Taking the plunge with Tresiba

I decided today to sign up for an account in order to get some advice from all of you.

Due to some issues with pump therapy (scar tissue, failing sites, lack of available sites), I’ve decided to try out Tresiba but obviously have a bunch of questions. My current therapy consists of basal through the pump and bolus through MDI (Novolog).

Current Basal rates (totaling 17u):
12:00 AM - 4:00 AM = 0.600u
4:00 AM - 6:30 AM = 1.00u
6:30 AM - 12:00 AM = 0.675u

I probably eat roughly 150 to 170 grams of carbs a day, mostly from fruits and starchy veggies. I’m exciting but also a little nervous about making the switch. I’m most exited about the freedom and not having to deal with the infusion sets (been on the pump for around 10 years), but I’m nervous about the dreaded Dawn Phenomenon. I plan to inject the Tresiba around 9 PM each night.

Below are some of my initial questions.

  1. How should I transition to Tresiba? Cold turkey or reduce my basal every day for the next few days? (e.g. 50%, 30%, 0%)
  2. Where do you all inject the Tresiba?
  3. How well does the basal cover your DP? As you can see by my current basal rates, I have around a 50% increase for a few hours in the early morning.

Welcome to TuD, @Adam. I started here with only reading and not posting. That lasted for a good year. I found active participation more rewarding once I started posting.

I’ve used Tresiba with an MDI protocol as well as pairing it up with a pump to deliver boluses, the so-called “untethered” regimen. I just used the cold turkey transition and things worked well for me. One of the advantages of Tresiba carrying the basal load is that I could disconnect from the pump for several hours while maintaining good control. This works especially well if planning on enjoying water activities like a beach vacation.

I injected Tresiba in my abdomen mostly.

This makes using an MDI basal insulin tricky for some of us. I also experimented with various times to inject Tresiba and often used 9 pm. I found that Tresiba (at least in me) didn’t seem to care what time of day I injected.

I finally discovered that if I injected enough Tresiba to control my dawn phenomena then I would go low in the late afternoon.

If I were to go back to using Tresiba, I think I would experiment with the untethered program but use the pump to provide about 25% of the total basal needed. That way I could add insulin in the early morning to provide that needed basal bump. One large benefit of this is that you can avoid the Achilles Heel of pump therapy: rapid movement (hours, not days) into diabetic ketoacidosis (DKA) if pump insulin is unknowingly interrupted. This can happen with a leaky site, bent cannula, or even a site that walls off insulin absorption.

I know running untethered is more complicated than straight pump therapy but I didn’t find it much of a burden. The only reason I stopped doing it was that I started using the automated insulin dosing system, Loop.

Good luck and please provide updates!

I started tresiba about 2 months ago, and slowly took 1 or 2 units less each day for about 3 weeks to a month… but it was worth it, and the eversense cgm definitely helped. I’m a little heavier, so I ended up using about 14 less units than my split lantus doses, but you’ll probably only drop a few units, the only thing I can recommend is to have smarties or bananas around until you decipher the right dose, and try to count carbs correctly during your transition… you won’t have as much control as you did on the pump, but you will be free of the pump hassles… a good insulin pen helps also…I use the Owen Mumford auto pen and the savvio, but in the us you have to get the savvio from Canada

MDI is great, and can be just as good (or in some cases superior) to pumping given the current options available. The problem you may have is finding a Tresiba dose that meets your needs day and night. I would definitely try it, but don’t stop there if it isn’t working for you. There are other basals, such as Levemir, that can be taken twice a day and at different doses to more accurately meet your needs. You’ll read about many people who love Tresiba on this forum, but also plenty of others, like me, who were frustrated by its lack of flexibility but had success on MDI with Levemir or Lantus. Also make sure you get a pen that doses in half units for Novolog (the NovoPen Echo). I’d also recommend trying Fiasp, which works so much faster than Novolog. Lastly, make sure you find a way to emulate square wave/extended boluses on MDI or you will be frustrated when eating anything that digests for hours. You can take multiple injections or use Regular insulin which takes roughly 45 min to 1 hr to kick in and lasts 6-8 hours.

