Tresiba Basal Insulin

I’ve put on 2-3 lbs. I think some of it is related to getting the dose right, too much insulin can encourage weight gain. In order to get the basal high enough overnight I seem to end up going low during the day. I haven’t found the right balance.

@Brian_BSC do you split it? I seem to have quite a pronounced DP with it despite splitting the dose. I don’t normally go low during the day unless if I’m unusually active. I still feel like 2-3 lbs is a reasonable weight gain for the switch, I’m just worried that 8 lbs in such a short amount of time is out of control and causes me to be even more IR.

I do split my dose but it doesn’t appear to allow me to profile my dose to get more basal overnight. I mostly split my dose out of habit being on Levemir for years.

That’s the problem I wrestled with using Tresiba. I could get it balanced for a day or two but I lacked consistency. I experimented with Tresiba for three months and then returned to my pump. One member here uses an “untethered” regime that uses Tresiba + a very low level basal with the pump except where Tresiba needs extra help, like dawn phenomena.

I know you don’t use a pump and this would not be useful to you but I think it might be worthwhile for me and possibly others. I thought about and discarded this idea before since this regimen adds, rather than reduces, complexity. For me, a little more complicated is no big deal. The high percentage time in range, few lows, and reduced variability is the real prize.

Good luck with your Tresiba experiment. I found it an amazing insulin, especially it’s flexibility with dose timing.

I’ve been considering a hybrid basal regime. I have a bunch of Levemir pens left. I was thinking of using Tresiba as a basal that keeps me at a good level all day and then just augmenting that with a Levemir shot at night to combat my DP. I was going to talk with my endo about that later this month.

Interesting idea, but what to do about the many hours from bedtime Levemir until DP actually starts?
DP is the principal thing that might get me eventually on a pump. For me, Levemir was pretty good though (split dose) and Tresiba has been even a bit better (single dose).

That will interesting to see the results. I trust you’ll deliver the Tresiba and Levemir in separate doses, right? I’m not certain but I don’t think it may be mixed.

You are right they cannot be mixed. But I do take Humalog and then reuse the pen needle on Tresiba just like I did with Levemir. I asked my endo about the Humalog/Levemir. I probably should ask her about the Humalog/Tresiba.

Actually, Levemir has an onset of 1-3 hours, but is supposed to peak at 8-10 hours. So taking it before bed means that it peaks pretty much right when I want it.

These tendencies confuse me and concern me somewhat… Not in any one particular individuals case but in the big picture that as new technologies come along that could make our treatments more simple and effective like improved basal insulins… Somehow a widespread tendency is to actually use these new tools to complicate our treatment— eg “untethered treatment” “hybrid basal” etc

This concerns me not that any individual wants to do so… We are all free to do what we want. Have no problem with that, but in the big picture it does cause me 2 concerns.

  1. someday we are all likely going to require the assistance of another with our treatment. Whether it’s in old age, whatever. When we’ve further and further complicated the plan over the years to the point that nobody by ourselves understands it-- where does that leave us when we ourselves can no longer understand it?

  2. when breakthroughs in technology no longer stand to enjoy full fruits of their labor, the incentive to produce breakthrough technology is diminished. Eg everyone starts mixing tresiba with levemir or using it with a pump untethered, the drug is only half as successful commercially as it otherwise would be, and the next great breakthrough only has 50% the incentive to come to market.

I wonder if we’ve reach a point of diminishing returns with our treatment complexity sometimes.

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That is a very interesting option!
Would you then only take Tresiba once and Levemir once, or would you keep splitting Tresiba and just add an extra shot of Levemir?

I have to say, I’ve been toying with the idea of possibly taking a shot of Novolin 70/30 to cover my protein intake for dinner plus combat my DP in the morning. I already take R for dinner which seems to work nicely though can drop me at times as well right before bedtime. Of course, I never really have to worry about going low at night as DP seems to correct all of that all on its own.

I think that if I do that, I will continue splitting Tresiba. I just wonder if taking so many different kinds of insulin might not complicate things due to the different peaks and timing, then having to keep track of all of it.

If that’s your experience, great, sounds like you might have found a good solution. Thanks for link, interesting to read, but in the YDMV theme, I had fairly different results than those shown in the table. And lumping Apidra with Novolog is definitely an apples and oranges comparison for me.

I would probably just take Tresiba in the morning and Levemir at night. I previously had tried Levemir augmented with NPH in an attempt to get higher levels overnight. And this is just a thought at this time. And part of my toyng with the mixed regime is that I actually have like a two month supply of Levemir sitting in my fridge.

ps. And while YDMV, the link I provided was from the site run by John Walsh who wrote Using Insulin and Pumping Insulin.

I’d think of this particular example as more of an off label kind of use which would actually expand the market and utility of the new product rather than dimishing its overall use. For most people the simplicity of new products will certainly be a principal part of the attraction.
What to do in very old age? … well, that’s a whole separate discussion … There’s a cure just five years away, right?

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Hey guys - just jumping in. Dr. Bernstein recently talked about Tresiba and said that he tells all of his new patients who are using Tresiba to take it twice a day mandatory.

He said morning and before bed. I’ve been on it once a day but i do tend to spike a bit at night if I have a large protein meal. I am a low carber.

Thanks

You make a good point, but when I start having the same thoughts, I remind myself that the people creating complex regimens for themselves are a small percentage of the overall population of people with diabetes. I’m totally guessing, but I bet at least 90% of those enjoying the benefits of Tresiba are using it as intended with no added steps.

Why in the world would you take an insulin that lasts ~ 42 hours twice daily? Does he give any reason or are we supposed to just take the guru at his word? Once a day works wonderful for me I would not do this unless he can state an actual reason.

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If I recall correctly his reason was “because they lie”
Whatever that means…

I don’t think this is a widespread tendency, Sam. I long ago accepted that a lot of what I do with diabetes tech and treatment is non-standard. I’m comfortable with my residence in the skirts of the bell-curve.

A pump, new insulin formulations, a CGM – they’re merely tools in my book. Human beings are at our creative best when we don’t accept the apparent limits of any technology. That’s when breakthroughs happen. And after a while the breakthroughs are so thoroughly adopted by the mainstream that they’re not seen as novel or creative any longer.

The things that have made my life with diabetes so much better have, to a large extent, come from people with diabetes tinkering around the edges, experimenting, and finding a better way.

The extended bolusing available on a pump is a good example. That feature was available on pumps long before I finally read reports of people figuring out how to dose for protein and fat when using a carb-limited diet. When I tried their techniques and they worked, I was thrilled. It improved the quality of my life a lot. Some people write off techniques like extended bolusing for protein and fat as exotic and needlessly complicated. It can look that way when you first consider it but looking in the rear view mirror, it looks simple and makes great sense. Simplicity and complexity can be a matter of perspective.

I do worry about taking care of my diabetes when I can no longer do it. When I look at the state of our health care system, I have no illusions as to what I can reasonably expect. Most health care givers, even the credentialed ones, would probably fail diabetes 101. What can I do about that?

I can document what I currently do including my pump settings, basal profile, insulin to carb ratio, my insulin sensitivity, etc. But what guarantee do I have that a nursing home I may end up in will follow any of that? It’s a frightful thought and one that I can’t waste much energy on. It falls under the heading of the “things I cannot change.”

In the meantime I will continue to tinker with my diabetes tools because I can. I benefit from this tinkering and it’s not just a rhetorical question.

Well those tendencies are certainly widespread in the discussions on this forum, which account for pretty much 100% of the people I know who are actively managing diabetes. Perhaps it is not a very representative sample…