Hi Everyone. I am new to this forum. I found it while searching for answers to a specific question about an issue I am having.
I am 57, have had Type 1 for 24 years. I use Triseba and Humolog. I have been having a pattern of both Triseba (and before that Lantus), not seeming to work for a full 24 hours, especially if I exercise. I am fine during the day, then exercise, go low, correct, get back to normal by evening, and then overnight my blood sugars creep up, starting around midnight so they are well into the 200s by morning. Seems to happen no matter where my BG is at bedtime (happened last night, even though BG was 104 at 11 pm when I went to bed).
I am thinking about double dosing my long-acting, with more in the morning, and less at night. Thoughts?
I should add that I had tried the insulin pump earlier this year for three months (t:slim with CIQ with Dexcom G6). It definitely resolved the night time issues, but I had a lot of issues with infusion sites causing highs and being painful and irritation.
For me Tresiba is longer-lasting than Lantus but still not perfectly flat.
You called it “double dosing” but we here generally call it “splitting the dose”. Same total number of units a day, hit in two shots 12 hours apart. Yes I did that with Lantus.
I think splitting the Tresiba basal insulin into a two doses, one morning and one evening, seems like a tactic worth an experiment. I do have a couple of questions.
When do you currently take your single Tresiba dose?
When do you usually eat your last meal of the day? Any evening snacking?
Do you sleep the same hours every night?
Do you get enough sleep?
Sleep plays more of a role in glucose management than we tend to give it credit for. If you’re not letting at least three hours pass between your last bite and your head hitting the pillow, you’re compromising your ability for healthy restorative sleep as your body is still working on digestion as you start to sleep.
People who don’t sleep well tend to have higher blood sugar than those who do get a good night’s sleep.
By the way, I noticed that you were diagnosed with T1D at the age of 33. I found out when I was 30. I’m sure you’ve listened to the surprise people express when you tell them that you were diagnosed as an adult. That whole juvenile diabetes label has really stuck. Well, it gives us something to talk about at parties!
I have been taking Triseba at 8 am. I do tend to snack after dinner, mostly to offset lows that seem to occur after I take my evening bike ride and take my dogs to the dog park. I check my blood sugar before bedtime, to make sure I haven’t overshot my low and I’m in normal range (95-125). I sleep well, except going to the bathroom.
And, yes, getting diagnosed at 33 was a shock to me. In fact, they initially diagnosed me with Type 2, but I was dating a doctor at the time (who initially thought I had diabetes), and she said I was way too thin to have Type 2, and she was right, 6 months in, when they did a Peptide C test.
I use Tresiba and Novolog, although I used Humalog for several years. I used to split my Lantus dose, but have no trouble with Tresiba. I take my total of 12 units between 6:00 and 7:00 am.
I eat an early dinner, but need to eat a bit of protein before bed, or I will drop too low in the early morning hours. I wake up with a glucose reading between 80 and 90 most mornings. I have found no need to split my Tresiba dose.
Welcome to the group Michael.
Hi Marylin. Feeling good about finding this forum, after so many years.
I used to split my Lantus dose and started using Triseba hoping to avoid it. Currently taking 16 units of Triseba at 8 am. I might be eating snacks with too much fat after dinner (¾ cup of mixed nuts), where the sugar doesn’t hit until after bed. Seem possible?
Do people think it is possible that when I exercise, I am burning through some of the Triseba, so there isn’t as much left for overnight? Like I said, I tend to go for a bike ride and long walk in the afternoon and evening (at 120 to above and not falling before exercise), then I go low before or after dinner, and then go high after bed. I have read that there is some evidence that long acting insulin absorption doesn’t increase from exercise, but this is not consistent with my experience.
I ride my exercise bike for an hr a day and I have never had the experience of my Tresiba being used up.
If I was going up in the night, I would assume that I needed to raise my Tresiba by a unit. That might necessitate the need to lower my Novolog before meals.
Good to know. Maybe I’ll up my Triseba a little and see what happens.
