Transition Levemir to one shot PM Tresiba

So, I picked up sample of Tresiba this morning at endo’s office. I’ve been told two things today as Endo was not in office.

I take split dose of levemir 4units AM and 4units PM. I took my 4units AM Levemir at 8AM this morning and was told to take the full 8 units one dose of Tresiba this evening at 8pm…stay on that unitl monday and call office.

Then, CDE just sent me an email telling me to, since I took my 4units AM dose of Levemir this morning, to skip my Levemir PM dose tonight, SKIP my AM dose of Levemir tomorrow morning…THEN take a full 8 units PM dose of Tresiba tomorrow night. Can this be right?

The problem with Levemir is it doesn’t last long enough for me, per dose…I think. (sometimes I don’t know what the problem is). How can a type 1 go this long without any basal on board?

Any advice, suggestions…PLEASE?


Your CDE’s advice is very cautious. I looked up the duration of Levemir action in the package insert and found its duration of action as “up to 24 hours.” I know that insulin duration is partly a function of the size of the dose. All other things being equal, a larger dose of long acting insulin will last longer than a smaller dose.

That being said, your dose of Levemir at 8 units is relatively small. I suspect that it will not last the full 24 hours. Even if it does, its effect will likely wear out before the next evening. According to your CDE’s directions it sounds like to me you will be without any basal insulin in your system from the time your PM dose wears out until the following evening with your initial dose of Tresiba.

I am not a doctor and I’ve never taken Levemir so I am not qualified to give you any medical advice. What I will say is what I would likely do under similar circumstaances.

I would go ahead and follow your CDE’s instructions but I would keep a close watch on blood sugar levels during the next day. If you blood sugar starts to rise I would consider adding the Tresiba dose as early as 4 p.m. the next day. Tresiba is very forgiving as to the timing of its dose and you could easily give the second day dose at 8 p.m. with little likely ill effect.

That’s what I would do if it were me and of course, you are the one with skin in the game and the ultimate authority. In any case be sure to check your BG frequently and keep emergency glucose handy. Do not hesitate to set an alarm or two to wake you up to check during sleep time.

Good luck with starting Tresiba. I’ve used it and was impressed with its performance.


Thanks, Terry. actually my endo, whom is off today, just called me directly and told me to start tresiba Saturday night…to take 4 units levemir tonight, take 2 units levemir tomorrow morning and then my full one night time dose of Tresiba Saturday night…and actually, the size of dose doesn’t really make any basal MDI last longer…the analogy I use is: if I take one tylenol it lasts 4 or 6 hours, if i take 2 tylenol the dose is increased and stronger but it still only lasts 4 to 6 hours, if that makes sense? Thus, that’s been my problem with Levemir (or Lantus) it only lasts as long as it’s going to last…adding more makes it stronger, I just then go low especially when it kicks in, but burn out of it too soon.

Are you still on MDI with Tresiba and no pump?

I edited my first response, so I’m hoping you reloaded to the page to get my edited answer. Your endo’s plan sounds reasonable to me. If you go high, it won’t last very long.

Good luck with your start.

No, I returned to pump therapy after about 60 days on Tresiba + Apidra pens. I wasn’t happy with my overnight control. I have a relatively strong dawn effect and need a prominent basal bump from 3-9 a.m., something my pump does better than Tresiba.

Your basal doses are very small to notice any of this effect. I’m thinking if you were taking 20-30 units of a basal insulin, you may notice a longer duration. This is a more common effect with insulin resistant T2Ds that might take even 40+ units of long acting basal insulin.

Very true, thanks. That’s why a split dose never really worked for me either, the doses are just smaller. Well, I too have strong DP…I’m hoping this one dose tresiba overnight will work…I’ve never woken to a good number. THANKS!

You could also follow your CDE’s original advice and correct with a little rapid-acting insulin throughout the day, if you see a rise. That;s similar to what I used to do on full-day fasting days (on an endocrinologist’s advice). I would take my usual night time dose the night before and skip the morning dose, but correct throughout the day if necessary - taking my regular basal the following night.

Of course, I am not a doctor and also never tried Tresiba, but that’s probably what I would do.