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Your problems with Tresiba mirror mine, but this make sense given how inflexible it is since it can only be taken at one dose that supposedly lasts 24+ hours. Have you tried taking Levemir or Lantus in split doses? I’m surprised you always say you would go back to Tresiba if ever on MDI again, when there might be better options that come close to solving the problems you had with it.

I’ve tried Levemir and Lantus in the past with no luck, but my diet was completely different back then. If Tresiba doesn’t work, I may try Levemir again.

I’ve been using Novolog for a long time. Haven’t heard of Fiasp, but it’s worth looking into. I assume the onset is a little quicker?

Thanks @Terry4 I will definitely keep you posted on my results.

You make a good point here. My conclusion about my use of Tresiba is that it was good enough. I guess my success with other methods, like Loop, removed the need to explore basal insulin consideration more closely.

Reading your point, I do think experimenting with Levemir dosing twice per day would be a good thing for me. At this point, with a 80%+ time in range (65-140 mg/dL or 3.6-7.8 mmol/L), < 5% hypo, glucose variability approaching that of a non-diabetic and my usual effort only half of previous treatment regimens, I’ve reached a pleasant spot in my diabetes journey.

Your reminder is a good one for me, however. I should consider basal insulins, other than Tresiba, if I’m faced with this decision in the future.

1: The Tresiba will take at least a day to ramp up. Either continue your pump basal for the first day, or cut it back 50%, and check bg’s super frequently.

2: I take Tresiba each evening (ballpark 9PM but sometimes 11PM or 12PM.) As to injection site: I use my belly for my fast acting insulin. I use my rear end or legs for the Tresiba. I can notice that my belly is fast-absorbing and the rest of me is slower absorbing.

3: When I take Tresiba at 9PM, I find it has a broad peak in activity in the 4-6AM hours and does a superb job keeping dawn phenomenon from happening.

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What were your issues with Levemir? Were you taking it twice a day? The impact I find diet has is it can cause your basal needs to increase or decrease overall. When I go through phases when I’m eating a lot of junk food or snacking more throughout the day for example, my basal needs increase. I would think Levemir would be better for this than Tresiba because you can increase or decrease the dose ~12 hours as needed. The other issue diet can cause is digestion of food hours after rapid-acting insulin stops working, causing spikes. This is especially a problem at night, and again another reason I would think Levemir or Lantus are superior, as you can take more at night to combat food spikes as well as meet your basal needs on nights when you have eaten a big meal. As for Fiasp, it’s the same as Novolog but with a couple of additives that speed up its absorption. This does mean it’s out of your system quicker, and so it can lead to spikes if you eat big meals or food high in fat/protein, but this can be combated with Regular insulin or multiple injections after eating. It is much, much faster up front as many on this forum will attest to. I can eat things I couldn’t before without almost any spike. My best advice is to think like a pump if you want to be successful on MDI, and do what you would do if you were pumping. Most people fail on MDI, not because of diet, but because they are just told to take the same amount of basal once every 24 hours, given pens that only dose in whole units which make it difficult to dose or correct accurately, and are told to take one injection of Novolog or Humalog before each meal without thinking of the consequences of fat and protein on digestion.

I was on Levemir over five years ago, so it’s hard to remember the issues. That being said, I know that my sugars were out of control but that doesn’t mean it was b/c of the Levemir.

And yes, I agree that diet changes my basal needs significantly.

I’ve been on tresiba (17u at 9:00 pm) for two days and I’m happy with the results thus far. Below are my Dexcom macros for the past two days.