@MichaelJohn63 I am type 2 DM for 30 years, using Lantus for 12 or so. I have split the dose for over half that time doing 2/3rd at night and the other 1/3rd 12 hours later. Begining this year I began MDI, using Humalog before meals and having a Dexcom CGM.
I actually inject Lantus in thirds. The reason was a combination of DP and FOTF and my BG ramping up high 2+ hours after the noon meal. The Humalog keep BG in line but as it tapered off there wasn’t enough basal to keep things in link.
I’ve actually decreased the Lantus dose by 5 units, the last one is cut in half. My night time BG tends to be 80 to 90mg/dl.
We are all different in how our bodies respond to food, exercise and insulin, which I am sure you know.
Try the split dose, The reason I began splitting was hypos 6 hours after taking the full dose before bed. Don’t believe the hype about these basal insulins being flat. Lantus has a sight rise at 6 hours. I’m sure Triseba is not flat either.
I just looked at the curve for Triseba and it is definitely not flat. Considering that it is still active for 36 hours, I wonder if the dose after 24 hours is stacking on top of the previous dose. That may give a flatter curve.
I’ve never read anything of how well Triseba works.
@MichaelJohn63 – I know you’re focussing mostly on your Tresiba dosing. You need to do that so you can find the dose size and timing that works for you. Removing other factors that can muddy that analysis helps with troubleshooting.
My personal experience has taught me that my overnight blood glucose levels are typically in-range and steady when I can start sleeping without bolus insulin active or food being digested.
I think evening eating along with the requisite bolus insulin complicates things. Even if you don’t think you can be successful with avoiding evening eating, I’d recommend that you at least do the experiment and see what happens.
I think one of the things you want to look at, is your dosing. If you are dropping too much, you actually have too high of a basal dose or are giving yourself too high of a bolus. You might want to do a basal test. With an MDI basal shot you should not drop" too much" at any point during the day in normal daily activities. A basal test will tell you if it’s a basal issue or bolus issue in dropping too much.
To exercise and not drop, generally you have to eat extra or you take less insulin with a meal so you can exercise. A lot of us use exercise to help control a spike because it helps insulin work faster/better.
The climb could also be a delay in digestion of what you are eating at night. Protein and fats hit your system at a later time, plus fats will slow down the absorption of carbs. So say, you snack on something high protein, it is starting to hit you an hour after you are asleep and so a slow climb. Or back to the basal wearing out…
I would second the splitting of Tresiba, that way you can adjust the amounts given if needed, plus you won’t have that wearing out effect that might be hitting you.
This is really solid advice. It is also in line with what the physicians assistant at my endocrinology clinic told me a few weeks ago. I am beginning to wonder if the problem is not burning through my Triseba but because of bike riding, but maybe after a bike ride and a long walk, the Humalog that I am taking for dinner is too much because I’m using my insulin more efficiently at that time after exercising and therefore I need to lower my insulin to carb ratio so that I’m not over collecting for my bolus for dinner. What I have found is that I eat dinner, and then I go low, and then I have to eat to cover the low and then I’m higher at night. If I could get my bolus correct for dinner, after exercising, and didn’t go low after dinner, I wouldn’t need to eat anything before going to bed to compensate for it and then have it sit there metabolizing while I’m asleep, therefore raising my blood sugar. That might be the answer.
Michael, I have been at this for 62 yrs and I think of myself as very experienced, but I still am constantly asking myself why my body is doing this or that. We are all different and we all have different insulin needs. We are really in it for the long haul and it can get frustrating to say the least.
First you do need to find out how much Tresiba you need to take. I need 1/2 unit less than I am taking, but the pen I use only comes in full units. I need to do something to correct this, but find it easy to just eat something before I go to bed. That might not work well for someone else, but it works well for me, because it allows me to sleep without worrying about lows.
You have been given some great ideas for finding out your ideal basal dose. Once you find that, you will have an easier time with figuring out how much Humalog to use. It sounds like you are on the right track.
