Hi all,
I’ve been away for a while…had a baby 10 months ago and, as much as I love it here, it wasn’t the most helpful resource for pregnancy and T1, so I focused my energies on a couple of Facebook groups during that time and since having my little one.
After having my baby, I found my normal pump sites to have terrible absorption and so I recently decided to take a pump break and use Tresiba/Novolog.
My question is this: I know Tresiba is a once-daily, and I know Bernstein has recommended it be a split dose. I find myself going low around 3-4 am most nights, after taking my dose at 9 pm. Then in the afternoons, I am running much higher. On occasion I will forget to bolus or under-bolus (see: chasing infant + two teenagers), and my blood sugar will be SKY HIGH. Today I had a HIGH reading on my meter…something I haven’t seen in years!!! This was not happening before I switched to Tresiba, yet my Tresiba dose is about 3 units more than my TDD of basal on my pump. What gives? Any thoughts? Should I split the dose and see if it helps?
Thanks in advance for any insight.
Are you confirming the early morning lows with a meter or are those just based on a cgm? My cgm alerts low around that time the majority of nights and a finger poke always proves it wrong… I am not sure why.
It wouldn’t surprise me if you needed to take more units of tresiba than you needed with whatever you were pumping. Many pump users report significant decrease in their basal units when delivered through a pump… logic dictates then than many would see significant increase with mdi…
There’s no harm in trying to split the dose or take it at different times of day but I am a bit skeptical that it’ll make much difference… certainly worth a try though.
Hi Sam,
Thanks for the reply. The low is confirmed via dexcom/physical feeling/finger stick, although I don’t always test, but I’m often up with the baby, so it’s easy enough. I know some people get compression lows overnight with their cgm. That has never been the case for me. I’ve read a lot of the TuD discussion on Tresiba and on folks changing the timing of their dose and not seeing that it’s made much difference. Maybe I’ll increase by a couple of units and see if that helps during the daytime before splitting the dose.
Rochelle
Could be breast feeding causing headaches with your blood sugars too if you’re doing that… that would be a good indication of why you were having trouble with both pumped basal and tresiba all of a sudden… may just be a do the best you can situation for now and add some late night snacks to counteract the lows…
I take Tresiba once per day. They just lowered my daily dose from 19 to 16. It sounds like something is too high if you are going low in the middle of the night, that is not good. Perhaps lowering your does at night if you take insulin at night? I take Tresiba in the morning.
I switched from a pump to Tresiba/Apidra for several months last year. My TDD basal on the pump was 13-14 units but the best Tresiba daily dose ended up at 19 units.
You could try the split daily Tresiba dose and see how it works for you. I tried various timing on Tresiba and it didn’t seem to matter. My experience with Tresiba was the opposite of yours, high (160-180) overnight and low in the late afternoon.
Sam, absolutely. I’ve never had such erratic numbers as when breastfeeding, so that thought had crossed my mind. I’ll have to try the snack route (not since being on R and NPH have I had to do that!) and see what happens.
Rochelle
Yes, I may switch to a morning dose and see if I have a better outcome.
Rochelle
Terry, I remember reading your thread about this. Why did you end up going back on the pump? For all the praise I’ve heard about the long, flat trace of Tresiba, I’m disappointed to not be having better numbers.
Rochelle
My 24-hour Tresiba dose left me with a pattern of overnight highs or late afternoon lows. I eventually used the so-called “untethered” tactic of combining Tresiba with the pump and that was very good. I let Tresiba carry about 2/3 of the basal load. My dawn phenomena basal needs make it hard for most basal insulins to control my 3-10 a.m. surging BGs without driving me low in the late afternoon.