I’ve recently switched to Tresiba and have a few concerns, specifically about it’s “ramp-up” to a steady-state. My doctor switched me from Tresiba to Lantus because I told her Lantus didn’t seem to be lasting ~24 hours so I was usually taking it 16-24 hours after the previous injection, primarily when I would notice my blood sugar trending up (I test every 2-4 hours). However, this method seemed to be working fine with me usually taking Lantus in the morning and after a few hours it would begin to combat my dawn effect. Here’s a recent example for reference:
4am: 118 (fasted)
7:30am: 128 (injected 5u Lantus) (fasted)
10am: 117 (fasted)
1pm: 98 (fasted)
430pm: 120 (this was after a lunch of 32oz. of steak at ~2pm, no rapid-acting insulin)
My doctor said at such low doses Lantus tends to not work for a full ~24 hours so Tresiba would likely be a better option for me since it lasts longer and is overall a steadier basal. She prescribed 4u daily but I started at 3u for two days, increased to 4u for two days, now I’m on my 3rd day being at 5u and my fasting blood sugars still aren’t as good as it was on Lantus although it’s SLIGHTLY improved. For example, I would wake up at 4am with a 130 blood sugar, take 5u Tresiba, and at 8am my blood sugar would be 150. I wasn’t having this issue with Lantus.
My main concern is if there is any information about Tresiba taking this long, or maybe longer, weeks perhaps, to ramp-up and actually start working as a basal insulin. based on my testing it seems like it has no on-set whereas Lantus has a slow onset over about 1-3 hours. I’ve also read because Tresiba is so long-lasting that titrating doses should only be done every 3 days, now that’s a clue to how slow this insulin actually settles in and actually starts working properly. To me this is rather annoying, having different dosages linger around, whereas with Lantus you can titrate daily and it’s in and out of you each day, you can make fine adjustments each day, much more convenient, at least in my view.
To provide a bit more background information into my current situation. I’m also on Humalog but I only take it to correct blood sugars over 140, I don’t take it with meals because I only eat beef, water, and salt. When I was on Lantus I rarely, if ever, need to take Humalog. But with Tresiba, I’ve been needing to correct my morning blood sugars (6am-10am ish) and sometimes nightly (12am ish) but during the day my blood sugars are fine. I eat two meals a day, usually fasting for 14-18 hours each day. Due to this system It’s pretty easy to notice trends and differences in Lantus vs. Tresiba since there aren’t many other variables to account for such as carbs, rapid-acting insulins, etc.
I’m sure I’ve left out pertinent information so if anyone has any questions or is confused about anything I’ll try to clear things up. Thanks for any help in advance!