose a basal setting which keeps you safe overnight as you will be asleep and not really in a good place to treat. Then you can deal with highs or lows during the day.

Also, from what you describe you have the Tresiba U-200 pen. Ask your doctor to revise your prescription to U-100 and then you can take 17 units. In the meantime it would be a reasonable approach to alternate 16 and 18 units per day. It will give an approximation to 17 units a day. But also understand that you may never find that Tresiba is able to match your needed basal profile like a pump.

ps. I use Tresiba and actually find that it keeps me quite flat and does better for my overnight readings than any other basal insulin I have tried.
In the meantime


I have the same situation with Tresiba. 2 units either way changes from the lows in the morning & bedtime, to highs all day. I opted for the higher dosage, and eating a few carbs, rather than taking correction doses for the highs, as I stay flat at night. But that is MY treatment choice - I don’t recommend it for everyone.

Changing a dose on Tresiba should take 2-3 days. Seeing a change in a single day’s dose may well be because of changes in your body, exercise, or whatever. This is because of the long duration of action of the drug.

As Brian said, the U-100 pen might be a more comfortable choice for you.

This is the same thought I had. @Karla52, did you wait 2-3 days after a dose change to judge its performance?

When I used Tresiba for three months last year, I ran into a similar experience. I could not find a dose that would control my overnight glucose well yet not lead to late afternoon lows. I have a prominent dawn phenomenom need in the early morning hours.

When I combined Tresiba with a pump (the “untethered” regimen) I was able to stabilize my blood glucose around the clock. But that’s more trouble than most people are willing to put up with unless they swim every day and/or want to disconnect the pump for an hour or two at a time.

Yes, @Terry4. I find that if I do not wait until the 3rd day to judge a change in dose, nothing is truly stable. I usually wait 4 or 5 days to really judge performance. I have gone a full 48 hours without an injection of Tresiba, with little impact, so I know it lasts in the system that 42 +/- hours they claim.

I have that same predominant dawn phenomenon, and a second “dawn phenomenon” in the afternoon.

I actually tried your “untethered pump” regimen. It worked well, but yes… too much trouble for me. I like simple :wink:

What time of the day do you guys find is the best time to take Tresiba? AM PM ?

I find it makes no difference at all. In fact, if I’ve forgotten an evening dose and do it in the morning instead, I have about the same basal experience. This is clearly the value of a basal that has such a long and flat activity curve.

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I agree with @truenorth on this one.

When I fly to Moscow, I have already taken my daily morning dose. I take my next one “tomorrow morning” in Moscow (so about 12 hours later). Coming back, same deal, except I am getting my dose about 36 hours later.

It flexibility is what I really like about Tresiba.