Increased basal dosage since moving to Tresiba

I am now using Tresiba, and it works amazingly well. Every now and then, I like to do zero-carb days (except for carbs in fiber, which don’t raise the blood sugar). On those days, the BG graph is almost entirely flat. Really cool.

However, what surprised me is that the basal dosage increased compared to Lantus. I used 10 units of Lantus 1x daily, but now use 14 units of Tresiba. I thought that typically people need less basal after switching to Tresiba? Also, I’m still honeymooning (C-peptide levels are still there a bit), so isn’t 14 units a little high for a honeymooning T1?

I’m not worried, just a little surprised and curious. Maybe I actually did need more Lantus as well, but didn’t notice it, because the small Lantus peak coincided with the increased basal need in the morning. Or maybe it is a product of a slowly fading honeymoon.

I switched from Basaglar to Tresiba but kept the same dosage.

It could be on Lantus you had a small peak at the right time of day for you.

Yeah, that’s my guess. Although, I’ve had problems sleeping enough, so this may be influencing the dosage too (higher stress level due to lack of enough sleep).

When I took a pump break and switched to multiple daily injections, my basal went from about 14 units on the pump to about 19 units of Tresiba. I don’t think it’s typical that basal needs go down when switching to Tresiba. It’s an individual thing and sometimes difficult to compare. When you were using Lantus, you may have benefitted with taking fewer units of meal bolus insulin due to a Lantus peak occurring post-meal.

Do you mean that your c-peptide levels are still relatively high?

One standard for typical insulin produced daily in a non-diabetic is 0.5 units / kilogram of body weight. What is your typical total daily dose of insulin? That’s basal + bolus total. I use about 0.4 units/day per kilogram of body weight and my body produces little to no native insulin.

While your honeymoon status may be interesting, the most important thing for you is to maintain healthy blood glucose levels for the greatest amount of time each day while eating a nutritious diet.

My fasting C-peptide levels was measured at 0.81 ng/ml two weeks ago. Normal is 1.10 to 4.40 ng/ml according to that lab. And I weigh 74 kg. According to the 0.5/kg rule, my non-honeymooning basal dosage would be 18.5 units per day, which is not too far off, is it? But given that 0.81 ng/ml is not that far away from the normal minimum of 1.10 ng/ml, I’d expect it to be lower.

My typical total daily dose varies a lot, because I tend to eat fewer carbs, and the amount of carbs fluctuates heavily. I’ve had zero-carb days, and a few days with >200g carbs. On average, I use maybe 3-10 units of Humalog daily.

I am beginning to suspect that 14 units may be a tad too high though. I’ll try 13 units next. I notice this because the BG has been decreasing veery slowly over the day. I mean, there’s a slight downwards trend. I’ve increased to 14 units only a few days ago, so maybe I’m just now beginning to feel the effect.

Also note that I do not think this is insulin resistance. That’s because one unit of Humalog drops my fasting BG by about 50-60 mg/dL.

Tresiba’s nominal duration of action covers 42 hours. That means that any dose changes will take at least two days, maybe three to make the effect felt. I would agree that with a slight downward trend of your blood glucose over the course of a day could mean a basal dose that is too high.

That’s assuming a linear effect that may not be present. Again, while I think that the honeymoon effect is interesting and, of course, beneficial, the important thing is to maintain as close to normal blood glucose as is reasonably possible.

I agree that according to your current total insulin use and sensitivity to corrections, insulin resistance is not a factor.

By the way, the idea that basal insulin should comprise 50% of the total daily dose makes no sense to me. Some doctors view it as some kind of rule and I just don’t get it. Meal and correction boluses can go up and down influenced by a whole variety of factors. Insulin needs don’t remain static from day to day. Diabetes is a dynamic disease.

I agree, also because my I:C ratio is a bit high for a honeymoon (or low? I’m always confused about how to denote this), hovering around 1:8-1:12, which I think are I:C ratios more commonly found in non-honeymooning T1Ds. Perhaps C-peptides are present but most of the insulin is not “finished” in the beta cells somehow. As long as I’m not actually insulin resistant, and my BG is fine, I’m not worried.

I also got myself a stationary exercise bike now, so I’ll see how this changes things.

It sounds like we have some things in common. Similar weight ~74kg and dosages. Since diagnosis I’ve been taking 7 units tresebia and 1 unit of fiasp per-meal. I’ve been keeping my meals to 20-30 carbs each. If a meal is less then 10 carbs I don’t take insulin but still try to go for a walk.

My one and only blood test so far showed c-peptide at .92 (random, non-fasting test).

Normally I find 1 unit of fiasp is enough for 20 carbs. If I have a little more then 20 carbs I walk around the neighborhood and drink a little extra water. I would need to eat more carbs per-meal to have 2 units of insulin.

I’m not sure where I am in my honeymoon period or how long it will last. I also take Jaridance and Januvia. My doctor says at least while I’m still making some insulin I might as well use those medications. I’ve read there are studies researching those medications effect on beta sell preservation and glucose control.