Should I keep increasing my basal? C'mon Tresiba!


#1

I’m really not sure why Tresiba is doing this to me but here’s what I’m dealing with:

I increase it by a unit (I’m at 18u now), and for the first 7-8 days I do great! My average is always between 120-140, and overnight I’m so stable and averaging at around 100; going to bed at 100, waking up around 100.

Until suddenly, it stops working. I battle my evening highs again, spikes after every meal, doubling on Novolog for every single thing I eat. What gives?

Is this just my body needing more basal insulin? It’s crazy to me because I was only on 15u of Lantus before switching. I keep thinking I have this Tresiba thing figured out, but once that first week is over with a new dose, I’m running into problems again. :frowning:

I am definitely opposite of what so many have found on Tresiba with cutting their doses in half. One thing is for sure; I’m not having many lows at all. Maybe one once a week which is great! But I can’t get around this wall I hit after one week on an increased dose.

Should I just keep increasing it? My daily average after that one week mark is anywhere between 150-190 :confused: and I battle trying to get back to normal and wake up around normal in the morning; it’s like I stay higher.

Any thoughts? I have definitely noticed that it has nothing to do with food. I’ve been sure to eat the same things with this new 18u increase, and was doing so perfectly fine up until now after a week. I’m back to having highs even with just eating salad. It’s making no sense to me. :woman_shrugging:


#2

My crystal ball is empty, but its an interesting post. Why did you switch insulins? Are you committed to the switch?


#3

@mohe0001 Yes I’m committed! My old insurance stopped covering Lantus, but would cover Tresiba. I stocked up and have about 9 boxes of it now, so I don’t want to waste it. It’s also saving me money since I don’t have to fill my insulin for a while which is nice since other expenses have popped up. I have new insurance that would cover another one, but I’m trying to make it work well. I do like that I’m not battling lows constantly like I was on Lantus, so I wouldn’t want to go back to that one. I’m just not sure why this one doesn’t want to work after a week.


#4

Do you take your injections at night? My DD does and we found what we thought seemed like the insulin losing strength as it approached the 24 hour mark. However looking at the graph of the action of tresiba, it sort of looks like maybe it is running thin around hour 42 or 44. We find that splitting it into three spots for the injection makes it last longer. Maybe if you tried six, six and six in different locations you may see a difference. Just spitballing, who knows ydmv.


#5

I ended up taking more tresiba than I used Lantus. As with any insulin, if it’s not enough it’s not enough… I’ve seen several people lately find good results with using half their total dose 2x daily… although I don’t


#6

My Tresiba dose changes all the time. I went from 19 units when I started Tresiba to 21 units after a few weeks. Last week I was taking 24 units and the past couple of days I’ve been taking 22 units and I may need to knock it down even more.

Have you done any basal testing yet? I find that I drop overnight no matter what dose I take so my daytime tests are what I rely on to make sure I’m getting the right dose. Tresiba isn’t the perfect insulin but it is way better than Lantus (at least for me) and I am constantly experimenting with my dosage. I also started to split my dose to combat dawn phenomenon and I find that I am much more stable with this switch.


#7

@Sprocket1 I’ve thought about that! It still isn’t making sense why for 7 days it would work perfectly fine with me taking it at night, then all of a sudden it doesn’t until I increase :frowning: I’m not sure if splitting would be beneficial since my numbers are running higher, no matter the time of day. I’m overall confused by it.


#8

@Firenza Yes I have! Both when I started the new dose, and always after that one week mark both on 17u and 18u. During the first week, I’m steady and no dips or constant highs, like it’s working perfectly. After that, I climb no matter what. Corrections hardly make me go down (I’ll be say 170, take 1 unit Novolog and stay at 170). I’m not running into issues of 200-300 numbers all day like I was before yet, but I’m not nearly close to where I want to be. I’m not having any lows, just dealing with my numbers climbing, some spikes, and finding it really hard to stay closer to normal range. That first 7-8 days though on 18u was smooth sailing. I did some basal testing then, and coasted at 103 for hours which was nice.

I thought about splitting but I don’t deal with dawn phenom; my numbers just climb all day long. I can get to a normal 100 in the morning but with harder work and corrections through the night, but during the day I’m having to increase my boluses and use twice as much Novolog again. I’m lost.


#9

Did you try taking it in the morning instead of at night? Tresiba’s overlapping pattern may mean that your dose is more concentrated at different times (that depend on when you take it). I definitely notice small peaks and valleys on this insulin- which is why I split the dose.

If you need more basal during the day, then it may be worth a try to take it in the morning.


