Tresiba (Degludec) Vs. Lantus (Glargine)

Type 1 and LADA
1

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)
7pm: 79

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!

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Welcome to TUD @anon7061735! That’s kind of a tricky one. I don’t have any experience with Tresiba, but what your dr said about Lantus may apply: that such low doses may alter how it behaves. Hopefully someone who has been using Tresiba can respond. I guess there’s always the option of going back to Lantus if that was more advantageous for you.

I’m curious about your very restricted diet (dunno if you’re familiar with Owsley Stanley, but it sounds a lot like his diet). Do you use any nutritional supplements
at all, or where are you getting your vitamin C from?

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Thanks for the warm welcome! I suppose I’ll just have to keep experimenting with Tresiba for a bit longer and go from there based on the results.

In regard to my diet, I’m sorry but I’m not familiar with the man you mentioned. However, I have researched extensively and have found that quality cuts of beef contain all essential vitamins & minerals essential to life. It’s true that beef has only trace amounts of vitamin c, but when one does not consume carbohydrate their vitamin c requirements go down substantially. Vitamin c is molecularly identical to glucose, so your cells compete for its uptake. To prevent scurvy on a high carb diet you need 10mg daily of vitamin c, on a beef only diet this requirement is even less.

So to answer your question, yes I do take supplements, but not as many as I did originally and I plan to take even less eventually stopping altogether, potentially weening off all supplements except Himalayan pink salt which has up to 84 minerals. I started off with fiber, multivitamins, cinnamon, and a slew of other vitamins. Essentially taking about 6-8 a day. Now I am only taking d3, Apple cider vinegar, and alpha lipoic, all in capsule form. I plan to stop taking these sometime in the future but may opt to continue taking d3 during winter months.

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Interesting—you’ve clearly given it a lot of study.

Owsley was a figure from the 60’s, kind of a genius in his way, and associated with the Grateful Dead and the counter-culture of the period. One of the things he was known for was that, like you, he maintained an all-beef diet.

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I was comfortable making dosage changes after 3 days at a dose. It took about that much time for me to see the full effect of a dosage change. Some people see the effects of dose changes sooner though.

I didn’t experience anything like this. It took about a week for the insulin to ramp up, and I dialed in my dose after around 2-3 weeks of experimenting. My final dose was within ±1 units of my Lantus dose. I was taking 23 units though- significantly more than you are.

Also, welcome to the forum! I hope Tresiba works out for you once you get your dose dialed in.

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Oh that’s before my time, but it seems that this diet isn’t anything new. I’ll look into him and see if I can find any studies or anecdotal literature about his diet

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Thank you, this is really helpful information.

Personally speaking, don’t you find it annoying that titrations on Tresiba can only be done every 3 days? Whereas Lantus you can titrate daily and see the effects because it’s typically in an out each day. I’ll attach a picture for reference. Let me know your thoughts

insulin
insulin.PNG684×523 96 KB

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Yes, I found it very annoying. I used Tresiba for 1.5 years before I switched back to Lantus.

There were lots of things I liked about Tresiba, but my basal doses vary with exercise frequency and my monthly cycle. I also have different basal needs when traveling. I need to be able to change my basal dose daily.

I think Tresiba is a really good fit for someone who has a routine schedule where their basal needs don’t change regularly. I really liked how it wasn’t a big deal if I took a dose late, and I liked only needing to take a dose once per day (I inject 2x per day with Lantus).

My basal needs just vary too much so it wasn’t a good fit. Ive spoken to others who saw the full effect of a dose change much sooner, so it definitely varies from person to person.

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Oh so you’ve actually discontinued Tresiba and have gone back to Lantus? That’s very insightful information. Do you have experience with any others long-acting insulins?

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Yes, I switched back. Lots of other people love Tresiba though. Just depends on your needs.

I used NPH when I was a child, but it’s very different than Lantus or Tresiba. It has a very pronounced peak.

