Toujeo wears off?

I started on Toujeo around October 1 and had my dose figured out in a couple weeks: 4 units morning and 4 units evening. In early December I lowered the 4 units evening to 3 units. The last couple weeks, my blood sugars are rising starting after around 5 am, although I started a new pen a few days ago. Before Toujeo I was using Humulin N, and my morning blood sugars did the same thing. I had been pleased that Toujeo kept my blood sugars from rising, but I’m losing my excitement about it.

If my Toujeo pens have been unopened and stored in the refrigerator since I got them October 1, I presume that each one should be good as new when I start it. I’ve been taking insulin for almost 30 years, so I’m not a novice, except with Toujeo. I’m noting the same problem in the late afternoon, as my blood sugar begins to rise several hours after lunch. I can take a shot to lower the late-day rise, but for morning blood sugar, I’m asleep and let it go higher. Does Toujeo lose effectiveness as you get used to it?

I can’t speak from experience with Toujeo but I’ve observed my early morning basal needs change. I use a pump and I recently had to change my early morning basal rate a lot. After few weeks with this higher rate my basal needs are retreating close to where they were a few months ago.

The biggest lesson I’ve learned in the last year is that insulin needs change. They are not a “set it and forget it” deal. This month marks my the start of my 33rd year using insulin to treat diabetes.

There are, of course, many other variables that could explain this such as, increased holiday eating, increased evening snacking, less exercise, and even worse insulin absorption due to overuse of favorite injection spots.

I’d bet it’s your body’s natural insulin need variability but you’ll have to discover this yourself. In any case, you need more insulin in the early morning hours. Try restoring your evening dose to 4 units and monitor closely for early morning lows.

Thank you. I know that insulin needs change, but I’m surprised at how quickly Toujeo changed. I had just cut my nighttime dose from 4 to 3 a few weeks ago because my morning blood sugars were starting to drop, and I didn’t want to raise my dose and risk a low, but I guess I’ll try that. I may increase my morning dose too, although waiting to see what effect the evening increase has. My eating is fairly strict, my A1C’s average about 5.7, I’m not overweight at all, and I get aerobic exercise regularly. My eating and exercise were not affected by the holidays.

I’m not sure that Toujeo is going to be the wonder I hoped it was. I was disappointed with Lantus, which is why I finally went back to Humulin N after 10 years of Lantus. But Toujeo apparently is just a repackaging of Lantus. I’ll keep experimenting, as I have some Toujeo left, but I suspect I’ll end up back on N.

Have you considered Tresiba? Again, I have no experience with it but it has an interesting action profile. It’s typically taken only once per 24 hours and has an action curve out to 42 hours. I’ve seen some positive comments from members and their doctors written here. You can locate many threads on TuD using the search term “tresiba” after clicking on the magnifying glass icon in the upper right of your screen.

I hadn’t considered Tresiba. I hadn’t even heard of it. I listened to Bernstein, and I’m very interested in Tresiba, even as I added to my suspicions about Toujeo. “We have a big problem with many Type 1 diabetics where the basal insulin does not even last overnight if you inject it at bedtime. It’s a problem for me and for almost every Type 1 diabetic I have who is not making insulin.” Bernstein prescribes Tresiba twice a day, scoffing at the “1 shot every 2 days” manufacturer’s recommendation. “These wild claims are commonplace amongst insulin manufacturers.”

Wow! So even Bernstein has problems with dawn phenomenon! I’ll use what Toujeo I have until it’s gone, but I won’t order more. I’ll see if I can get Tresiba. (If Tresiba doesn’t do the trick, I’ll go back to N or to generic Lantus, if the price drops enough.) Bernstein concedes it might result in complications that haven’t had time to show up yet, but points out that there’s also a risk in rising blood sugars every day.

Thanks for the tip!!! I’m learning to use tudiabetes: I wish I learned to use it more before now.

Yeah, I was surprised that Bernstein recommended to take Tresiba 2x/day. I think I would start with 1x/day and see how it works. If control is not as good then add a second Tresiba shot. You’d have to divide the total daily dose and split it between the two long-acting injections. Depending on how your blood glucose responds you may need to divide the daily Tresiba unevenly between the two shots.

I don’t know how you get N to work at all. It’s been a long time since I’ve been on MDI and used it. I had some crazy and from-out-of-nowhere lows with N.

