Dose once or two times a day with tresiba?

Treatment Insulin
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My Tresiba pens run out in about 15 days of daily use, but when on vacation I will take a spare pen. Usually, they are not stored in a refrigerator while I’m on vacation and there have been times when I’ve accidentally started using one shortly after opening the other. Putting all that together, I would say the oldest one I’ve ever used had probably been in use for no more than about 4 weeks with refrigeration about half that time. I’ve never noticed any decrease in strength. Not the range of experience you are looking for, but it’s all I can offer😊

The original thread was interesting to me. I only take one dose per day, but I do notice that it seems to tail off in the evenings (maybe 41 to 43 hours after the shot). I think this might be a reason for some people to take 2 shots per day. I use a higher Novolog dose per carb for my dinner and that seems to cover me pretty well.

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Tresiba sheet is right, 8 weeks after starting use as long as you store it per manufacturer guidelines. That is not to say it WON’T last longer. The 8 weeks is just the maximum length of time that Novo Nordisk can guarantee efficacy.

Sam19 is probably right that doctors reflexively say 4 weeks.

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Hi l am type 2 and am now taking 10 u once daily. I am having headaches lightheaded after eating up to 3-4 hours. Do you think reducing my tresiba insulin dosage to 5 u might help?

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Changing your dosage should be based on your bg level. Do you test bg with a meter and see trends that may show you need adjustment? In my experience, headache is more common when my bg is high, and I need more insulin.

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@Jen Thank you for this! I was diagnosed with Steroid Induced Diabetes when put in the hospital in DKA and that due to the chronic nature of large doses of steroids for a lung disease then became permanent and is thus now classified as type 2. The endocrinologists told me with damage to my pancreas, etc. I wasn’t making hardly any insulin at all anymore, in addition to insulin resistance. I have been insulin dependent since they released me from the hospital 4.5 years ago. This also often happens to people who have organ transplant. I’ve never before commented on a forum. I have read them but never commented. I always feel badly as though those of us with type 2 are judged and blamed for having this, and all sorts of assumptions are made, and that’s a shame. So thank you Jen for speaking truth to this issue! I appreciate it!!

With regard to Tresiba, my doctor had advised me to use a split dose, no idea why. I have always used it that way. But recently I’ve developed an issue where my BG is great and then suddenly goes up about midnight. My A1c has been stable at 5.2. But I don’t like this new pattern that requires extra bonus and disturbs my sleep. So that’s why I was checking and found this discussion. Not sure what I’ll do, except I’ll try the basal test someone above suggested.

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@MayaK Hi. I know it’s been a long time, but this is relevant to me now so I hope it’s ok to ask. When I was first on Tresiba I had PD and doc told me to split to equal dose AM and PM. That fixed the PD. Based on the reported duration of Tresiba I have no idea why, but it worked. Now a few years later I’ve recently been able to reduce my dose from 18 each to 14 each and all has been smooth for several months then recently I developed a pattern of my BG being a nice level between 85-110 at bedtime and then around midnight it suddenly hikes right up the hill and my CGM wakes me with a high alert at 150! Any clues, ideas, suggestions? I’m at a loss. Thanks!

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Welcome to TuD, @TinaB! I spent a few years lurking at this site before I commented. Nothing wrong with that.

I’m sorry this happens; it’s an unfortunate social consequence due to ignorance on the part of both the general population and even some medical practitioners. It’s not right and definitely shouldn’t be heaped on people to complicate their struggle with diabetes.

While the broader community is more supportive of my type 1 diabetes, their ignorance of all things diabetes is difficult for all of us. The best we can do is to educate when we can and try to temper our outrage so we can live a healthier life.

I used Tresiba for several months back in 2016 but I only dosed once per day. I found it a reliable basal insulin and it if I missed my usual dose in the evening, it didn’t miss a beat if I gave that dose the next morning. In other words, Tresiba, once beyond the first week, was very steady for me and didn’t seem to care if my dosing schedule varied.

I know that Dr. Bernstein likes to use Tresiba as a split dose. You may get more response from a forum with more Bernstein followers.

Regarding your midnight BG spikes, is it possible that may be the result of delayed effect from protein and fat from your evening meal? If true, that would call for adjustments to your meal dose, not your Tresiba.

You didn’t mention meal-time insulin in your comment but I’m assuming that your failed pancreas doesn’t help with meals either. Perhaps you can fill in some of your mealtime dosing info here, such as which short acting insulin you use, your insulin to carb ratio, your correction factor (AKA insulin sensitivity factor) and the duration of your pre-bolus.

Do you use an insulin pump or multiple daily injections (MDI)?

You’re right to be alarmed about your sleep being disturbed. Good sleep is essential to good health for everyone, especially for diabetics.

Your CGM is an essential tool for someone who uses insulin. In addition to providing a fundamental layer of safety, it makes adjusting insulin, both basal and bolus easier to do. I review my CGM statistics (Dexcom Clarity) almost every day. It has made me much more competent at dosing insulin for me.

