Hi,
I started Tresiba about 2 weeks ago. I started with 14 units in the morning at 6:30 am- everything went well for the first few days but then I stared havin lows during the day and in the middle of the night (from 12a-4 am). I barely had to use any Humalog to bolts for meals Dior g the day, in fact with dinner I didn’t use any, but would still gonlow about 3 hours after dinner. I eat low carb, 15-30 carbs per meal. So, I reduced to 13 units per day - but would end up high in the Morning- my CGM shows blood sugars starting to rise around 3 am. I tried this for a three days and had consistent highs in the morning. Any advice on what to do? Maybe switch the time I take it? I’m at a loss
When I took Tresiba, I found that it didn’t matter what time of day I took it. The package insert talks about that timing flexibility when compared with a basal like Lantus. The only real dosing rule for Tresiba is to keep doses at least 8 hours apart. I tried taking them in the morning, afternoon and bedtime – it didn’t seem to matter much.
The size of your dose is about the only choice you have to make. You must realize that this insulin can take 42 hours to play out so dosing every 24 hours will feature some overlap. This is not a bad thing but you must realize that you should not make any drastic dosing size changes without letting a few days to elapse and a dose steady state to settle in before drawing any conclusions.
If you are going low after eating and not taking any meal insulin, then you will need to experiment with lower Tresiba doses. What you want to see is steady blood glucose if you miss a meal and don’t take any Humalog.
Always keep glucose in your pocket and don’t be afraid to test more frequently. Writing your numbers down will help your brain to recognize patterns. Good luck! I really liked Tresiba.
Thanks Terry. I have been T1 for 25 years and for most of it I used Lantus and humlog. I have been in and off multiple pumps as well, but I never really could get used to the feeling of the pump and prefer MDI along with my Dexcom. My A1C doesn’t change much from pump to MDI and is usually In The low 6’s. I found I only started having “dawn phenomomen” after I had my son 4 years ago. Any other women out there experience this? I always have glucose tablets, snacks and juice on hand. And I’m used to testing my blood sugar at least 6 times a day. I think I will titrate down the Tresiba and experiment with my bolus dose - I have to get the lows fixed Bc I get terrible migraines and am unable to function when I get them 
I imagine losing the demanding dose timing of Lantus is not something you will miss.
I have a pronounced dawn phenomenon curve and a basal rate bump programmed into my pump to neutralize it.
I also experimented with using a pump and a basal insulin to share basal duty and enable regular extended periods off the pump for things like swimming. This insulin protocol is called “untethered.”
I am also trying to figure out my dose of Tresiba. I started at 16, now at 13, I might drop to 12. I am retaining water like crazy though! I made the switch to Tresiba because I accidentally dropped my pump in the tub, it’s not waterproof. I am starting to really miss my pump. I don’t like feeling like a sausage, however my control is pretty decent so far.