Tresiba does not stay active long enough

I’ve been using Tresiba for about 2 years. For me, it only lasts for about 10 hours with a strong peak from 4-7 hours. Even taking it twice a day does not work. Has anyone else experienced this?

I take Tresiba once per day as an “untethered” addition to my pump supplied basal rate. I don’t notice any symptoms like you describe but I’m curious about your report.

Have you done any basal tests? Does that include skipping meals to observe the independent action of your basal regimen?

I’m wondering if your mealtime doses of insulin may be under-dosed and placing an undue burden on your Tresiba basal dose.

How often do you make changes to your basal or bolus insulin? Do you tweak it as needed or do you prefer to stand pat with your insulin doses for longer periods of time?

Sorry if my questions exceed your interest in this topic but those are the thoughts prompted by your question.

By the way, welcome to the TuDiabetes community!

I have had no trouble with Tresiba and I take it only once a day. In my 61 yrs of living with type 1, Tresiba is the best insulin I have ever used. I have used other insulins which have not worked for me though, while they worked fine for others.


Well, everyone is different, but your experience is opposite mine. For me, basal insulins I’ve tried from shortest-acting to longest-acting are Levemir, Lantus & Tresiba, in that order. @Terry4 has a good idea to do some basal testing - that could help figure out what’s going on.

Thanks Terry. I do test by skipping meals, and I use Afrezza which theoretically has no activity after 90 minutes or so.

For example, last night I took 6 units of Tresiba at 9 PM, about an hour after my last dose of Afrezza. after midnight, my BG steadily dropped until about 6 AM. Then it started to rise until about 8 AM when I had to take some Afrezza to bring it down. Had I taken more Tresiba, I would have been extremely hypo overnight.

I haven’t changed my dosage much recently, although this morning I did take 12 units to see whether the greater volume of insulin would reduce the peak and cause it to have a longer duration.

Thank you. Terry did have some good ideas, and I just replied to him.

A successfully basal dose will keep your BG relatively flat for periods of fasting, like overnight. I take Afrezza, too, and while I can count on it being done at about 80 minutes, I have also, on occasion, observed some steady drops after that. You might want to check your overnight basal control without taking any Afrezza during the test. You’ll also want to be at least four hours since your last bite of food before you retire for the night.

That seems like fairly typical morning insulin resistance that many of us experience. Afrezza is a good way to knock that down.

A 9 pm Tresiba dose is not the likely the reason for going hypo or hyper overnight. It takes 2-3 days for Tresiba to achieve its steady state action. I suspect that there are other factors confounding your situation. Things like exercise, food, and bolus insulin are common things that can muddy the water in trying to tease out which factor is primarily responsible for poor overnight BG traces.

Do you use a CGM?

I think you could learn a lot by experimenting with this scenario and writing things down to enable good analysis. I would eat the same evening meal that I finish at least four hours before bed and no evening snacking. Take your usual Tresiba dose at 9 pm as well as the other time of day you take it. Do this like three nights in a row, same meal, same no food time gap, same bedtime and record all blood sugar numbers.

When you make changes to your Tresiba dose, let three days go by before testing and drawing any conclusions as to whether that change was effective or not. You need to analyze things once Tresiba achieves its steady state after three days or so.

Thank you again. I will try your suggestions. I am using a CGM which will make experimenting easier. BTW, for my weight of 170 lbs, 12 units per day of Tresiba seems very low and not expected to cause hypoglycemia. I am not exercising, so I can’t find any explanation for the hypoglycemia.

What complicates this more is that I take glucose a few times overnight to treat the hypglycemia, and that adds an additional factor into the analysis.

It’s hard to decide which factor to address first with insulin dosing. It’s generally good to adjust basal insulin before making bolus insulin changes. If you need to take glucose a few times overnight, that obscures making any clear analysis of the current basal dose. If you need glucose overnight, I would abort the experiment and start fresh another night. You can not make any good conclusion about your Tresiba doses until you can remain relatively flat BG overnight, without hypos, for three nights.

This could take some time, even a few weeks. Be patient but persist until you like the result.

Your morning dose of Tresiba is an important factor here. You need to make adjustments to both the am and pm doses to get to a good outcome. Good luck.

Thanks again. Yes, I do usually adjust am/pm doses in parallel. The only way for me to avoid hypo without taking glucose at night is to reduce my Tresiba to less than 12 units. I may experiment with that but anxious about taking such a small dose.

I plan on posting my results in a few days.

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It might be that your basal needs are higher during the day than they are at night.

That makes sense, but is it possible that I need less than 6 units of Tresiba at night? It just seems like such a small dose.

This is a good point - Tresiba’s great virtue as a long-acting steady basal can also be a frustration for MDI users. It’s the same reason I bolus in the early morning for dawn phenomenon and related diurnal changes in insulin sensitivity. It’s the main reason I consider going to a pump (tho still haven’t).

I’ve had good results with Tresiba. I use it once a day, and if I forget or can’t on my usual schedule, it seems quite forgiving. ydmv

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I seem to have solved this problem. Prior to my initial post, I was taking 12 units twice per day in two equally divided doses (ie/ 6 units twice per day). Since my initial post, I have been taking 12 units once per day. This change has dramatically improved my BG levels–I can’t explain why.

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