I feel your frustration but eventually you will get it worked out for awhile anyway. It just takes time and experimentation.
You can’t use up tresiba that way, it is released slowly.
If your sugars are high in the morning, you won’t use up more tresiba than if they were in range.
And yes fat can slow your carb absorption and also increase insulin resistance.
I concur taht splitting your dose sounds like a good plan, if your basal needs are different at different times.
I’m using tandem pump and I am very lopsided
I use 7 units from 9pm to 9 am for basal, and I use 15 units from 9am to 9 pm.
My pump magnifies this because it’s constantly adjusting it, I used to run at an even 24 units basal per day, before ciq.
You have all provided really good, supportive, thoughts and ideas. The collective wealth of experience and years of doing this are encouraging and helpful. Thank you so much. So, I guess I really do need to figure out basal first. Then, monitor my boluses at night, so I am not processing either food or fast acting insulin at night. I know my Diabetic Nurse Educator says I tend to overcorrect as well, or take more bolus than I need, and then have to correct after my meals.
I can’t remember if I mentioned this before, but my A1Cs are typically in the 6.3-7.0 range over the past several years (mostly mid-6 range), and I have cut out most bad foods for more than 15 years (no alcohol, no meat (except fish and seafood), almost no dairy, mostly low carb), so my cholesterol numbers are “very good.” I just worry right now because my average BG numbers have been creeping up the last month or so. Also, being on the Tandem pump had almost no effect on my A1C results (better control at night was offset by lots of problems with infusion sets and sites resulting in multiple prolonged highs, even though things were great when the infusion sets/sites worked properly).
I really want to figure out how to stay on track using pens because despite all the advantages of being on a pump, I kind of hated the “cannula” (needle) being in my all the time–even though for some reason the Dexcom sensor doesn’t bother me at all.
This is my first time having sought advice from other diabetics, which is weird considering how long I’ve been dealing with it. Feeling grateful right now. Thanks again everyone.
Well, the ideas here seem to be helping so far. I took your advice (and the advice of others), by eating nothing after dinner. I did have a little bit of a low before bedtime, but corrected precisely with a few glucose tablets, then stayed steady during the night at 82-86, woke up at 88. I plan to continue this trend. In light of the slight low blood sugar over night, I decreased my Triseba from 16 units to 15 units this morning. Will see if this makes a difference.
Congratulations Michael. That is very good news!
You were smart to experiment with avoiding eating after dinner. Your BG results could not have been better ranging from 82-86 and waking up at 88. Snacking in the evening can be difficult to manage; avoiding the snack is easier. If you build it into a routine like @Marilyn6 and constantly monitor it, it can be done. I’ve found, however, if my basals are set well, avoiding the snack is much less risky.
When you change your Tresiba dose, allow 2-3 days to elapse before you analyze and consider another adjustment. The 42-hour insulin duration overlaps from day to day and the effect of any changes takes some time find a “steady state.”
As I understand the theory of basal/bolus insulin dosing, basal insulin is meant to metabolize the drip of glucose (glycogen) coming from the liver, nothing more, nothing less. Bolus insulin is taken to counteract the glucose effects of food and any hyperglycemia.
Control IQ, as I understand it, modulates basal rates (in addition to high BG bolus corrections) to control blood sugar. If the user miscounted carbs or her/his insulin sensitivity fluctuated then CIQ adds or subtracts from the usual basal rate to make a bolus correction within basal delivery. This portion of insulin should not be considered as basal.
Now I realize that the body does not care one bit whether insulin is designated as basal or bolus, it just wants the right dose of insulin at the right time! The concept of basal and bolus therapy is for us humans to grapple with the inevitable insulin delivery tweaks required. Any solution that we discover is temporary and we should not expect it to endure, yet still enjoy it while it does! Diabetes is fickle.
That’s true. Our metabolism changes hour to hour.
Mine is very fast daytime and very slow when I’m sleeping.