Switching from lantus to tresiba or toujeo


#1

currently taking 21 units of lantus am and 4 units pm still getting lows during night and tough not to get highs midmorning.
and recommendations. I have samples of tresiba and toujeo. wondering which one to try or stay with lantus


#2

My insurance moved me to Toujeo and I haven’t had any problems. My doctor gave me a sample of Tresiba, but I have not tried it yet.


#3

No insulin formulation, by itself, will restore your blood glucose to optimal levels. Having said that, the newer insulins have become better over the years. In this case, newer basal insulins produce flatter action curves and for many reduce the daily basal doses down to one per day.

If you’re keeping good records, why don’t you experiment with your Tresiba and Toujeo samples? The best place to start is by seeing a competent doctor, possibly an enodcrinologist, to help guide you.

Last year I experimented with Tresiba as I disconnected from my pump for three months. I told my doctor that I thought using the 7-day basal average over seven days would provide a good starting dose. She agreed. For me that was 14 units/day. I eventually moved that up to 19 units per day.

Tresiba performed very well for me but I wasn’t able to eliminate a morning rise in blood sugar due to dawn phenomena without going low in the late afternoon. There are many people in this community, however, who use Tresiba and enjoy great BG control. Good luck.


#4

My doctor switched me from Lantus (which I had been using for over six years) to Tresiba just over a month ago. I am quite pleased with the results I am getting. The main reason he switched me is that I keep my blood sugar very much in the normal range of 70 to 100. He was concerned that my last A1c was 4.8 and that I was likely going low. This has not been the case. However, I am quite often on the edge using Lantus.

I find that the Tresiba is much flatter, longer lasting and much less likely to put me on that edge of going low. I started out using the same dosage as I was with Lantus (28 units in the morning) after a couple weeks I settled in at 26 units of Tresiba also in the morning. That seems to be working very well for me.

That being said, we are all different. I have seen several posts from people who were not as pleased with their results from Tresiba. But I have not seen anyone have significant issues with it either. If you are having problems with stability it may be helpful. But Terry is right, your basal insulin alone is not the complete answer. It may however be a help.


#5

I agree with the comments above. Tresiba has worked much better for me to keep overnight bg levels flatter. I used Levemir for several years in between Lantus and Tresiba and liked that better than Lantus, though it required 2x/day. Tresiba works fine with once a day.

For morning highs, the only solution that works for me is bolus. You can see more on that in many threads on this forum. Here’s one:


#6

I’ve used both Lantus and Levemir (as pump back up) but I had to inject 2x - once in the morning and once before bed. I’ve tried Tresiba and its pretty flat and I only need to inject it in the morning.

If you go with a once a day insulin like Tresiba and you still fight morning highs, you can just try changing the timing of the injection. It takes 10 or more hours for the insulin to peak, looking at the graphs, so maybe try injecting before bed. Be sure to run any experiments you want to try by your doctor or CDE first.


#7

i love Tresiba! i tried Lantus for 3 weeks, then asked endo for Tresiba. it is stable throughout day and lasts 48 hours but is injected once per day. very simple.


#8

I switched from Lantus to Tresiba and have not had one single 3AM low since the switch. It took me a few weeks to settle on a basal dose for the Tresiba but once “dialed in” it works much more predictably for me than Lantus.


#9

I am just wondering why you are taking the 4 units in the pm, when Lantus is a 24 hour med? You have effectively increased your overnight dose by very nearly 20%.

That being said, I just switched from 44 units of Lantus nightly, to Toujeo, and found no need to even change my dose at all. My fasting bg has remained the same within 0.1 mmol/ml, and I haven’t experienced a night low since. An added bonus with the Toujeo is it is 3:1 vs. Lantus, so the amount injected is a third as much (pen is geared different), and it doesn’t burn NEARLY as much as the Lantus.

So, long and short is,
a pen lasts 3x as long with Toujeo
less pain with Toujeo
better control with Toujeo

Hope this helps.


