How do I change my basal time?

Type 1 and LADA
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Hi everyone!

I have switched to Tresiba, and have been on it 2 months now, with varying different amounts. I think I’m set on 17u at night currently, but I keep running into a problem I have posted about before.

My evening numbers, from about after dinner till a little over the time I take my next Tresiba shot, I’m high. 200-300 numbers, and I’m constantly having to correct. Now, when I first switch to a new dose of Tresiba, it’s not like this. I level out and I don’t have to fight as hard. However, about a week or so after my new dose amount, I’m right back up there.

I take my shot at 11pm. I take medications at 10pm that I need to eat with. This has never been an issue before; when I was on Lantus, I didn’t have highs like this at all, not at the same time every day. I find that if I eat a snack after my Tresiba shot, around 12am-1am (I’m a night owl), my numbers do better and I’ll end up around 100 after that snack, and wake up the same number or less. If I don’t eat, I stay around 160 or sometimes lower, but wake up around 140.

I don’t always feel like eating though, and no matter how I’ve eaten through the day or for dinner; pre-bolused, low carb, high carb, no fat, all fat, no matter how I eat, it seems I can’t get away from these evening highs, that if I don’t eat off later, follow me to the next day.

My question is this: I’m thinking MAYBE if I switch my Tresiba time from night, to morning (my morning/noon time), it might help. If I decide to do this, do I skip taking it at 11pm, and just take it that next morning at 11 am?

I see my doc tomorrow so I’m going to ask. Overall my numbers have been poo, while I’ve been adjusting to Tresiba. The past 2 weeks though since I’ve hit 17u I’ve done so much better. I just can’t seem to figure out this trend of evening highs.

I’m really just posting to see if maybe switching my time might help, or if I might always just have a period in the day of highs. I’m not sure. I have looked into basal testing, but that’s going to take like a week out of a month to do. I also don’t expect much help out of my doc; I see a PCP, no endo, and the nurses know nothing about T1D. So here I am, my go to place; you all seem to know a heck of a lot more than I can find help from the “professionals” :joy:

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I don’t know what medications you’re taking, but are any of those hormone medications? If they are, that may be the cause of the highs.

Alternatively, Tresiba does have some small peaks and valleys, and these are more pronounced when you’re taking it once per day rather than twice.

If it were me, I would try changing the timing of the Tresiba dose (as you proposed). I currently split the dose into 2 shots per day (AM & PM). Occasionally I’ve forgotten a dose, and I honestly can barely tell the difference. I run a bit higher about 12-24 hours later, but then everything seems to fall into place again. I’d just skip the dose and then take it when you first wake up. You can graduate to 11 AM the next day. This may not resolve the problem, it really depends on what is causing the problem.

I’d guess it has something to do with the medications you’re taking, or it may be that when you eat, you’re giving yourself extra insulin so you don’t end up high. It’s difficult to tell, but I don’t know why Tresiba would be more effective with food in your system. It seems like there may be a different variable that’s causing the highs.

If your dosing time is when Tresiba is in a “valley,” then changing the time may help- especially if your medications are contributing to the issue. Just my opinion though :slight_smile:

I hope it starts to work better for you! I’m sorry this transition hasn’t gone smoothly.

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@katers87 Thank you! I doubt it’s my medications; I’ve been taking the same meds for about 9 years now, and never had this issue with Lantus. It almost feels as though Tresiba isn’t lasting the full 24hrs for me or something. I have tried eating a low carb meal for dinner, higher carb with no animal fat or protein, any combo of foods with no luck, once my dose of Tresiba has hit that one week mark. It’s so strange! It’s almost as if I have to keep increasing it a unit at a time, but at this point I’m even taking more than I did of Lantus. Everyone else I’ve seen who switches to Tresiba, has had to take half the amount of their old basal, so I’m just confused.

I’ve also seen some people say that they split the dose like you do, and others say that it’s not advised or will make a difference. I might try switching my times though, so thank you for letting me know how to do it! I’ve only ever taken my basal at night so wasn’t sure! :slight_smile:

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My experiences were actually a little similar to yours then! I split the dose because I was noticing a dawn phenomenon after 1 month on Tresiba. No problems in the first month, but then I had a steady increase around 3-4 in the morning (I would take my 1x daily shot around 8-9 AM).

Splitting the dose really, really helped me. I don’t know if it’ll help with your situation, but I hope so!

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Have you adjusted your dinner insulin to carb ratio to make it more aggressive?

You may try this as an experiment. When I used Tresiba, however, I found zero effect connected with the time of day that I dosed. I know from reading here that Lantus and Levemir time of day dosing does matter to the resultant blood glucose levels.

You could do that and I wouldn’t be surprised if your BG levels are unaffected by that transition. As an alternate, you could deliver 1/2 the night-time dose and then deliver the other half the next morning.

Keep notes so that you can draw the right lesson from your personal experience. Good luck!

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@katers87 Thank you!! That’s good to know; I know we’re all different and sometimes just have to experiment. If I can’t get a solution from my doc, or figure it out with time change, I’ll have to try it! :slight_smile:

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@Terry4 Thank you!! Yes I have tried increasing my dinner bolus, sometimes even 3x the amount for little carbs! When I first increase my dose of Tresiba, the first 3 days I’m more insulin sensitive; my carb to insulin ratio will be 1:20. Now it’s increasing to anywhere from 1:10 to 1:5 which is strange for me.

