Tresiba help!

Does anyone know if tresiba is better taken at night or in the morning. My 9 year old daughter just switched from lantus at night and now she is taking tresiba at the same time at night .she is spiking in the middle of the night even after increased dosage . She went from 214 at 8pm before bed to 288 at 4am . I know that’s high before bed but even if shes in range she spikes .Shes on 4.5 units and was at 3. I dont understand tresiba fully but I’m about to pull my hair out with these night time spikes . Should I split the dosage??,

Here’s some info until a Tresbia user finds your post: Tresiba Basal Insulin - #358 by tonilynn20

You asked this on another forum. I’ll repeat the answer I gave there since you may not have seen it.

I have been using Tresiba for over two years. It is my favorite of all the basal insulins I have used (NPH,Lantus,Levemir). It can be taken either in the evening or in the morning. Ponder (of Sugar Surfing fame) takes it in the evening. I take it in the morning because it is easier for me to remember to always take my dose as part of my morning routine. You can try both and see which works better, but for now I would recommend picking one and sticking with it, and focus on adjusting the amount needed, which I assume your doctor is in the process of doing.

BTW, 4.5 units per day is by no means a large dose (I take more than four times that, but of course I am older and larger) so finding out how much she needs can only be done in the way your doctor is doing it: making small incremental adjustments and carefully checking the results via BG testing.

I also use Tresiba and take one shot per day in the evening. I generally see my blood sugar drifting up early in the night, but then leveling off about 5-6 hrs after my shot. If I increase the dose too much, it might stay level early in the night and then drop late in the night. People assume Tresiba lasts for 48 hours. I think it varies by individual. For me, I think it is most effective from hour 6 to about hour 42. I think my Novolog dose for dinner makes up for some of that decrease. I talked with my endo and she suggested 2 shots per day, but I haven’t made that switch yet. I do think it would reduce the variability I see, and the brittleness I seem to have with dinner Novolog. In comparison to the NPH I used many years ago, Tresiba is remarkably steady, but with CGMs, it seems like there’s always room for improvement. Good luck with your daughter! I am interested to hear what you do and how she responds.

If I increase tresiba that’s exactly what happens to my daughter. Tonight she went to bed with a BS of 115 and by 4am 310. For dinner at 6 she had noodles, a turkey burger, a little ketchup, broccoli and homemade iced hibiscus tea . The noodles and ketchup are low carb they never affect her , the turkey burger has 22 g of protein no sugar or carbs. I dont know it may have been the digestion of the turkey burger . Tresiba was given at 8 pm before bed

For me (an adult), Tresiba is very long-acting and quite forgiving in terms of when it’s administered. Theoretically, it should not matter what time of day you choose, and split-dosing should not be necessary (in contrast to Levemir, for example). Maybe with small doses (4 to 5 u) things can be different, but I don’t see why that would happen. I suspect you are wrestling more with a growing child’s changes than with the need to adjust Tresiba timing, especially if you’re already administering it in the evening. Best wishes to you both

Everyone is different, but I sometimes get high blood sugar overnight after eating a meal with a lot of protein. I don’t consider protein in calculating Novolog dose before the meal, just carbs. If I have a low carb meal with a lot of protein, I usually have to take some extra Novolog before bed or during the night to correct. It would be easier to figure insulin doses if I ate the same thing everyday, but I’m not ready to do that. One of the problems with diabetes is there are a lot of different things that can affect blood sugar. If you can find a Tresiba dose that usually keeps her level through the night then you may be able to make other adjustments for different meals. I should mention that I weigh about 170 lbs and take 10-12 units of Tresiba each evening. Everyone’s diabetes is different, but it sounds like you are paying attention to the important details. It will take time to figure out and no matter how vigilant we are there are always some times that we are out of range.

It sounds like her basal needs are not constant throughout the 24 hours. A lot of people need different basal amounts at night compared to the daytime.

If she has variable basal needs, Tresiba is not the ideal basal insulin to use.

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I have only recently learned about Tresiba. Could you clarify the how often a person is supposed to inject Tresiba. I’ve read one shot lasts 42 hours. So, I am a bit confused by people saying they inject daily. Thank you in advance

No basal insulin lasts exactly 24 hours, or exactly any number of hours. They all have a waxing and waning curve. By injecting more often you get more overlap between the waxing and waning, so overall more steady overall coverage.

In the case of Tresiba there may be some small amount of coverage at 42 hours, but a relatively small amount. For most people injecting approximately every 24 hours gives a surprisingly consistent activity curve. For example it is used every 24 hours by Ponder. Other people take it every 12 hours to increase the overlap even more. I have never heard of anyone taking at a set schedule more than 24 hours apart.


Thank you for the info. I assumed that by taking Tresiba that frequently it would be stacking insulin doses. But, I understand that basal insulin doesn’t necessarily last the whole duration of hours claimed.