People like you, who become diabetic due to steroid treatment, are very few compared to those of us who contracted diabetes due to autoimmunity (T1D) or insulin resistance (T2D). But once your pancreas is unable to secrete much insulin, your struggle becomes similar. It is no less important than it is for the rest of us here. I personally believe that your case more closely matches T1D, not T2D, for whatever that’s worth.

Participating with comments and posts can help you a great deal. I’ve found that writing clarifies the mind and provides a self-education that will help you long term. Welcome and good luck!

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@Terry4 Thanks so much for your kind words of empathy and support. Yes! I have definitely also experienced ignorance on the part of healthcare practitioners, including my new PCP, and it’s maddening! In fact it’s healthcare practitioners where I generally deal directly with such issues, since as I said before now I haven’t interacted in an online setting I’ve just read comments. If diabetes wasn’t complicated enough I also have MS, hypothyroidism, severe asthma with eosinophilic phenotype, chronic fatigue syndrome, and severe central stenosis of the cervical spine all with symptoms that cross over and muddy the waters so to speak. So for example, now I have this new PCP just automatically assuming that the symptoms of dysesthesia and other autonomic dysregulation which happens to include neuropathic pain in my feet, legs, and fingers, and right hand is diabetic peripheral neuropathy instead of the demyelination in my CNS diagnosed in 2006 with lesions in my brain and spine 11 years before acute onset of SIDM in 2017. She has also decided the symptom of frequent urination and nocturnia I have, which are just two of the many urologic symptoms of the combination type neurogenic bladder dysfunction from MS, is Polyuria “another diabetic complication.” Never mind that I don’t produce more than 3L a day! Oh but I have diabetes so that MUST be why I have to pee frequently, even if it’s not a lot of volume, right? (Hand to forehead.)

So yes, ignorance and assumptions get terribly frustrating and annoying! And yes, I must utilize stress reduction techniques to manage those additional stressors. As I have also learned from my CGM how BG can go up just from mental stress.

My sleep however is disturbed every night by other factors in addition to CGM alarms, including ones that are not accurate but require finger stick anyway. I also have wakings due to MS and an elderly 19 yr cat with dementia who about twice a night now yowls in confusion and needs snuggles before going back to bed. Amazing that I always hear her cry down the hall, but sleep through CGM low alerts, right next to my head, and hubby has to wake me. :stuck_out_tongue_winking_eye: CGM is a game changer and a life saver even if it’s also a pain in the butt some days. It’s a trade I’ll take!

I may not be hip to all the lingo or the functions here, and not used to sharing medical stuff on public forum, so bare with me. Also, I have no idea who Dr. Bernstein is, other than I saw his name mentioned and several referred to “his ways” etc…

Apparently it’s not as “rare” as once was, as I read endocrinologists have cited upwards of 35-40% of their newly diagnosed patients are SIDM. I had never heard of it until I had it!

Correct, not making much insulin at all, so I need insulin with food. For short acting insulin I use Humalog Kwikpen. My basic carb ratio is 6:1. I have to vary it a bit depending on the meal. For example, I can sometimes eat a Kind almond bar of 16 carbs and not need any Humalog, but drink an Atkins protein shake of 9 carbs and need 2 units, which is 5:1. Or have a salad of kale, broccoli, cabbage, carrot, pecan, cranberry, and orange with a grilled cheese for a whopping 65 carbs and need 7 units, which is 9:1. I don’t vary my diet a lot. The duration of the Humalog is usually about 4-5 hours, I think. I think that’s what you asked.

I had been at 18 U Tresiba bid, but have been losing weight :+1: so have gradually reduced it down to 14U bid. I went down to 13U bid but noticed I had to do a few more post meal corrections and I rather not have to do that.

You mentioned possibility of evening meal being the reason for the new pattern of late evening BG increase. However, my diet had not changed. Then last night just as things do…change :joy: I was up to treat three lows during the night and did not have that increase at around 11:30pm to midnight. I didn’t do anything different diet wise. I exercised less yesterday than the day before. So as with MS, sometimes diabetes just seems to be predictably unpredictable. :expressionless:
I’ll keep watching CGM and Clarity for any insights.

Speaking of Clarity reports, I miss the old reports that capture all the events of each day. Now I find every day is missing LOTS of events! Bummer.

Thanks again for your warm welcome, hope I didn’t vent too much. Gee, first convo with a fellow diabetic in public and I sort of let it fly! :stuck_out_tongue_closed_eyes:

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All of these insulin to carb differences make perfect sense when you take into account fiber, protein, fat and how fast the carbs can digest. The kind bar has quite a bit of fiber in it so it doesn’t need as much insulin. Protein shakes in my experience are not what they appear to be in terms of how they should affect BG and your salad has a bunch of fiber and a decent amount of protein along with the fat from any dressing or the grilled cheese to slow the carbs down allowing your body to handle it with less interference from you.

As for the sudden BG rise in the middle of the night stress hormones are the most likely culprit especially since you have multiple conditions that can cause sudden stress to pop up that you wouldn’t even know about without having diabetes and like you have already seen it went away with a bang suddenly.

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Thank you. Yes. Regarding the meals I wasn’t surprised by this, just explaining that I adjust my insulin dosing depending on the makeup of my meal since he asked what my carb ratio is. I was explaining it depends on what I’m eating.