I’m familiar with Levemir, but I haven’t used it. My understanding is that it’s more sensitive to dose size than Lantus is.

Were you doing 2 shots/day of Lantus?

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No, I was only doing one injection each day of Lantus, typically at some point in the morning when I noticed my dawn phenomenon starting, although Lantus sometimes prevented it. So typically I would inject one shot a day but not always 24 hours apart. Sometimes ~18 hours but also sometimes past 24 hours such as 32 or 36 hours. On the low dose of 5 I noticed I would need another shot every ~18 hours. When I was taking 8 or 10 I would need to take a shot every 36 hours or risk a possible low from stacking

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I’ve been on Tresiba for 2 years and for the most part it is better than Lantus for me. I do have issues due to hormonal changes etc. with Tresiba being so long lasting. I will freely switch back and forth 1-2 units without waiting for the 3 days since if I personally did that I would either be low for two days or high for two days but this was only after really figuring out how Tresiba works in my body. I personally wouldn’t willingly go back to Lantus since I would have terrible unpredictable lows on it but I would consider going on Levemir since the ability to easily change the dose is appealing.

I’ve been a diabetic for 27+ years so I’ve used many insulins. It took me several weeks to get to a baseline dose with Tresiba and my dose was quite a bit different than Lantus although I don’t remember how much.

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That’s interesting but certainly not surprising. As far as I know Tresiba has a much flatter profile and far less variability than Lantus, up to 4x. Considering this, that’s why I though the Tresiba vs Lantus debate was basically a no brainer, with Tresiba easily winning. However I do still believe Tresiba is probably superior for most people, it’s definitely not an easy switch and each insulin has its pros and cons

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I was on Tresiba for 2.5 years and it worked very well for me. I had some issues with morning highs but the addition of Trulicity evened that out. I used Humalog as well.

Then the insurance formulary changed and I had to switch out to Toujeo which didn’t work well for me at all. I had to take 1.5x more than Tresiba for it to be effective and had to swap out Trulicity for Victoza since the morning highs were a regular occurrence. (Victoza’s peak effect is 8-12 hours after injection, I’d take it at 8pm to coincide with the morning creep that started at 4am)

The formulation of Tresiba is different than Lantus so you have to be patient about titrating up/down and give it at least 3 days to see if that’s going to be effective for you.

In the end though, you have to decide which insulin therapy regimen works best for your diabetes.

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I haven’t seen a method like that before. It seems like it would be difficult to stay on top of it, especially while sleeping! Hopefully Tresiba works out for you because it sounds much easier.

With Lantus, I split my dose into 2 shots/day. Lantus typically lasts about 20 hours for me. I time the small peak (at 5-6 hours) of each dose to align with the times I need more basal, and I align the 4 hour gap (between the 20-24 hour marks of each dose) with when I need less basal. This generally works pretty well for me, and I’m able to change my dose easily.

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Sometimes I can’t resist the obscure cultural reference. He definitely thought there were scientific reasons behind his diet, but I don’t know if you’ll find much about it from an analytical p.o.v. An intriguing character from a historical p.o.v. though, if your interests bend that way. Mainly he’s known for being the legendary dark genius who concocted the LSD that drove a lot of the cultural transformation back then. And an electronics whiz who designed and built the band’s sound systems.

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This is basically the same information I found doing a quick search on him lol

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Doing some more research, trying to make Tresiba work, and I’m kinda confused about something. On this graph, there is a (n=27) marker. My best guess is that it’s the number of participants tracked for the given study, such as data collected from 27 patients. I see this (n=x) in other literature but haven’t come to fully understand what it means. Hopefully someone can inform me. Thanks in advance!

yup
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Yes that’s correct in all scientific research studies the value “N” refers to the study size - in this case the number of participants in each group. Realize the larger the “N” the greater degree of statistical power in the study.

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Excellent thank you so much!