#10

That’s pretty indicative that it’s just not enough basal… don’t worry about how much you took of which insulin in the past, just observe what’s happening today and adjust accordingly…


#11

@katers87 I did for the last week when I was on 17u before increasing again. I didn’t notice any difference in any of my issues. After the one week of an increase dose, it just stops working as well :confused:

@Sam19 That’s what I’m thinking, I just find it strange. I have to do what I have to do though I guess!


#12

Is it possible you’re producing clinically significant amounts of insulin antibodies? All insulins do trigger antibody formation, but it’s usually not enough to make much of a difference. You might be supersensitive.

I’ve also had some odd results with Tresiba. When I increased the dose, the next morning fastings were much lower, even though it’s supposed to take several days for Tresiba to make a difference. But then the numbers crept back up. This happened 4 times. When I asked an endo about it, the first thing he thought of was antibodies.

From package insert:

“Insulin administration may cause the production of insulin antibodies. In rare cases, the presence of such insulin antibodies may necessitate adjustment of the insulin dose to minimize the development of hyper- or hypoglycemia.”

From RxList:

" In studies of adult type 1 diabetes patients, 95.9% of patients who received TRESIBA once daily were positive for anti-insulin antibodies (AIA) at least once during the studies, including 89.7% that were positive at baseline. In studies of type 2 diabetes patients, 31.5% of patients who received TRESIBA once daily were positive for AIA at least once during the studies, including 14.5% that were positive at baseline. The antibody incidence rates for type 2 diabetes may be underreported due to potential assay interference by endogenous insulin in samples in these patients. The presence of antibodies that affect clinical efficacy may necessitate dose adjustments to correct for tendencies toward hyper or hypoglycemia."


#13

I didn’t think about this! Or really understand it, even though I read the side effects prior to taking it. I’m really not sure. I honestly would have been tested if I had thought of it myself! I just had blood work done so I can’t afford more at the moment. I wish there was an easy way to find out, but this would make sense really!

I’m playing around with new foods, seeing if that helps. But really, I wish I could just settle on a dose and be golden. If only diabetes were that easy :roll_eyes:


#14

Daisy, I don’t think testing for antibodies is usually done outside research settings (except for GAD in the newly diagnosed). But you could ask your endo about it.


#15

@gretchen Oh! Well, I wouldn’t go through the trouble. It sucks that something we have to take could cause that, causing issues though and there isn’t any type of way around it. :confused:


#16

Daisy, we don’t know for sure if your problems stem from antibodies. It’s just a suggestion. There are so many factors that affect BG that we can eat the same things as we did yesterday, get the same amount of exercise, but BGs are a little different today. One just try to get good numbers, but there’s no guarantee.

Your situation sounds strange because it was so sudden. Another thing that can have an effect is if the insulin has gone bad. Was it a new pen? Did it sit out in the sun? Did the dog chew on it? I know someone who said her insulin went bad because she kept it in the door of the fridge, which got a lot of vibration from slamming the door, and that apparently made it degrade.


#17

@gretchen I know it was just a suggestion! I just think in general, it sucks that it CAN happen, not that it has happened to me :slight_smile: And it hasn’t been sudden actually; this has been happening since starting Tresiba. The dose will work for a week, then it stops. I’ve been increasing it every month, last month it was twice, to see if the increase in dose helps but it doesn’t. I’m stumped by it really.

I’m sticking with my 18u for now, playing with foods, etc. to see if I can get it to cooperate. Might just be time for my body to need more basal; I’ve been T1D for 6 yrs now, only ever on Lantus and haven’t ever really needed to increase, so it’s possible that’s the cause for it all :woman_shrugging:


#18

Since you’ve only been diabetic for six years then it could definitely be that your beta cells are dying off a bit more and it could be in a sporadic or regular manner. If they are dying off then you probably need extra insulin.

Do you have a c-peptide test result from the last year or so? If you do then next time you go to your Dr. you could ask for a c-peptide test to compare and see if there has been a significant change.


#19

Another possibility is scar tissue. You didn’t say whether you are using a pump. If so, and if you changed sites before the odd results, it could be scar tissue.


#20

@Firenza I don’t! I only had my C-peptide and islet cells tested when I was diagnosed, and they came back basically non existent at that point. I haven’t been offered to have any test like that done since. I’ve only seen one endo and he moved, so only seeing a PCP now. I’ll keep this in mind though, and maybe bring it up when I see her next!

@gretchen No pump, I’m on mdi. No scar tissue or much of it I would say; I use my Novolog in the same places and always rotate too. It doesn’t seem to have any issue working right, as long as my basal is set fine. On Lantus I didn’t have these issues and that was only 3 months ago that I stopped taking it. I did think of this though, so I made sure to rotate around even more just in case it was my injection sites getting worn out!