I just started on basal only (Tresiba) three days ago, and originally my endo suggested taking it at night, but my pharmacist recommended taking it in the morning for the first week to ensure I wasn’t going too low at night and be unable to deal with a hypo.
I have been taking it directly after eating, and have noticed that instead of having one large post-prandial spike, I am now having one large spike an hour after eating/insulin and one slightly smaller spike about two hours after.
Ex: Today I went from 96 to a high of 137 (used to be in the 170’s) down to 97 at the one-hour mark.
Then I spike again to 127 at the two-hour mark.
Now, at the nearly three-hour mark I’m having sustained little spikes and drops.
Should I be injecting prior to eating instead? Or further after eating even? I’m just not certain what I am supposed to be seeing, and what is “normal” for basal-only insulin.
Tresiba is a basal insulin and it’s not intended to control post meal spikes. Ideally, basal insulin metabolizes the glucose output of the liver only. My experience with Tresiba is that, when the dose size is correct and no recent food is eaten, blood sugar is stable.
Tresiba acts over a 42 hour period and it needs to reach its stable state in 3 or 4 days.
Tresiba doesn’t care whether you inject before or after a meal. You may need to use meal-time insulin too, according to what you observe. The post-meal BGs you report are not alarming.
If I were you, I would keep a written record of your insulin doses, times, and blood glucose tests. Then you can discuss with your doctor about options.
If you pay close attention and keep good records you will witness your insulin dosing competence will eventually overtake your doctor’s skill. Be conservative and work with your doctor for the meantime.
Thank you so much for taking the time to respond. I know my endo was reluctant to put me on bolus insulin yet as my BG spikes sharply and sometimes higher than 180, but also usually comes down within an hour or two.
I can definitely see the effects of the Tresiba overall, I just wasn’t sure if anything else was supposed to be happening. I feel both over and under-whelmed about the insulin lol.
I use the MySugr and Libre apps to note down times I eat, what I eat, and when I take the Tresiba. Thank goodness for these apps, because otherwise I’d forget everything lol.
Every time you get a new prescription please read the information sheets that come with them. If its illegible they are available from the drug manufactures. Here’s the info sheet for Tresiba. The info Terry gave you on Tresiba is in sections 2.2 and 12.
Slight correction that doesn’t change the intent of what Terry said. Initially Tresiba takes 8 days to reach maximum concentration. After that dose changes reach a steady state in 3-4 days.
The information from the pharmacist conflicts with the guidance from Novo Nordisk. Stick with what your Endo told you.
If your BG spikes sharply after meals, bolus insulin is the solution. Basal insulin won’t do a things to prevent spikes. Did you ask your endo why he was reluctant to put you on a bolus regimen. I’d want to know. There is a lot to learn, and it can sometimes seem overwhelming. Are you TYpe 1 or 2? Stay with this group and ask questions, you’ll get some very helpful and caring responses.
From what my endo told me, he is leery to do bolus insulin currently because my BG level comes down within a certain time (I do not recall if that was one or two hours).
I’m not sure he even thought I really needed basal yet either, but I had requested it if possible to help preserve my remaining beta cells.
There is so much to learn and know that I feel utterly overwhelmed, but I have gotten so many great answers and advice from the people here.