#10

Now that I am using a dexcom cgm for the past 7 weeks I have gradually stopped doing the split pm dosage. I still have days of highs and some days lows. It has really helped having the dexcom
Mostly eat fish and spinach ,broccoli and green beans for dinner and that has allowed me to stop the pm extra lantus.
Stress really affects my bgas .thanks for all the comments. Being a fishing guide in high season in the Keys with no days off til mid may I’ve decided to stay with lantus for next couple months


#11

I was switched from levimer to lantus maybe 3 years ago. I do split doses,5 am 15 pm. Iam having trouble swimming so will cut my morning dose or eliminate it. Will need to evaluate it. I am hoping lantus will eventually be old enough for a lower copay. No plans to change anything. Nancy


#12

Yes, I’m late to this conversation as Tresiba is old news by now (September 2018). However, after 40+ years on Lantus, I’m finally making the switch.

Here’s one basic (and probably obvious question): If Tresiba lasts 42 hours, and you take it daily, how do the doses not end up eventually “stacking”? Don’t the doses overlap over time, with a new dose every 24 hours? Why no additive effect?

Other than that, I see the general advise it to give it 72 hours or so for things to settle in, and to take slightly less than one’s old Lantus dose to begin with.

Any further advice is very much appreciated.


#13

Well with tresiba I still have nighttime lows and daytime highs but tresiba is more steady in the long run. As far as stacking I’d like to hear more from other tresiba users


#14

Yes, Tresiba doses do “stack” but in a way that gives a flatline of long-term basal dosage. Because your daily dose is a constant XX units, that’s the amount that your body works with on any given day (after the initial few days of startup).
I don’t think Tresiba is active for anything close to 40 hours for me, but it is stable, active for more than 24 hours and pretty forgiving – if I miss an evening dose I’ll just do it the morning with little to no discernible difference.
I’d give several days before evaluating its performance.


#15

Thanks Ed111 for your experience with Lantus and Toujeo.

I have been on Lantus for a few years and am considering asking my endo if I could try a sample of either Toujeo or Tresiba.

I don’t have any complaints with my Lantus, BUT, . . . . I am thinking that it is not lasting a full 24 hours. I would like to try Toujeo and see if there is any difference in my results.

I thought the burning with the Lantus was me hitting a bad spot when injecting as it does not always happen but when it does, wow, it really does burn.


#16

I’m still using the Toujeo quite successfully, with very few lows,(usually caused by heat and exerting myself more than normal), so quite happy with it.
One other thing I have found is choice of needles makes a bit of a difference. I switched from the BD ultra to NoviFine plus, which has a larger diameter base, which helps prevent pushing the needle in too far, as the larger surface area against your skin kind of gives you a better “feel” for skin contact, if that makes sense). I feel that has helped cut down on some of those burning shots as well, by not allowing the needle to go as far under the skin.

Ed Burgers

Snowman1_23@hotmail.com


#17

I have a question for tresiba users, how long do you wait to make an adjustment? Recently I killed my pump (not on purpose!!!). On Sunday I started on tresiba, however I think I need to lower the dose, but I’m not sure how long I should wait to have it settle? I started with 16 units at bed time, but reduced to 14 for the past 3 days. I am still trending low, should I reduce by 1 unit or wait?


#18

I switched from Lantus to Tresiba a few weeks ago. Eventually I found my right dosage, and then it worked like a charm. Flat basal all day long (except for very mild waking phenomenon).

Now things are different again, but that’s because I started exercising more. Tresiba dosage is going down as a result. This is the one disadvantage of Tresiba: Dosage changes take longer to take effect. But, well, that comes with the territory, I’d say. You either have an ultralong basal or a basal that you can change quickly. Can’t have both. (Pumps are an entirely different category.)

So, I am trying to establish a regular workout schedule to maintain exercise-induced insulin sensitivity. Which is not a bad thing to do anyway.


#19

I made the switch also after having used a sample of the NovoFine PLUS, It does help prevent pushing needle in too far.


#20

OK… insurance ok’d the Tresiba after my doc sent an appeal, and the tell-tale styrofoam box arrived today. Tomorrow morning I’ll take my first dose, after 41 (? maybe had NPH first) years on Lantus. I’m a bit nervous, but will reduce my usual dose by a bit, and see how it goes.