Which insulin do you take for highs. No matter what I eat my sugars go up by bedtime. Then high in am. Even on tresiba. Do you take an extra unit of novolog before bed or add 2 units to tresiba at night. I took Lantau for 5 years and it wasn’t working as good. Thought tresiba would help me out. Since starting it. I get more highs at night. Any one have any suggestions
Some people require more insulin at night. Their basal needs are higher at night. Tresiba by itself doesn’t work well for that.
Levemir has a shorter span than Lantus. If you use Levemir, you can take it in two doses, morning and night. And take more at night than you do in the morning
Depending on the total amount you need, Levemir can have a span of only 12 hours, which is great if you need more at night.
What is your total basal amount for a day?
If you want to stick with Tresiba, taking a little bit of NPH right before you go to bed can cover some of your extra nighttime needs.
I take 18 units. On lantus I was on 16. I use the 200 Tresiba so it only goes by 2 units I have an endo that doesn’t answer much. I can’t keep my evening sugar from going up.
So, since starting Tresiba you go high after your evening meal and wake up the next morning high as well. Do you tend to go low at any point in your 24-hour day? Are you keeping any records of dose, timing, food, and exercise?
Your Tresiba increases will need to go up in 2-unit increments. If you decide to increase, wait 2-3 days before considering another change. It takes a few days for the Tresiba to reach a steady state.
When I used Tresiba for four months last year, my body didn’t seem to care when I took my dose. I mostly dosed Tresiba at bedtime.
Did your doctor have a titration plan? Did s/he want you to update after a few days so you could decide the next move?
I’m a personal experimenter but I always try to be conservative and keep a ready source of glucose handy.
My insurance stopped paying for lantus so I had to change only choices were Tresiba or Trujeuo. Went with Tresiba. I am changing to humalog next month since my insurance won’t cover novolog any more. It’s all going to be different. My endo hadn’t said a word. So it’s up to me to figure out. I wanted to go from 18 units to 20 at night but worried it might cause low sugars in am. I asked my dr office. No answer. So just doing research. I heard it will take a few months till figure out. I just started on it in may. I won’t ever use the pump so need to get this right. Hate these sugars over 200. Don’t want them causing health problems
In an ideal world the doctor for someone with diabetes would be available all day, every day to help make insulin adjustments. I ran into the same harsh reality not too long after I started on insulin. I concluded that I needed to learn to dose insulin as the only practical solution.
Get a notebook and start keeping records of your dose size, timing, and blood sugar readings. There’s no shortcut to this process. You need to discover what your body needs. But this is a great skill to master since you’ll need to do this the rest of your life. Experiment, document, analyze, adjust, repeat – it’s that simple.
Make conservative moves. Let any Tresiba changes settle in for two or three days before considering another change. Keep emergency glucose close at hand. Don’t be afraid to set a night-time alarm if you start to trend low during sleeping hours. Fingerstick a lot – there is no prize for learning how to fly blind.
As I said, this is a great skill to master. Unfortunately, there is no perfect dose to discover and then never change. Diabetes is a dynamic disease and learning how to change with it is the key. There is no perfect permanent insulin dose, only the dose you need now, today.
I’m not saying to ignore your doctor. Keep him/her apprised of your doses and changes and give him/her an opportunity to weigh-in. It’s an unfortunate reality that doctors do not have enough hours in the day to make every insulin dosing change for every patient.
You can do this!
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If your body has a natural tendency to go higher at night, I think it will be tough to handle that on only Lantus or Tresiba. Something that might help is Levemir. It can have a shorter acting timeframe, depending on how much you take for how much you weigh. (For Levemir, anything less than 0.2 units per kilogram of body weight gives it a much shorter time. )
Instead of once a day, suppose you took Levemir at 9pm and 9am. That covers you 24 hours. But then what you can do is adjust, take more at night and less in the morning.
If you’re going high at night before bed and staying high, maybe it’s just after dinner, especially if you’re eating a lot of protein/fat. It doesn’t necessarily sound like your Tresiba dose is off, if you’re then somewhat stable overnight, more like you need something to cover that evening rise. Sounds like something worth trying some short-acting in the evening for, to prevent the rise in the first place.
On the other hand, if it’s more of a slow steady rise overnight, then that could mean your basal needs are higher enough overnight that an insulin as stable as tresiba might not be the ideal choice (vs something like Levemir which you could take more in the evening).
Hi Kathy60,
I have problems that sound similar to yours. I have found that if I can get my bgs under 140 at least 3 to 4 hours before bed they will stay there. Otherwise my seemingly perfect bgs will skyrocket at night by 100 to 150 points. My solution and I am not sure if it will work for you or not, is to have my smallest meal at night, never after 6:30 pm, take enough Humalog (and correct as necessary) to ensure my bgs are between 110 and 140 at bedtime. My nighttime meal is easy on the protein and fat, is generally vegetable based, and has less than 20 carbs if possible. I currently use Tresiba in the am with breakfast and Humalog at meals and for corrections.My Tresiba dosage ended up being the exact same dosage as my previous Lantus dosage. The only difference is I don’t need to split the Tresiba dosage into twice daily. I am a HUGE fan of Tresiba.
