Tresiba/humalog/carb question

Hello All:
I’m reaching out for a dialogue of what works for others. I’m not on a pump and definitely not an expert after Type 1 for over 57 years!
I’m on 11 Tresiba at bedtime, then supplement with humalog with carbs. I try to stay low carb ( under 30 gms) per day, mostly non starch veggies. At times my BS is under 90 when I awake, sometimes much lower. I compensate with 15-30 carbs without humalog. No further carbs. By afternoon it reaches 160 ish so I compensate with humalog. Then sometimes it goes up further, sometimes goes way down when I take a long walk. Feel like I’m on a roller coaster. Question: Better to lower my tresiba and take more humalog during the day or keep tresiba as is and compensate with carbs? Then my low carb way of life goes out the door. Thank you for letting me ask for help!

It’s always a challenge to balance the background basal insulin, in your case, Tresiba, with the Humalog meal/correction bolus insulin. While my experience is mostly with an insulin pump, the basal/bolus concept still applies.

The way to address your issue is to focus on finding the right basal (Tresiba) pattern first. You report that sometimes you wake up too low and then late afternoons find you mildly high.

You might consider splitting your Tresiba dose into bedtime and wakeup doses. The best way to troubleshoot basal insulin is to include some fasting. Skip breakfast one day, lunch the next and dinner the third day. Keep a written log on dose size and time and then write down the blood sugar levels when you check.

Tresiba acts over a 42-hour period, so any changes made to your Tresiba dose must be allowed a few days before making any additional changes.

The Tresiba dose can be considered right when your blood glucose remains steady without eating. Once you have the Tresiba dose set then you can work on your meal and correction dose size.

Do you assess the carbohydrate content of your meals and then calculate the meal dose using an insulin to carb ratio? This is a good place to start but you’ll soon figure out that certain meals use certain size doses of Humalog.

You won’t be able to analyze your meal dose appropriateness without getting your Tresiba figured out first. I know it’s a bit of a pain in the tail but you will learn things on this process that you can use later.

Have you read any books about using the basal/bolus regimen to dose insulin? Think Like a Pancreas by Scheiner is a good one but there are many others.

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I use Tresiba and Novolog and am on Injections. I take 12 units of Tresiba in the morning. Although I followed Dr. Bernstein for 11 yrs and only ate 30 carbs daily, for the last 4 yrs I have followed the guys at Mastering Diabetes and eat about 275 plant based carbs and use about the same amount of insulin. I feel much better on this plan.

I love the Tresiba/Novolog combo, but I also like to eat 3 meals a day. I take between 9-12 units total of Novolog.

Although we use close to the same insulin we follow very different ways of controlling our glucose levels. I am very happy with my control and my way of eating, but you might like something entirely different. I also use exercise to control my levels. I ride my exercise bike 7-8 miles a day split between right after breakfast and lunch.

I just carefully changed my units of insulin until I found what worked for me. Sometimes I try taking 11 units of Tresiba, but I always move it back up to 12.

I was dx type 1 in 1959, I am 5’1” and weigh 105, A1c 5.1, 85% TIR


you, Terry and marilyn! Never heard of the Mastering Diabetes plant based way of eating. I do use the InPen to gauge carb/humalog ratios. I follow the theory of less carb less insulin so less fluctuations, altho experiencing more now than ever. It’s important to me to eat WHEN I want to rather than having to eat at certain times, per childhood. PS I take between .5-2 units humalog per meal with plant carbs.

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Isn’t it wonderful that we can just eat when we want to now?! I sure remember all those years when we didn’t have a choice. I still eat 3 meals a day, because I like spending time with my husband while we share a meal. I could certainly skip a meal or two if I wanted to.

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