So you’re thinking that the BG rise that was suddenly occurring almost every night, for about the last three weeks, starting at around 11:30pm to 12:30am, was from stress? You said “middle of the night stress hormone” I’ve not heard of that before. Is that something going on in the body separate from a mental stressor? Some physical stressor? Is that what you mean?

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As you reduce the number of units of Tresiba, the shorter its duration becomes. The effect is not as pronounced as it is with Lantus but it’s there. (I say that as an experienced Tresiba and Lantus user in the 14-20 unit range).

It’s entirely possible that in reducing from 18 to 14 units per day, you might get flatter action by splitting those 14 units across two shots of 7 each, 12 hours apart.

It’s also possible you could “pre correct” the rise to 150 each night with a unit of short acting insulin before you go to bed.

Or you could add a unit or two of Tresiba or shift the time of day you take Tresiba.

You had gone down from 18 to 14, maybe it’s time to back to 15 or 16.

150 is not the worst number in the world. If that’s your largest bg excursion then we are very much in the realm of “fine tuning” where we try small shifts of a unit in dose or the exact timing or splitting is enough to make the small tweak.

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Hi Tim. And thanks for your input. My total daily dose of Tresiba is 28U since I split dose 14 in AM and 14 at PM, usually 10am and 10pm, which is down from total of 36 (18+18). But now last night I had a low at 7:45pm and then it was down to 72 at 9pm so I had a Greek yogurt of 9 carbs. When I went to bed just after 11pm it was 103 where it cruised until midnight when it popped up to 135, but then is gradually fell by itself. I was awake just before 4am and it was 82. Then back to sleep. I was awakened to 55 at 5am. I had 15 carbs of soda. Back to sleep and awakened at 9:40 at 57. Did I do anything different yesterday diet or activity wise? No. Was there anything different health wise that I could discern? No.

150 is above where I want to be at night and some of those nights when it went up it was up to 173 before the Humalog correction dose kicked in and brought it down. I understand we each have our own goals and different health profiles and comorbities that come into play. I try to keep as close to normal as possible for impact on my health. I have too many negative impacts and challenges on my health as it is. I don’t need high levels of glucose added to the mix. But additionally, I don’t want the extra lows either. Those aren’t good, and especially for me in that means extra calories in my day, which creates extra challenges to weight loss goals. Arrrgg! So it’s all a real challenge to be sure! I know. I know. I’m wanting my broken pancreas to behave normally. But a gal can dream right? :crazy_face:

I read previously where someone else had written, “studies of automated insulin delivery people with diabetes sometimes need half as much basal insulin on some nights and twice as much insulin on other nights.”

I haven’t found any such studies. Has anyone else. I’m beginning to think my body is sure acting this way!

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I forgot to say, I thought about the “precorrecting” you suggested, but as you can see that pattern I developed for a few weeks weeks has switched directions. Additionally, if my BG is 82 when I go to bed and I take even a unit of Humalog I may likely tank myself before it goes up, if it goes up, and then there I am adding more unnecessary empty calories again. That’s why I decided that probably wasn’t going to be a good solution for me. But thanks.

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We all play a complicated game managing our glucose levels with insulin. You have to pay more attention to it than you like to and it’s certainly sneaky when you pay attention to something else.

Using a CGM enables us to look at all kinds of statistical data. The obvious measures that get adopted for personal goals are time in range, daily average BG, and time above and below range.

One statistic, glucose variability as measured by standard deviation (SD) and coefficient of variation (CV), should garner more attention from us. I believe that when setting glucose goals, we should focus on glucose variability first.

I’ve learned that reining in glucose variability to < 25 mg/dL SD and < 25% CV will then permit you to safely lower your average BG, and A1c, as well as increase time in range.

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As far as I know your body treats physical stress and emotional stress the same way, with a release of cortisol which raises our BG. In a person with a functioning pancreas the release of cortisol in the short term is helpful and your pancreas would automatically dose you with a bit of insulin to cover the rise in BG. For us though we have to manually correct the BG rise.

I’m on the Tandem pump with Control IQ now and it handles these issues for me most of the time but if I were still on MDI I most likely wouldn’t correct a BG of 150 since there would be a chance of then going low.

This is why many of us choose to use an insulin pump whether it’s one that adjusts automatically or not since you can have many different basal rates and change them easily as you need to. Tresiba is great for those that don’t have much variation in their basal needs but any hormone fluctuations from cortisol to a woman’s menstrual cycle or just a varied exercise schedule can be an annoyance with a super long lasting basal insulin.

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Hmm. All very interesting. With the way the Dexcom is so often off base the idea of an insulin pump has actually scared me. Maybe something I will explore more now that I have exposure to people actually using them.

I’m 21 yrs post menopause so that particular hormonal issue is pretty much past me.

It’s currently 1:43AM. BG is 70 via finger stick. Dexcom has been going off with low alarms for the last 50 minutes. I inserted a new sensor this evening and it’s always wacky for at least the first several hours. But apparently no midnight rise tonight, seems I’m on the low side again. I’ll just have to watch and see how things go.
Thanks again.