Time in range: 92%
Lows: 6%
Highs: 2%
Average Glucose: 98 mg/dL
Standard Deviation: 23 mg/dL

I may need to reduce my dose a little based on where I’m trending between meals. I will see what happens this afternoon. Check out the graph below from last night.

Also, the tresiba kept my DP in check which is another plus.

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I decided to give 17u another try (third day at this dosage), but noticed a significant decline overnight (dropped ~40mg/dL from midnight to 4am); therefore, I’m going to reduce my dose by a unit to 16u.

I also noticed some insulin resistance in the afternoon to late evening, which probably has to do with the tresiba profile but I’ll have to perform some basal testing to verify this. I currently take the tresiba at 9pm each night. Anyone else experience this?

Well, 17u is definitely too much. For the past 16/18 hours, I’ve been going super low. Therefore, I cut my dose last night by 10% to 15u. I’m wondering if I need to cut back even more. I’m still going low this morning, but understand it will take a day or two to see the impact of the 10% reduction.

Currently on day three of 15u of tresiba. I’m still taking the tresiba at night (9 pm). Things are definitely starting to settle down, but I’m still trending down slightly during the night. Therefore, I’m going to lower my dose to 14u tonight and see what happens.

Below is my feedback thus far:

  • Tresiba is definitely a very steady basal insulin. In the beginning, I noticed some high sugars in the evening when I first started the insulin, but I believe that was due to the food I was eating. We will see what my evening sugars are like when I change the dose.
  • When exercising, I don’t plunge significantly like I did with the pump.
  • I have to cover all of my snacks/carbs with fast acting insulin (Novolog). When I was on the pump, I ate a banana before a workout. On Tresiba, I have to take some Novolog with the banana or I see a spike.
  • My sugars aren’t crashing as much as when I was on the pump. I don’t think this was necessarily the fault of the pump, I believe it had to do with my sites.
  • When I go low ( < 70 ), eating one or two glucose tablets brings me back up to normal range. This was definitely not the case when I was pumping.

I plan to lower my dose to 14u tonight. Therefore, will report back in a few days.

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I inject on the outer sides of the butt cheeks. Lantus.

Creeped me out to much in the beginning last year doing it in my abdomen like they told me to and in the process of searching if the butt was OK one web page said you get a slower more steady absorption there then any place else.

I was too new to notice a difference as I didn’t know how to eat right yet and was all over the place.

Have been taking 14u for a few days, but now have some confusion.

The first two days at 14u seemed to be great and steady, but yesterday (day three) I was trending high two/three hours post-meal. For example, last night I ate dinner at 4:45 pm. Two hours post-meal, I was 135, but an hour later I was 167 and then two hours later I was 200. I didn’t eat a high fat/protein meal, so I doubt it was the meal. To me, it seemed like the tresiba was wearing off.

So here are my questions. Looking for some guidance based on your experience.

  1. Should I stay with 14u at night and perform a few basal tests to verify things?
  2. Should I move the injection time to the morning? (e.g. 6:00 AM)
  3. Should I split my dose?

I obviously don’t want to make too many changes at once; therefore, I may change the injection time to 6:00 AM, then give it a few more days to see what happens.

Adam, Tresiba can be so long-lasting that it’s easy to overshoot while adjusting dose. Just 5 days ago you were on 17u a day, yes? For several days after that even after lowering your dose, the “17u” was still kinda wearing off.

If after a few more days 14U doesn’t seem to be enough, with constant corrections of short acting necessary, bump it back up to 15u or 16u.

I know this can be hard to get used to after years (in my case nearly 40 years) dealing with insulins that never lasted more than 12 hours and you want to see the effect of a dose change right now (or at least in the next day).

Five days ago I was on 15u, which caused hypos during the night. I’ll give 14u a few more days to see where I end up.

15u might be a better dose overall, but not if it’s giving me hypos at night. That’s why I was asking about changing the time I take the tresiba.

Do a miss a meal basal test, You need the bolus out of your system and then see if it rises or falls from there.

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