Anyone like me using Tresiba Basal Only No Bolus? I am trying 15 grams or less carbs per meal to avoid bolus. I started Tresiba on OCT 18 and at first fasting was more around 100. Now I am at 200-250 fasting bg at 18 units per day of Tresiba. I increased to 19 units per day yesterday and will wait a total of 3 days before increasing to 20 units per day.
I wonder if 20 units per day is “HIGH” as I see others taking much less. I am worried due to weight gain of 16 pounds in first two weeks of insulin in October. I am trying to walk more and have started back with yoga. I was at a great weight and this increased weight is very depressing. I feel bloated and eat a low carb diet. I eat very healthy. Today plain greek yogurt 9 grams carb per 1 cup, blueberries, walnuts. Lunch was a salad with cottage cheese, tomatoes dressing and avocado one half.
I can’t figure out what I am doing wrong. I am 54, 5’3" used to weigh 125-130 for many years and am confused why my bg is still too high. I see the endo mid January only second appt with this endo. I think the Tresiba must be too low. I hear others here taking half the Tresiba that I take. I can hardly handle the basal and hate the thought of a bolus for meals.
20 units is not extreme by any means. Don’t fall into the trap of comparing your dosages to other people’s. This is as individual as anything ever gets. Physiologies vary tremendously from person to person; as one of our members likes to say, “if you want to treat diabetes ‘by the book’, you’ll need a separate book for each diabetic.” There are truly enormous variations from person to person in terms of what works successfully. You definitely need to discuss this with your medical team.
I’m going to suggest a possibility that is very low probability. I wouldn’t even mention it except for the fact that your description is so far off the usual bell curve to begin with.
Body chemistries vary wildly from person to person. Some insulins don’t work for some people, and some people have unfavorable reactions to particular ones. Humalog is an example; one of my dear friends can’t use it because she has a severe unpleasant reaction. In my case, it’s utterly useless—might as well be a placebo for all the effect it has. Is Tresiba the only insulin you’ve tried, so far?
Also: you say you haven’t used a bolus insulin. That’s really a different issue, separate and apart from this. If it’s truly your fasting numbers that are out of control, it almost has to be a basal problem. Conventional wisdom is that the basal needs to be dialed in correctly before there is any chance of dealing successfully with the mealtime issue (assuming there even is an issue there to begin with).
Thanks for your thoughts. I was on an insulin in Germany in 2008 and can’t recall what it was but it was a syringe and vial. I gained about 15 pounds immediately. I went off insulin cold turkey after about one year as it was horrible a yo-yo and my bg went to 40 and I thought I was going to die and was eating spoons of sugar on phone with 911. For 2009-2016 I have managed with oral meds, exercise and low carb. Did Paleo diet for a few years. Gestational diabetes in 2000 and diabetic ever since.
I was placed on Lantus in Oct 2016 by my gp as I awaited an endo for 5 months moving to this city in April 16. Prior I was seeing a GP and on Invokana and MEtformin for 2 years, but in past year Invokana stopped working. My bg was going to 500 and knew I had to do something so agreed to insulin. So I was on Lantus from Oct 18-Nov 3 then endo first visit I asked for Tresiba. Have been on Tresiba since Nov 3. I think Tresiba is working, just confused why it was down to 100 range fasting and now past few weeks more like 200. I believe I have an unusual Type 1.5 brittle diabetes, doctors say it is unusual. C-Peptide was only slightly high at last test a few months ago.
I am going to try a walk today and see what happens. I have seen 117 and around this number mid day. It is definitely dawn phenomena for me and morning is typically the highest reading per day. I am just feeling a bit hopeless at this point. So tired of taking the insulin and seeing high numbers. I will try going to 20 tomorrow morning. I do want to hold off on Bolus as I am afraid of going too low and can hardly handle the current insulin one shot per day. I wonder if I am not injecting right, but don’t see any insulin spilling. I have been injecting in thighs and avoiding my stomach. I can’t figure out this weight gain and why I am so hyper sensitive to insulin and weight gain.
I need to get out to walk even though it is rainy it can only help. Thanks again for your help.
What, is, your bedtime numbe, compared to your morning number? Have you tried testing at different times during the night to catch when the rise starts?
I typically don’t use bolus for keto meals, however I do need to make corrections based, on various factors sometimes.
What are your before eating and 2 hours after eating numbers? Are they very close?
With fasting numbers that high you may need to increase by 2 or more units initially, and then in smaller increments as you get closer to target.
Currently fighting a chest infection and levels are not normal…
Has anything changed? Could you have an infection (mouth infections, even apparently mild are known to cause highs in some).