The part that I bolded is actually not true. The Tylenol analogy does not translate very well to the use of insulin. For relatively low doses of insulin, this may be reasonably accurate to a certain extent. But when comparing a small dose of basal insulin to a much larger dose of basal insulin, the larger dose actually does “last longer” to the extent that its actual efficacy is extended temporally.

ah…OK, not by what my Endo, pharmacist, and two CDE’s have told me but again I’m using smaller doses so maybe they’re just referring to me specifically. If one takes 32 units vs. 20 units it’s still only supposed to last 24 hours…maybe it will last only 20, who knows but they don’t dose it with the understanding it could last 30 hours if dose is higher. thanks. Again, there are so many variables in terms of ‘efficacy’, it’s not linear…

The way it works is that a smaller-than-needed dose may not last the full amount of time it is “supposed to” last. A dose large enough to be effective will come closer to lasting the full time that the particular insulin is “supposed to” last.

In other words, let’s say that you actually require 30 units. A 30-unit dose will theoretically last 24 hours. A 32- or 40-unit dose will also theoretically last 24 hours, but a 40-unit dose may cause you to go dangerously low. If what you need is 30 units, a 20-unit dose may not actually last the full 24 hours.

Insulin, like may other meds, can be quite tricky. It has a lot to do with how something is metabolized over time and it becomes confusing when the degradation is not linear in nature.

Yes…I know…for some small doses work fine… that 20 unit dose could cause someone to go dangerously low too and could indeed last 24 hours for some or maybe only 10 hours for others…it’s dependent on how one’s body uses the insulin, where injected and so many other variables, too. Thanks.

The way that I heard the “theory of large doses” from Bernstein is that you should simply the dose into a “sphere.” The dose size measures the “volume.” But the absorption is proportional to the “area” since the insulin has to leave the sphere to enter the body. If you have a dose of 8 units that would have an area of 4. But if you have a dose twice that size, the are of the dose would be something like 6.3. The larger the dose, proportionally the smaller the area of absorption and the longer/poorer absorption. This is why Bernstein recommends breaking large injections into small injections of 7 units or less.


Hum, so this what I’ve hard too…

Adding a snippet . . . the other reason the tylenol analogy doesn’t work is that it’s comparing apples to oranges, procedurally speaking. Taking two tylenol will result in approximately double the amount in your system, but for the same period of time. That part is true.

However, that’s not how you do a split dose of basal insulin. Those two are administered hours apart, not at the same time. So the overlap is less by some amount, potentially a lot. It’s a different scenario.

the split dose has nothing to do with the tylenol analogy…it’s just adding more insulin - more units which makes it stronger but doesn’t make it necessarily last longer…splitting a dose never made it last longer either, that never made any sense to me; the doses then become smaller so less potent, too. it lasts as long as it lasts, i.e., taking a larger dose of basal isn’t going to make it last for 2 days LOL, it makes it stronger.

the tylenol analogy is what works, it’s what Endo, CDE and pharmacist suggested, too. thanks.

Hi, I take Lantus, just one shot of 12 units taken at night but until recently, I had taken just 9 units every night for about 2.5 years.

Even with just taking 9 units, my Lantus has lasted at least 24 hours. It is my belief that it is not the difference in the number of units that dictates if the dose will last 24 hours, it is the difference in people.

What I am trying to say is, for some people, a certain amount of insulin will last a certain amount of time, and in other people, it won’t, regardless of the amount taken. But, that is just my opinion.

However, I do know that even when taking as small of a dose as 9 units, Lantus lasts over 24 hours for me. I also know that it does for many others, but for many others, it doesn’t.

Just like in everything else, we are all different in how medicines, including insulin, works in our system.

1 Like

thanks, ‘stang’…that’s exactly right and what my endo, CDE and pharmacist said, too. it’s what I’ve and most others have experienced, too…the dose is going to last as long as it lasts…I can take 4u or 6u, AM dose of levemir it still lasts only about 9 hours for me…a bigger dose just causes me to go low. It’s just the way my body absorbs the insulin. That’s why the tylenol analogy works, larger dose makes it stronger, it really doesn’t make it last longer. thanks!

You’re right about the tylenol analogy; I was reading it backwards. Is there such a thing as conceptual dyslexia? :confounded:

1 Like

Yes David there is.
For dyslexia info I recommend Dr. Sally Shaywitz at the Yale Center for Dyslexia and Creativity.

Not that you asked. Just sharing info.

I’m thinking of making a contribution to that new lobbying group, DAM (Mothers Against Dyslexia). :sunglasses: