Dose once or two times a day with tresiba?


#21

I now suspect it’s a little bit of both as there’s certainly a rise in the early morning that sometimes lasts until almost noon. It’s not consistent though and it seems that eating before bedtime makes it worse.

It seems that going to bed really low is the only way to fix this almost. I really don’t want to increase my night dose but I almost wonder if I can just split current dose differently so I end up taking more at night but less in the morning? I might just try that and see if it makes a difference. Tresiba has such a slow absorption rate and it makes making any adjustments quite difficult.

Thanks for all your help, @jack16! It’s very kind of you to try and figure this out with me. :slight_smile:


#22

Have you been splitting Tresiba since this earlier post? Wondering how it is going for you. My son has split his Tresiba dose. No problems. Wondering if it will get in the way of rebound from heavy exercise as it “sits and hovers” in the body.


#23

At my last endo appointment in September she berated me for being silly and splitting my dose. She asked that I not split my dose and just take it once at night. So fare it has worked out fine.


#24

This is ridiculous. The thought of splitting a 48 hour lasting basal insulin is just nuts, that’s just grounds for an overlapping messing…and, frankly you don’t know what you’re doing. For a type 1 to follow Dr. Bernstein is also ridiculous.

And, BTW…if you talk to any good endocrinologist, or take the time to actually read the TRUE studies of 1 to 2 dose basal shots, there are NO benefits…no greater numbers splitting lantus or levemir, period…the data shows the only difference in splitting vs. 1 dose is one may have to take a bit more on basal on split dose and less bolus on single dose or vice versa. Google and read the actual CLINICAL TRIALS! the concept of splitting up basal on MDI is primary for those whom take LARGE quantities of Levemir - Lantus, TYPE 2 DIABETICS because the insulin in huge doses, which they take b/c they’re overweight and resistant to it, unlike most true type 1’s, sits in a ‘bubble’ underneath the skin because THEY HAVE TO TAKE SO MUCH.

Also, flat basal insulins can’t cover DP, it’s flat, this is a surge of hormones (cortisol, adrenaline, liver dumps, etc…). That’s why people go on pumps, to attack the DP in the AM, which for most is when they actually wake up…so, increasing a night time basal shot does nothing.

I’m really taken aback by some of the suggestions on here. It’s shocking. Also, Type 2’s should NOT be giving any advice about insulin, management or anything else to type 1 diabetics. We have an autoimmune disease, our pancreas DOES NOT WORK. SMH! You type 2’s got something way different going on and it’s ridiculous too how you suggest they’re even close to the same thing…THEY ARE NOT! Again, ask any endocrinologist.


#25

waking to 120 is not high…


#26

Once a day, before starting back on pump.


#27

About 1% of our pancreas doesn’t work. The other 99% works just fine.

I had a huge benefit to splitting Lantus more than ten years ago at the suggestion of my endocrinologist. To the point that at the next appointment he went, “I can’t believe these are your numbers!” because they were so much better. And ditto to splitting Tresiba (though I ended up going back to my pump).

I think you may have this mixed up. From what I have read, those who take large doses probably won’t have to split their dose, but those who take small doses are more likely to need to split as the dose wears off faster.

I’m a “true Type 1” (diagnosed suddenly as a child in DKA) and am overweight. Recent research shows that about half of people with Type 1 are overweight. People with Type 1 certainly can and do develop insulin resistance. Many people with Type 2 are not overweight at all. Some with Type 2 have their pancreas “burn out” so that they produce little or no insulin and need insulin to avoid DKA, just like those of us with Type 1. The line between the two is often more blurred than many believe.


#28

I have to disagree with everything you say here. Levemir is not a flat basal, it has a curve and, while the peak is not as strong as say NPH, it can be timed to mitigate DP for many people. For most type 1s it will not last 24 hours at a reasonable dose, and the other advantage of splitting is that it can be adjusted every 12 hours more like a pump. I could care less what clinical trials have found, many of them deal with differences between people who have A1Cs in the high 7s, 8s and 9s. I’m certain someone with an A1C in the 8s won’t find a huge difference just by splitting basal and that’s what these trials focus on. Lastly this is a disease that is treated through trial and error and unique for everyone. If you dose according to clinical trials and pharmaceutical literature you shouldn’t expect great results.