Echo the others - there is no too high dose, there is, only the dose suitable for you?
You more than likely need a combination of basal and bolus insulin, a.k.a. MDI (or alternatively rapid-acting “bolus” insulin delivered by an insulin pump). “Full-blown” Type 1, which the information you’ve provided leads me to believe you have, requires this type of treatment regardless of what you eat or how much exercise you get. You need to see a competent endocrinologist to help you adjust your treatment regimen. Additionally, I highly recommend that you read Gary Scheiner’s Think Like a Pancreas.
Just curious: Why are you avoiding your abdomen as an injection site?
Well I just walked for near one hour and shoveled driveway. it has been two hours since I ate my salad. 217 is my number now. Tomorrow I will increase basal to 20 units-have done 19 units past two days. Unless my number is 100 fasting I am going to 20 units. I have been under a great deal of stress lately. My granddaughter lived with me for 5 months and on Dec 1 I unfortunately had to let her go back to her father as I lost my petition for guardianship. She is almost 4 years old.
Most endos have told me Type 1.5 but they don’t seem to know. I checked out Think Like a Pancreas and read parts of it while caring full time for my granddaughter and working full time. I did not read the entire book. I injected in my stomach ten years ago in Germany and my stomach swelled up as did my entire body. I don’t like injecting into my stomach maybe it is psychological but I already am becoming obese in rapid order on insulin. I seem to be hypersensitive to insulin which is after all a fat storing hormone. I gained a lot of weight with every pregnancy around 60 pounds and lost it each time after a year or so. I swell up and had swollen feet and edema during my pregnancies. I ended up diabetic with the twins 17 years ago during pregnancy. I hope they find a cure to diabetes soon. I am afraid of pumps and just starting this insulin therapy two months ago. I wonder if there are very few on Tresiba only and no other insulin bolus…
I will start checking my bedtime numbers I usually am so tired I just fall asleep. Do some people take insulin at bedtime to help with Dawn Phenomenon?
You’ve already received some good suggestions here so I won’t repeat. This one comment did catch my eye, however:
We have an expression in the diabetes online community, “your diabetes may vary or YDMV.” While we do share many of the same traits many things differ between individuals. I don’t like to see a term like “brittle” being used since it implies to me that the patient and/or practitioner concludes the case is highly unusual and may not respond to reasonable efforts. I think with diabetes “unusual” is usual.
The reason I don’t like reading or hearing this conclusion because it’s often followed with a resignation that nothing can be done to manage the case. Concede defeat without thorough effort. That is not true! You may not discover all the techniques to manage diabetes well right away but you will figure out how to deal with it. Providing you educate yourself, stay motivated, persist, and keep a good attitude.
I hope you continue to participate here. This is a wonderful and effective resource for people like us. If TuD is not the right fit for you, there are many other good places to get peer support. I think this community is special. I rate it right up there with exercise in dealing well with diabetes.
Several issues stemming from the discussion thus far . . .
First, increasing basal from 19 to 20 units is a very minor change. If you are having numbers in the 200 range, a 5% increase in bolus insulin isn’t likely to solve the problem.
Second, remember that basal changes take three to four days to settle in and stabilize. Don’t change it today and then use tomorrow’s numbers as clear evidence of how it is or isn’t working. That can leave you going in circles.
Third, insulin is indeed a fat-storing hormone. Keep in mind that non-diabetic people have ample insulin. With insulin, you are processing food more nearly like a non-diabetic person does; instead of circulating in your blood, glucose is being stored. The point is that the closer to a normal physiology you get, the more the “normal” rules apply. In other words, eat more and you’ll gain weight. Eat less and you’ll lose. There just isn’t any magic shortcut. (How we all wish there was . . . )
Fourth: taking more insulin at bedtime isn’t always safe or effective when dealing with Dawn Phenomenon (or, as one of our admin team likes to call it, “Darn Phenomenon”). One very real danger from doing that is an increase in overnight lows. The safer solutions are, in no particular order, (a) a small bolus in the morning, and (b) a pump with appropriate basal rates.
This is more common with an insulin like Lantus that does not last 24 hours. People will often split their 24-hour Lantus dose between morning and bedtime. Tresiba lasts longer than 24 hours so you don’t need to split it. Another facet of Tresiba is that it doesn’t seem to care about dose timing so much. The only real rule is that you must allow at least 8 hours between doses.
Are you keeping a log? Writing down all your doses and blood glucose numbers and times will help you draw conclusions and illuminate possible tactics to try. It will also help your doctor understand your situation better. You don’t have to commit to a lifetime of logging! Just do it as long as you find it useful. It is a proven technique that will help you.