As a side note, I often take a walk after dinner to “help” the insulin hit and get some much needed exercise. My insulin absorption is not as effective the more stagnant I am. Example - If I eat 21 carbs, my I:C ratio with exercise is 1:5. Without exercise it’s 1:3. Given the cost of insulin these days, I exercise whenever possible.
Hope you find the help you need. This forum is a great place to look for help/advice, and there are many members here with a wealth of knowledge.
Thank you. Have you ever taken tresiba at night. My dr never told me when to take it. I was taking lantus at night and was having issues. I was hoping to take it in am since I figured I wouldn’t have these morning lows or highs. If it’s climbing in evening then I take a unit of novolog soon to be humalog then I pray it goes down at night. I am working on the carb issue. Trying to figure out meals with lower carbs.
When I tried Tresiba last year for four months, I tried dosing at various times of day. I started before bed and then I tried dosing in the morning. My control did not seem to care what time of day I took the dose. I remember forgetting my bedtime dose and then just taking it the next morning. It didn’t seem to matter. The only hard and fast rule is to never dose closer than eight hours apart.
I think other formulations like, Lantus and Levemir can be split or timed to advantage. Tresiba doesn’t need careful dose timing. It makes for more lifestyle flexibility and is easier to live with that way. At least it was for me.
I took my first several doses at night, purely for convenience and had zero issues. Then as I was running out of a test pen, I wanted to see how long it would last before my basals started to climb. For me, about 39 hours. When I re-started the Tresiba, I went to an am dose and have been there ever since. I am not sure it really matters too much during the day when you take it, since it’s efficacy is so long. The Tresiba curve is extremely flat compared to other basals and doesn’t stack in my experience.
Have you ever heard the term “eat to your meter”? It’s a fairly popular concept on this blog and can help you to avoid huge spikes. ( Diagnosed by noon, dying for a cheeseburger by 3 - #2 by Scott_A) Also identifying your Insulin to Carb Ratio (I:C) will help you to make adjustments with your bolus and corrections. My favorite guilty meal is pulled pork (no sauce from Costco) on romaine leaves with a sprinkle of cheese. Low carb/medium fat/high protein.
Please do ask if you are looking for ideas or answers. People here are super helpful!
21 carbs in a meal. Is that for dinner. I am always hungry if I eat before 5. I have a hard time finding dinner ideas. I have a hard time just coming up with low carb meals. That is my biggest issue I am guessing on my night highs.
One of my favorite "guilty"meals is Costco Pulled Pork on romaine leaves with a little cheese. I have 7 or 8 and I am full, it lasts me through the night and my morning bgs are in the low 100s. There was a time before/during Victoza when that would have been called an appetizer as I ate half of what was in the fridge. 21 carbs is a great number to shoot for IMHO, but unless it is heavy on protein/fat I would never make it to the next meal without a mid meal snack.
I have never found a website that had what I thought was the end all/be all meal plan for me. Over time I took ideas from many LCHP websites and turned the fat down to a more moderate level which suited my needs Bernstein has many ideas on this, and it seems to be a hot topic amongst nutritionists, CDEs, and other PWD. Not all are in favor. The link is from another blog and has several recipes that might give you some ideas.
http://www.dsolve.com/wp-content/uploads/2016/06/Low-Carb-Recipes.pdf
The best advice I can give you is to be nice to yourself as you try new foods/ideas, even if they don’t turnout as planned. Since none of us react the same, you have to discover what works best for you.
Just want I think I have it down bang it’s high again. Example I had a salad for dinner with very small amt of dreamfield pasta. Took plenty to cover. 2 hrs later bg at 110. Stayed there. Woke up this am at 298. I just don’t have a clue. Same meal I had the other day. No high. My bg has a mind of its own. The more I try the crazier my sugars are. Even if I don’t eat . I did find a protein drink 21 carbs to take in am. It seems to work as long as I take my insulin 30 min or more before. I am switching to humalog next month since my insurance won’t pay for my novolog maybe that will work better with my Tresiba. I will cut down on my food intake again. Start pouring over recipes again. I just don’t want any complications from these sugar highs. That is my biggest fear. I need to be around. I have a husband with lots of health issues I need to take care of.
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Have you tried having an alcoholic beverage (something with few or no carbs, like a bit of hard liquor either straight or with a calorie free/low cal mixer) in the evening? If it’s your liver kicking out glucose, that would suppress it and would at the very least be a good test of that theory and might even be a way to manage it.
I’m curious why not. If it’s a cost/insurance issue then that’s understandable and nothing more needs to be said. However, if it isn’t, I think at least trying the pump would be your best option for this situation. I’d gamble that nighttime/morning problems are the primary motivation for many to go on the pump who just can’t get it right with injectable basal insulins.
I hate needles. I have a hard time using a nano needle. Can’t get over it. So pens it is
I hate needles as well which is why I would never go back to pens. It’s one insertion every 3 days versus 5 or 6 shots per day. The pump lowered my diabetes stress by 80%.
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If your nighttime basal needs are higher than daytime, Tresiba is not a good choice by itself. You can add a shorter basal like Levemir, taken at night to increase your nighttime basal. In small doses, Levemir only lasts 12 hours, so if you take it at night, it would only be covering you at night and would wear off by morning.
Or you can supplement nighttime basal with a small amount of NPH, also taken at night.
Talk to your Endo about it.