Tresiba works over 42 hrs, extremely stable. I don’t see why you’d take it 2 times a day. does Dr. Bernstein mention any reasons for that?

Dr. Bernstein’s theory is that while Treshiba claims to be active and “flat” over 42 hours it is in fact not. And our bodies actually clear active insulin at varying rates during the day (high levels of clearance at night). Thus taking 2 times a day can address both issues.

And when we are told that basal insulin’s are “flat” we have to understand that is based on a measure of “end effect” which is usually achieving a fairly constant glucose infusion rate (GIR) when you have a patient in a insulin clamp. Other complicated actions come into play causing the GIR to flatten out (such as suppress heptatic glucose production). If you look at plasma concentrations of Treshiba over time you will get a vividly different picture of exactly how flat the response is.

The fact is that if you really want a flat basal insulin profile you should probably still use split injections.

I took a mix of R and N. I’ve forgotten exactly what I was taking, but it was something like 4R and 4N because the 4N would carry over to the next meal. At lunch meal I’d take about 3R and 3N (which meant I’d have about 4N units from morning plus 3R units from lunch, with the 3N going forward), and about 1R to 2R and 2N in the evening, with about 1N at bedtime. The two problems were
(1) the N would tend to force me to eat a little at the next mealtime, even if I wasn’t ready to eat. I could reduce that risk by taking a little less N the meal before I expected to eat less or eat later.
(2) the N wouldn’t carry me through the night. My blood sugar would start rising at, say, 5 am. The earlier I got up, the earlier I could take a shot to keep my blood sugar from going as high, but I didn’t usually want to get up at 5:00 or 5:30 on non-workdays.

One advantage I’ll point out of R over Humalog is that R has a longer residual time. If I took Humalog and ate a lot of bread or spaghetti or something with oil in it, my blood sugar could look pretty two hours after a meal but then it would go up, forcing me to take more insulin. Also, when Humalog brought my blood sugar down too much, by the time I realized it was going low, I had less time to prevent it, so the lows were worse than they were with slower R.

I’ve raised my Toujeo evening dose back to 4, and that’s helped, but I’m pessimistic about how long it will do the job, as I already quit Lantus after years of using it, and Toujeo is (as Sons of Apollo shows) another form of Lantus.

this is weird, i’ve heard other people complaining about toujeo wearing off as well, Lex Fleming (of madeulook) said she is back on lantus after an awesome couple of weeks but it stopped working for her as well. why would that happen?

I’d give Tresiba a go.

is Toujeo a ok insulin ??. my endo wants me to try it. but i thought i ask before i did anything.

I imagine it’s pretty good because my understanding is that it’s exactly the same thing as lantus except u300 instead of u100. The notion that they renamed it seems a bit gimicky instead of just calling it u300 lantus. I had good results with lantus (though I think potentially even better with tresiba). I’m not entirely sure why they’d prescribe u300 insulin to a youth onset type 1 like you unless you need a whole lot of insulin, but if it’s what my doctor was recommending I wouldn’t hesitate to use it.

for me it to try to get my bg under control. & right now i’m on 19 units right now. we working on getting everything under control.

Thanks for the detail. I’d love to see the graph that has this together with glargine (lantus) and detemir (levemir) all together. It was my impression after trying Tresiba that it gave a highly stable baseline, and you can see how with 24-hour (1x/day) stacking you could get a pretty flat rate. My result with a 2x/day Levemir regimen is a little different but not too much. For me lantus had some drawbacks but of course everybody’s got their own needs and calibration.
Similarly, it would be really interesting to see the comparable composite graph for humalog, novolog and apidra.

Sorry, I’ve not seen a composite graph of real data like. I’ve seen “made up” graphs, but I don’t believe them.

Toujeo doses were 10-18% higher In the Phase 3 Edition Trials comparing Toujeo to Lantus. Unit for unit Toujeo has less glucose lowering potential than Lantus. The triple concentration does not increase potency. The PK/PD is different from Lantus so don’t be surprised if it takes more units of Toujeo to optimize the fasting glucose.

Eric, why switch to Toujeo when you’re going to start pumping soon? (All you use with a pump is “rapid” acting insulin: Humalog, Novolog, or Apidra, which act as basal insulin when given continuously via the pump.)

Please decode PK/PD.

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right now i think I’m fine on Novolog. i did tell her i don’t want to switch.