Transitioning from Lantus to Tresiba

Everyone is different of course but I find that time of day makes little difference with Tresiba. If I’ve forgotten an evening dose, I’ll do it in the morning, with seemingly little or no change to my basal response. If you prefer morning, I’d just make the switch and go with it … and of course test & correct as always.

Yeah, I think I’ll try out the morning once the Tresiba is properly stable. Sometimes I come home very tired, and just want to crash, so doing it when I wake up makes more sense to me.

Definitely more stable BG today. It is beginning to look amazing. I did not have a rollercoaster BG before with Lantus, but with Tresiba, even the small ebbs and flows seem to be smaller. Also, I did not have to administer correction bolus today. Well, except on one occasion, but that was because someone neglected to tell me that the meatballs I had for lunch today did have a bit of sugar sprinkled in :angry: Not Tresiba’s fault though.

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I’m glad it’s working so well for you :slight_smile:

I suspect it will be a while until the titration is fully done. I wouldn’t be surprised if, after the days of creeping-up BGs and bolus corrections, I’m gonna get days with lows. But I’m glad I’m doing this while I am still honeymooning, since it means that errors in basal are less severe. Also, this way, by the time honeymoon ends, I’ll already be on a stable Tresiba basal, which sounds nice.

Need some help here. I’m having weird issues, and I am not sure if this is because of Tresiba. Here’s a screenshot of what I mean:

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Since I was seeing weird behavior, I did a test. I injected 0.8 units of Humalog (I prepared fast acting carbs to keep the BG from dropping too low). As you can see, the BG decrease started as expected. But then, suddenly, there’s this weird peak. It dropped back to 87 mg/dL … and has remained there so far. And notice that it has only been ~1 hour after injection, so the insulin is still active. And yet, the BG does not drop!

What the hell? What is wrong here? This completely destroys any usefulness bolusing might have. Any suggestions? Could this be Tresiba dosages not being large enough? Or perhaps stress hormones (I did not get much sleep)?

EDIT: I figure that this question would fit better over here.

Is that a Dexcom CGM? I notice with my dex g5 sudden temperature changes do the same to me. I can tell when I take a shower or jump in the hot tub as I see the same thing. Heat makes my cgm jump up and cold makes me go down. My cgm is far from perfect, but as I begin to understand what makes it display erroniously I begin to appreciate it more and more and just ignore the readings while I’m doing something that I know will skew the reading.

I do wish the manufactures would tell us what can skew the results though, as it took me quite a while to learn about “compression lows”, I was calibrating them in the middle of the night when my low alarms would go off. Now if I get an abnormal reading from a sudden temperature change (shower, hot tub, cool air blowing in the direction of my cgm) or a compression (sleeping on my stomach) I don’t calibrate the meter. My overall accuracy of my cgm is much better without the over calibrations that I was doing previously.

Nope, it is a Libre. And I am sitting in a room with AC.

If I see a random increase like that followed by dropping back down I chalk it up to sensor error because I know that my BG is unlikely to do that. If it is real and you confirmed it with a finger stick then I would say that you have diabetes and it sometimes does things that you probably won’t be able to explain.

At this point you seem to really be sweating the small stuff and as your diabetes progresses you’ll will see so many little things that will leave you scratching your head that you will develop a mantra “If I can think of a reason for it right away then I can correct it (or prevent it) otherwise I’ll let it go”. I’m not saying that you shouldn’t look for answers just that you may be causing yourself undue stress with this kind of questioning.

I think I did not emphasize my concern fully. The peak was not the concern - the lack of BG drop was. You’d expect the BG to drop more. Instead, it suddenly just stopped dropping. This is concerning, because what if this occurs during a meal? All of a sudden you get spikes from the meal even though you dosed correctly. Or what if this happens during a correction bolus? This is not “small stuff”, it can break your mealtime bolus, which is a big deal.

It means you’ll go high or take more when you see that you are spiking. Sometimes you will have high blood sugars no matter how hard you try and how right you do everything. It sucks.

Hm I suppose. But today has been much better so far. I increased the Tresiba dose a bit, and BG has been behaving much nicer. Let’s see how it continues.

If I have one tip on MDI it’s that I’d rather take a little too much basal than a little too little. I find even slightly less basal than I need causes massive problems, but slightly more, while it might cause me to eat a little more at times, just smoothes everything out so nicely!