Oh, and something I forgot. Probably you know this, but just for the sake of due diligence, I have to mention it.
If you are injecting in your thighs, just be sure you are injecting into fat, not muscle; otherwise, absorption may not occur at the proper rate. This is most particularly true for basal (as opposed to bolus) insulin.
It is not uncommon for people with T2 to be started on a basal only regime. And this is often an improvement in treatment but it is not a good regime. It can cause you to use your basal as a mealtime bolus, and basal is a really poor mealtime bolus.
When you just do a basal you can easily set your basal too high as a way of covering your meals. And then what can happen is that your after meal blood sugars can linger high for hours at the same time you insulin levels are higher than needed. This can be a recipe for gaining weight as your liver ramps up to convert all excess blood glucose into fat and the insulin “helps” you store the fat.
The way to establish your proper basal levels is basal testing. This can be done at a first order by taking your basal and going to bed with a normal blood sugar having not eaten or injected bolus insulin for 5 hours. Then you see whether you wake with a blood sugar that is within say 30 mg/dl of where you started. You cannot properly do basal testing if you have eaten or taken bolus insulin within 5 hours or so, it will just mess up the results.
If you find that 12 units of basal keep you flat overnight but you still go high during the day, that is an indication that you need a bolus insulin. You need a bolus insulin to cover your meals, even low carb and to deal with all that manna from heaven that just drives your blood sugar high for now reason.
Seconding what Brian says: it’s very common to start a T2 on basal insulin only, and it’s wrong. It’s wrong precisely because it’s a blanket one-size-fits-all protocol, and it doesn’t fit profiles like yours—which are numerous. The results you’re getting say that loud and clear. I won’t waste space simply reiterating the rest of Brian’s analysis; it’s spot on.
OK thanks for all the input. I guess I have so much to learn. I will be seeing the endo on Jan 12 and will discuss all that has occurred so far. This morning my fasting was 168. I will wait 5 hours from now, test before sleeping and see what my fasting number is in the morning. I did wait three days, going from 18 units to 19 units of basal Tresiba in the morning. Today I took 20 units of basal Tresiba in the morning. I inject into fat not muscle, of which I seem to have a plentiful amount.
I am not a Type 2, I don’t think. I have diagnosed in all categories, but several endos have diagnosed me as a Type 1.5 My current endo says I have characteristics of both but he believes I am a Type 1.5. I don’t take any insulin at bedtime. I take the insulin in the morning around 7-8 am. I take 1000 mg metformin in the morning and 1500 mg of metformin at night.
My endo is older and maybe he is old school. My goal is to get to around 100 and stay in a range around 100 throughout the day without the yoyo lifestyle. I need to find more foods to eat that are low carb or protein. My goal is to walk more, trying to do 1 hour per day of walking of some form of aerobic exercise like I used to do. Yoga 5-6 days per week. I seem to crave chocolate every couple of days. Have been buying sugar free chocolate and low carb chocolate bars with 6-8 grams per bar.
I wish I felt more comfortable with bolus insulin and measuring and pre bolus. I think if I can get my basal number set first, I will feel better about adding the bolus.
You can learn a lot about bolus insulin just by reading. The key characteristics of any insulin are onset, peak, and duration times. It wouldn’t hurt to know more about the topic before you actually start using it. Many people don’t get that advantage. Good luck!
I thought bolus was just for food. I think what I am reading here is that people inject a bolus insulin if they have a high blood sugar when not involving food. This is news to me. If you wake up with a high blood sugar, say 200, do people use a bolus insulin to bring their number down to ~100? I think I need a lot more education before I can start just injecting myself without fully understanding all of this. There is a lot to learn and they certainly don’t tell me at my doctor appointments. We are lucky to have this forum to share and learn and I am still learning and have much to learn! Thanks!
You’re inference is correct. Bolus insulin is used both for nutrition and blood glucose correction. I actually aim for 83 but we all do things somewhat differently. You already know more about diabetes and insulin than about 90% of the public! That’s both impressive and scary.
Why is it that people go high while sleeping? is it the laying still in bed for 8 or so hours? I want to understand the DARN PHENONMENON better. There is going to be a cure one day for this diabetes it is only a matter of TIME!
Dawn (darn) phenomena is our body’s way to prepare for the arrival of a new day. Except people with diabetes distort this natural event due to impaired metabolisms. While the liver may squirt out extra glucose to fuel our waking and preparation to earn a living, yet our metabolism doesn’t also supply the necessary insulin to counterbalance that activity. Everything in our body rises and falls along a daily circadian rhythm. Our temperature, for example, goes up and down in response to the sun and the sleep/wake cycle.
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