Sometimes I’ll even have a post dinner number that’s fine, say 160, but then within an hour its 250, despite the food.

But thank you for giving me the idea of half and half! I didn’t even think to do that. I know with Tresiba, it has more space in dosing time, but I didn’t know if 12 hrs would be too much! And definitely, always keeping notes. I keep a log book of my numbers, everything I eat, my doses, any meds I take, anything! I’m frivolous lol

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One tactic that’s helped me with post meal numbers is to take a 20-40 minute walk 30 minutes after I finish eating. I’ve been using a treadmill lately but walking in the neighborhood works well, too. I find it chops off the post-meal BG mountaintop and also helps with overall insulin sensitivity.

That makes me suspect the protein/fat content of the meal. I used to use extended pump boluses to counteract that effect. If I were on MDI, I might consider adding a second dinner dose of a small amount of old-fashioned Regular insulin. Or you could experiment with substituting your current dinner dose entirely with Regular. I assume you’re currently using a rapid acting analog insulin like Humalog.

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I have gone as much as 24 hours without seeing a change in my glucose patterns. I often travel to/from Russia, which gives me 36 hours between injections one way, and 12 hours the other way. I have never tried splitting, but I know many people like @katers87 who are very successful with it.

Agreed. And due to the snack at 10 pm, I would also question if that snack is protein. A few grams of protein, without carbs or fat, will tend to level glucose levels overnight.

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Like I have said, I have tried eating with and without protein, with and without fat, all carbs, no carbs; I’ve tried every possible way of eating with no change in the spikes :confused: Lately my night snack has been something like a 15g granola bar, or a little cottage cheese and a few pieces of canteloupe cubes. This snack is usually the snack at 1am that gives me the final settled down number, which sets me up for a good morning. If I skip this, it seems like I’m more high in the morning.

As far as the snack before that, it’s usually something like a smaller meal (I need something substantial for my meds). Anywhere from leftover dinner in a smaller portion (with or without protein), to something like a slice of toast. Varying carbs, varying protein, I just can’t figure it out.

I can eat the same things earlier in the day without any issues, so I really can’t understand the madness!

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Do you have a bolus insulin.?

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Yes, I use Novolog!

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Let’s work on one issue at a time. Too many variables complicates the solution more.

First, a couple questions:

  • how many days do you leave between dosage changes of Tresiba?

  • Do you have a CGM or are you relying on finger sticks?

By 15g granola bar do you mean 15g of carbs? 10 cantaloupe balls and 2 Tbs of cottage cheese would be about 13g carbs.

To me, those carbs making you have a good morning number would indicate you might be going low at night and the carbs prevent that. Without the carbs, the low then rebounds and gives you a high morning number.

A couple suggestions:

  • Dose your Tresiba at 9pm if you are going to dose at night. I actually recommend trying morning dosing to prevent a drop from the overlap in doses. If that doesn’t help, split your dose.

  • Take your nighttime meds at 8pm. There are very few evening meds that can’t be taken earlier. You should be able to take most of them with your dinner if you eat around 6pm +/-.

  • schedule an appointment for a medicine review with a pharmacist (not an RN, CDE, or your doctor). If your clinic doesn’t have one on staff, go to your nearby medical center. The pharmacist will advise you on med changes, timing, etc., to help resolve some issues you are having.

And avoid carbs for that snack with any meds you can’t take with dinner. Avoid things like toast. Try some good old veggies.

Despite what some people say, the later you eat, the worse it is for your overall health. At dark, your body prepares for sleep. Having food, especially carbs, in your system diverts energy from healing the body to processing food.

Disclaimer: I am not a doctor. This is not medical advice. Always check with your doctor before making changes. All comments are my opinion only. Your mileage may vary.

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I’m quoting your whole post so hopefully I hit all your points lol Thanks for taking the time to try and help me out!

  • I leave at least a whole week in between Tresiba doses, although I’ve been doing 2 weeks just to be sure, since I have hormonal weeks thrown in there as well.

  • Yes, 15g of carbs granola bar. No lows during the night; I periodically check, and I’m not ending up with super high numbers in the a.m. when I wake up, just around 140, so higher, not the good 70-115 numbers. I use just a meter, and check up to 15 times a day, sometimes more. I can’t afford a CGM right now, even the cheaper options are too much.

-I’m going to play around with my Tresiba does time. As for now, my doc told me to increase it again so I’m gonna see if that helps. If not, the time change will come.

-Meds and eating at night; I’m a night owl. I don’t go to bed till very late. I never had this issue on Lantus, which is why I’m not sure changing my med times will be beneficial. I might try it, but it throws me off balance. I have been taking my meds at the same time for 9 years, it will be a hard thing to change without forgetting to take them.

-As for a carb snack; I’m not sure this makes a difference for me. I have tried low carb or no carb snacks with insulin, with the same results. As long as it is some sort of snack after my Tresiba dose, I’m hitting a good number in the morning. If I don’t eat at all, I creep up during the night, and end up anywhere between 165 and lower, but not around my 100 mark.

Sorry for any confusion; it’s all hard to explain without writing down daily numbers and sending them on here to give a better idea. It’s a struggle, but I saw my doc today and was told to try to increase my Tresiba a unit at a time until things level out. If this doesn’t work over the next couple of weeks, I’ll switch the time, and if that doesn’t work, I’ll split the dose!