#29

Hum, I don’t know where you’re getting this 1% from. The pancreas has two main functions: an exocrine function that helps in digestion and an endocrine function that regulates blood sugar. T1’s don’t make amylin or insulin, cells within islet are destroyed. I have no clue how much of pancreas has any function at all, I didn’t give a percentage…nor do you know.


#30

maybe for some, YMMV. As I said, if you actually READ the clinical trials of splitting vs. one dose levemir, there is no significant advantage; one whom takes small doses of basal (myself), splitting a dose creates possible stacking, then ones just taking smaller doses to try and achieve the same thing. Often, when we switch different insulins, basals…our patterns will remain the same, our bodies have patterns, too…it’s not always the basal, thus the pump.


#31

Yes, YMMV, but splitting Levemir is the norm. It is heavily dose dependent and you would need to take a significant amount for it to work effectively for 24 hours. Again, clinical trials don’t matter. There are clinical trials saying there is no difference between using analogues and human insulin to treat diabetes - and I’m sure for people with an A1C of 8 or 9, it doesn’t make much of a difference.


#32

A simply basal rate check will show if the levemir is lasting 24hrs. some find splitting is better. Mysugr basal rate test is ok and will give accurate results.

In general they find splitting has better A1c

http://www.dafne.uk.com/uploads/223/documents/PU04.009,%20Version%201%20-%20September%202013%20-%20Insulin%20statement.pdf


#33

Your posts come across as outright belligerent. If you’d like to adjust your tone and have a reasonable conversation instead of just barking at everyone that they have no idea what they’re talking about—- people might be far more likely to be willing to listen to and exchange with you.


#34

So, I was trying to figure this out with a brand new diabetic here: BS dropping after eating during the day

Sorta just for the purpouse of discussing how stuff works. Its NOT a flatline activity curve for 48 hours. Thats not true. Its flatline for around 12 hours, then tapers off. Personally, I find this activity curve pretty confusing and difficult to work with…



#35

Really? I wonder how you know what I know and what I don’t know when we are strangers on the internet?

I learned that islets (where beta cells and other endocrine cells are located) make up about 1-2% of the pancreas when I took a basic anatomy and physiology course during my undergraduate degree. Within our islets, beta cells do not work, but all other endocrine cell types do work. This is not obscure information, and likely it would be in any basic anatomy and physiology textbook or could be verified with a single Google search.


#36

That’s the whole point though is that when it’s overlapped every day it becomes perfectly flat for all practical purposes… with minimal peaks and troughs. There is effectively no “curve” to work with… this picture illustrates its profile well when used daily.

This allows for an essential state of equilibrium, whereas meds like Lantus are constantly wearing off and recharging even if taken 2x daily…

Tresiba is truly a breakthrough to me.


#37

Following this thread as I have been considering splitting my dose. I was having reactive lows when taking 15u once per day of tresiba. I had worked up to 22u since diagnosis. Now I Am down to 5u once per day and running GREAT in the afternoons but high overnight.

I was wondering if splitting may help as it seems I need more insulin at night than the day, probably to the nature of my highly active day job.


#38

Lantus and Levemir are well known to not last for 24 hours, especially at smaller doses, which are what type 1 diabetics typically use. They last less (Lantus about 20 hours, Levemir less), resulting in a lack of basal for a few hours during the day. So, splitting them does make sense. In fact, this is marketed as one benefit of Toujeo over Lantus (even though both are the same insulin glargine) - Toujeo does last for 24 hours. Splitting Toujeo or Tresiba doesn’t make much sense to me though.


#39

I had more success splitting Tresiba than taking it in one dose when I tried, but there was overlap which caused very bad hypos approx. 9 hours after injection. You can try it, but I’d also recommend trying Levemir if it doesn’t work well for you, which lasts 10-14 hours at smaller doses and so is more conducive to splitting without overlap.


#40

I don’t think it works uniformly for everyone as advertised. At least when I tried Tresiba, it was way too strong in the first 6-8 hours after injection, but if I lowered the dose enough so it wasn’t driving me low for hours it wouldn’t last more than approx. 16-18 hours (so no better than 1 dose of Levemir, really). Splitting it made sense to fix this, but the problem is the overlap since it still does last longer than Levemir. Like everything, it’s probably magic for some people and a nightmare for others.