Thats a nice picture, @Sam19 . Super helpful. Thanks.
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I sense a lot of hostility in your responses here and it truly puzzles me.
Just to be clear, let me rephrase this; âFOR ME, waking up with 120 IS too high.â
I aim for non-diabetic numbers as non-diabetics do not develop complications. There are now studies that show that an A1c greater than 5.4, even in non-diabetic population, is a predictor of cardiovascular diseases. Hereâs one study.
I choose to not take any risks, especially being T1 for 33 years, I want to minimize any damage possible so I choose to be very tightly controlled and have an A1c below 5%. I feel great and my life quality has improved tremendously as as result. I was even able to reverse some previous complications. I do take relatively small amounts of insulin, and splitting Tresiba has helped me (after lots of trial and error with one dose then split but taken at different times) I was finally able to overcome dawn phenomenon.
I find your criticism very odd, @Sarah97 and unnecessary. I found something that works for me and Iâm here to share my experience. I did not ask for your opinion about it. This is an open forum and everyone chooses different ways to handle their diabetes, I was only sharing mine.
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This.
Iâve had great success with MDI, but dawn phenom is probably the biggest reason I still consider getting a pump. I have long thought Tresiba dosing did not need splitting or really have much concern about timing, but this makes me think about that again. Is the reason for your split success due to low overall insulin need, specific timing, or some combination of those with other factors ⌠?
I guess I canât just separate this one method I use (splitting Tresiba) from everything else I implement in order to tightly control my T1. This month I celebrate my diaversary of 33 years and I have no beta cell function of my own (though I suspect my alpha cells still function somewhat). I eat very low carb (under 30 grams a day), exercise regularly and follow Dr Bernsteinâs recommendations in his book Diabetes Solution overall and doing all of this has helped me get a much better handle of my control over time. I have many âtips and tricksâ in my arsenal, like not eating 5 hours before bedtime and limiting protein for dinner, but they all go hand-in-hand with eating the way I do and following Dr Bernsteinâs regimen.
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no, taking more levemir doesnât make it last longer, it lasts as long as it lasts. Say you take 1 tylenol, it lasts 6 hours, if you take 2 tylenol, it still only lasts 6 hours, take more does not make it last longer. Also, the reason MOST people need to split their dose isâŚwith large doses, typically type 2âs who need a lot of insulin, it pools underneath the skin a big pocket of insulin and does not all get absorbed, thats typically why doses are split it works better. the whole concept of spliting a normal basal smaller dose makes no senseâŚsay you take 6 units, that keeps you flat overnight but letâs say doesnât last long enough, how does splitting that 6 into 3u am + 3uPM even workâŚyouâre getting less insulin, they certain donât just stop at exactly 12 hour increments.
Thatâs not at all how it works. Its duration is dose-dependent. All insulin though, even Regular insulin and rapid-acting insulins will last longer at higher doses. If 6 units kept me flat overnight but didnât last long enough, I wouldnât split it into 3 and 3. Iâd take 6 and probably take another 6 or whatever I needed in the morning as well. It doesnât have to be an even split, the beauty of Levemir is you can take more during the day and less at night or vice-versa to meet your basal needs. The UK NHS recommendations are for Levemir to be taken twice/day. I can tell you through personal experience that one dose will not last past 15-16 hours for me, unless I took enough of it that I would be extremely hypo all day and night. Iâm not sure what your opposition to this is, it is well-established that Levemirâs duration is dose-dependent and that splitting it makes sense for most type 1s.
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Incorrect. This graph shows how the duration and peak of levemir increases with an increased dose.
Hilarious, what an audacious response! Seriously who are you to tell anyone how to speak or what to say. SMH!
ah, well then, every time one increased their levemir dosesâŚyouâre saying theyâre basal lasts longerâŚhow does that make sense.
*their
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Tresiba claims to last as long as 36 hours and unlike lantus and levemir, it pretty much stays flat for at least 24 hours. It took me about 2 or 3 weeks to finally decide on the correct dose when I switched over, but I prefer it, and for me it seems to last 24 hours. I always dosed twice a day with lantus and levemir, however I never tried the generic ish basaglar⌠I also usually had lows every 6 hours on both basal insulins, and just snacked every 6 hours until tresiba. drs usually recommend changing the dose every 3-4 days. Which is why it usually takes a little while to figure out the dosing, but at least for me, it was worth itâŚCgms help also
Me too, had exact same problem and Dexcom CGM alarm was driving me nuts every night starting at 2 AM. I slowly weaned myself off of Lantus/Levemir over a few week period and only use fast acting Humalog around meal times or to correct an impending high⌠Problem solved which also solved my dawn phenomenon. Endo just scratches her head but works for me and proof is in the clarity reports which keeps everyone happy.
C peptide test sounds needed or would probably helpâŚ
How will a C peptide test help adjust size or frequency of dose?
I suspect you might still have some insulin production, which is why you donât need a basal, unless you are shooting up every hour or so, or eating the 1919 type 1 diabetic dietâŚthe c peptide test simply tells you if you are making any insulin, and if so, how much⌠I wasnât tested for 20 yearsâŚmy Dr was surprised it was a negative number, but she said it wasnât the first time she saw it⌠at the time I was taking too much levemir, and was consistently dropping every 6 hours
You are right. I do make some insulin. I eat, dose and exercise to my CGM and am MDI so yes, I do shoot up frequently during the day and I am pretty much OMAD and eat very low carb. My treatment has been at Joslin for the past several decades and they are not yet able to Type my diabetes as my tests, profiles etc do not come near to matching Type 1,2 LADA, MODY etc. A few years back they had me do C-Peptide to prove that I was Type 1 as my 1:3 I:C and other characteristics made me look like a T1 but C-Peptide put me out of T1 range so did a battery of other tests just getting them more and more confused. After T1 fiasco they knew that I was MODY because that was the only other type I matched but they could not order the test and have insurance cover it because there are no other diabetics in my family from grand parents to grand children. I was looking for closure so I agreed to pay for the complete MODY exam and review of all relevant markers and they all came back negative for MODY. Until Dexcom, they insisted I keep my A1C between 6-6.1. After going on Dexcom and showing 30 days TIR 100% they allowed me to drop my A1C to 5.6. 30 years and no answers except that I can keep under control on fast acting Humalog.
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For Tresiba users: Once a pen is opened and in use, how long do you use it? Tresiba sheet says good for 8 weeks. My endo says 4 weeks. My experience is about 5-6 weeks before it starts losing strength. Confusing!
Thank you!
Your experience is really what counts. I donât use Tresiba but on the insulins I use or have used including Humalog, Lantus, Levemir, etc. I get several weeks longer than manufacturer says it is good for. A lot depends on the temperature and humidity where you live, if the pen has had some direct sunlight, especially in the car as well as how well it was refrigerated by your pharmacy before you got it. There are a lot of variables with all insulin, patients, and handling during the chain of custody from the manufacturer so really what works for you time wise, may not work for others.
I suspect your doc might just be citing 4 weeks as thatâs kind of the standard for most other insulin pens so it might just be memory based⌠Iâve never used little enough for it to be an issue, but I suspect for fda to have approved it for a 8 day room temperature shelf life despite the convention of 4 weeks that it probably had to go through some pretty rigorous testing
If memory serves correctly when it first came out it was approved for 52 days⌠which would mean that itâs increased since then (not 100% positive) but if thatâs the case it would mean that it even surpassed the initial longevity specs in further testing