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That’s what I suspected as well. I’m at 12 units of Tresiba now. Prior to that, I was on 10 Lantus. This was a slight increase, since I was having problems with Lantus as well back then when I was using 8 units. Maybe a product of fading honeymoon. It is also possible that I’ll have to titrate down the 12 units, but only if really necessary.

You’ll know when your honeymoon ends. I was so used to eating almost whatever I wanted, just dialing the carbs into my pump and seeing numbers between 4 and 7 (or whatever that is x 18 in American) when I tested. I thought diabetes was so easy and all it takes is a pump and carb counting. Then about 3 years in I was suddenly 15-18 after everything I ate and learned how diabetes actually works!

My honeymoon is not that strong. I notice things like stress, lack of sleep (which is just another form of stress for the body), exercise effects on the BG. And if I am off even by a little bit with my bolus, it heavily impacts my BG. I also think I’m noticing a slight dawn phenomenon. And the current heat caused slight chaos in my BG… So things like pre-bolus, careful choice of food (always mixing carbs with fats and protein and fiber for example), eating slowly if necessary (bread is one example) etc. are not optional for me. Otherwise, I get BGs north of 180 mg/dL (or 10 in your units) very quickly and easily.

EDIT: I’m still honeymooning after almost half a year though. C-peptide levels were are 0.81 ng/ml. (Lab’s reference range is 1.10 - 4.40 ng/ml.) So I suspect that I’ll have a not so strong but prolonged honeymoon, also because I classify as LADA. My hope is that honeymoon lasts at least until closed loop pump functionality is more established, or better yet, dual-hormone closed loop pumps are available. That’d be great :slight_smile:

I’m not that excited anymore. I think as long as they deliver insulin subcutaneously instead of directly to the portal vein there will always be problems and they won’t come close to how a pancreas works. I’m sure they will help a lot of people who struggle, but I don’t think they’re going to be as useful for those of us able to maintain tight control using manual methods.

Oh I am. I’ve seen figures from people who do DIY looping, and they are pretty awesome. The real gain isn’t so much about good numbers, since you can get that with tight control as well. No, the real gain is that you can get good to excellent control with much less manual intervention, thereby easing the burden that is T1D management. For example, after eating an unknown meal, such a closed loop can attempt to auto-correct late BG spikes, and only alert you if the BG still wont come down. A big improvement over having to closely watch the CGM graph yourself, right? Same if you injected too much - the algorithm detects a potential hypo, shuts off insulin, and minimizes the risk of a hypo actually occurring. This is of course not nearly as efficient as real beta cells, but it is exciting. (Please note that the 670g is a very conservative hybrid closed loop device, and others, especially DIY loops such as AndroidAPS or OpenAPS, are vastly more advanced and efficient.)

During the night it would be most useful to me, as I don’t bother with CGM alarms anymore so I can get some sleep and it’s very hard to prevent overnight spikes from food that digests later on no matter how hard I try. I understand the 670G is not a good representation of what looping can do. I still think subQ injection needs to be fixed before these things can really work though. Also I swear I’m not one of those big pharma is hiding the cure from us conspiracy people, but part of me feels like the goal shouldn’t be to be perpetually attached to more and more complex machines that require on-going purchases from a single for-profit company. I understand how hard managing type 1 is for so many people, especially parents of t1 children, so I’m not saying these devices aren’t needed and won’t be game-changing, but there is a part of me that thinks this is the wrong direction long-term.

I too think that these devices are an intermediate solution. Mid- to long-term, my bet is on smart insulin, aka glucose responsive insulin. Then, T1D management is reduced to one injection daily. The smart insulin then quickly hits the bloodstream similar to a rapid acting insulin, and stays there for the day, in an inert form, encapsulated. The encapsulation is lowered in the higher presence of glucose, and raised when there’s less glucose around. Result: almost perfect glycemic control with just one daily injection.

Not a real cure, but definitely a functional one.

The real cure would of course be (1) immune system tolerance buildup (to stop its beta cell attacks) and (2) beta cell regrowth / implantation. (2) could be done also if the beta cells can be encapsulated, which is currently a big area of research.

But the reason why I think smart insulin will come first is that it is THE product for pharma companies. The first company that develops stable, functioning smart insulin will totally own the insulin market. Everybody will want it. It will be a disruptive development.