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@greatperson - I second what@Sam19 said. Aug 2 to now is not enough time with Tresiba to determine a proper dose. It take a good 3 to 4 days to build up in your system and level out. Adjustments require a few days between them too.
I personally would not split Tresiba, especially based on Bernstein. Tresiba did not exist when he wrote his book. The 40 hour action of Tresiba would seem to indicate splitting would not change anything.
With your high blood pressure added in, you have classic signs of insulin resistance. Though Metformin is one medicine treatment for insulin resistance, there are many others that can be tried, as well as diet and lifestyle changes. i recommend you find a good endocrinologist with a knowledgeable CDE (preferably a PharmD) to suggest changes you can try.
Bernstein really likes Tresiba because he believes it truly lasts overnight unlike other basal insulins. He still recommends two injections a day for Tresiba. In the video below at about the 34 minute mark he talks about the use of Tresiba and split dosing.
Thank you Brian, I agree with Dr Berstein.
Normally my blood pressure is very low, it only became high when I started Tresiba. Yes I have a very high insulin resistance, and I have tried every medication for diabetes and none of them work for me, the only way to lower my blood sugar is not eat, which is impossible to do. I exercise, eat small meals and get plenty of sleep. Last night I got leg cramps, which is a sign of low potassium. I will continue the Tresiba for a month increasing dose as my doctor sees fit, and if it doesnt work then, sigh I dont know what to do. Thank you for your response.
Hi Jane -
I am new to this forum, so no idea how it works. Can you email me privately at (Email removed by administrative team).
Thank you,
Julie Husic
If it was me, I would edit your last post and take your personal email out of your public post.
Previous posts talk about how to leave a private message.
Are you using the u100 or u200? Have you and your doctor been increasing your dose to try to find an appropriate level? please keep us posted I hope it works out for you… I assume you’re using meal-time insulin too? If you’re rising that much throughout the day I would think meal time insulin would be a necessity… Sorry to hear it’s not working well for you… It’s definitely not a good thing to have sugars that high on a daily basis.
I personally can’t see any potential benefit to splitting the dose, but to each their own. I can be pretty certain that doing so will not by itself fix that your blood sugar is rising 300-400 points throughout the day without some other additional adjustments as well
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Hi,
My blood sugars have been that high for the last 5 years, I do not take any other insulin as it gives me such bad headaches I cannot function. I am using U200. I think I need to take it at night instead of the morning for sure. My morning insulin seems to be coming down.
I came to this forum to get ideas from others on what amounts worked for them, what is the difference between U100 and U200? Thanks for your help.
Hey Sam:
I’ve used an “untethered” approach quite successfully and am finding using Tresiba makes it even better. Until recently, I’ve found Levemir to be my absolute favorite insulin. I had been using a split dose, and when dialed in correctly, it gives me amazing, flat basal rates - and a consistency that I could not achieve with the basal settings on my Omnipod. My preference is MDI, but I use the pod when I travel on business due to the discretion and convenience it offers. When home, I just remove it. Because I inject my basal, I don’t have to worry about managing a basal transition from my pump to injections. The other benefit I’ve found is that the pods fail sometimes - and always at the worst time. Usually in the middle of the night, or on a long flight. It’s just Murphy’s law. With injected basal I don’t need to worry about quickly replacing a pod. The one downside has been trying to adjust my split basal when traveling to dramatically different time zones. Those have been the times where I will usually switch completely to the pump for basal and bolus. I’ve been trying Tresiba for the last 2 weeks and have seen first hand that there is amazing flexibility as to when you can inject it and still maintain the same basal control. I’m still tweaking the dose, but I have to say my first impressions are very good and this might be the solution for me in all time zones. I can use it in all situations and stick an Omnipod on when I need the discretion and convenience. And if there’s one thing I’ve learned in managing this disease, there is no “one way” to manage it. Do what works best for you to get you to the targets you desire.
Christopher
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Leg cramps can be caused by many things, so I wouldn’t assume it’s low potassium. Taking potassium without knowing that you do, indeed, have a low serum potassium level is a dangerous (and potentially fatal) crap-shoot.
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For many years I got leg cramps from time to time. For me it’s often associated with increasing levels of total daily insulin.
I have tried potassium supplements but that did not diminish the incidence of leg cramps. I’ve been supplementing with magnesium in the last year and it’s been a long time since my last episode. Leg cramps usually appear when I’m sleeping or getting out of bed in the morning.
I use this brand magnesium one dose per day, at bedtime:
I have no connection to the company that produces this product other than as a customer and user.
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Have you looked into if you might have allergies? Gluten or otherwise? You can try a few things and see if it doesn’t help which might point to the cause of your issues.
CONSULT WITH YOUR DR FIRST… But here are some suggestions you might mention to them.
Try an anti-inflammatory, strong enough does to see its effects. (I take 600 mg of ibuprofen, anything less for me isn’t enough but I weigh 200lbs). If your sugars go down or it helps your insulin work then you might have a lot of inflammation going on from something.
At a different day try an allergy medication to see how it affects your sugars. For myself I found gluten affects my digestion and inflammation and makes my sugars run higher.
Also try to cut out different foods you eat a lot to see if you might be allergic to something.
Just some ideas, I wish you the best.
With BGs constantly between 200 and over 500, I’d do whatever it takes to lower your BGs! Your’re on a fast train to other complications with those BGs, in addition to the gastroparesis with which you already suffer. Good luck and keep us posted.
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U200 is just twice as concentrated as u100— so there are 200 units in a cc instead of 100— so basically it’s just less watered down and you’re injecting less total liquid in order to get the same insulin dose.
All of our doses vary tremendously— some people take 2units daily, some take 200+, and everywhere in between. It really is a very individual thing that needs to be custom tailored.
Have you tried several different meal time insulins? If other medications have not worked for you and insulin is only option-- it seems like meal time insulin would be necessary and worth pursuing in hopes of finding one that doesn’t cause you side effects…
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In the video, Bernstein says he likes Tresiba but he has never used it. Then he says “in his experience” it “really lasts a long time” and that Nordisk exaggerates by claiming it lasts 2 days. So, he has no real experience with how long it lasts, and he gives false information.
Tresiba is claimed to last “up to” 40 hours. In my experience (and I actually use it), it lasts about 34 hours. I travel a lot, and never adjust my schedule for time zone changes. I recently left the Central timezone after taking Tresiba at 6am, arrived in Moscow (an 8 hour time shift) and took it at 6am the next morning in Moscow (10pm Central the previous day) which is a 32 hour sprint with no problems.
Based on it lasting more than 24 hours, there is no medical benefit to splitting a dose. Of course, I don’t think it would hurt, either (just my opinion).
Again, I follow a lot of what Bernstein says, but I take everything with an educated grain of salt and some basic logic.
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As @Sam19 said, insulin doses vary per person. Some people take less than other basal insulins, some take more. I went from 36 units of Lantus to 46 units of Tresiba - but it took me 2 weeks to dial in that amount as my doctor started me at 36 units of Tresiba, and you can only change the dose every 3 or 4 days. I know one person who is taking 140 units of Tresiba to control basal rates.
Insulin resistance depends on lots of things. Your weight, amount of exercise, genetics, allergies, infections, and other medications to name some. Many interfere with the blood glucose lowering effects of insulin. You really do not provide enough information for anyone here to give you good advice on helping with the resistance.
It really sounds like you do not have the information you need for good pharmacotherapy - you could need something like Farxiga, an amalyn analog for gastric emptying, a thiazolidinedione, corticosteroids, lipase inhibitors, and/or other medications that could help.
You really need a workup by a good endocrinologist, which is where I would start.
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Agree with previous, recent commenters re @greatpersun, that help with a good endo and some bg control seem especially important now.
I developed T1 as an adult. I’d never had digestive problems or leg cramps until the year before I was diagnosed, and have never had them since my bg’s returned to normal – well, the new normal, but it’s pretty close.
For me regarding basal insulin, a split dose of Levemir worked pretty well, and for me it definitely needed the split. Tresiba seems equally good so far, and I don’t bother splitting it.
All other insulins and believe me I have tried them all, give me really bad headaches, I was thinking not splitting the dose but taking two doses a day, but not til I get it approved by the doctor.
You do know how bad ibuprofen is on your stomach and liver and kidneys, I assume. I take arnica montana for inflammation and pain. I have had all the allergy tests, and no food allergies, just trees, dogs and cats. I have tried benedryl and it only helps the vomitting from gastroparieses.