Tresiba is legit! Read if you have the dawn phenomenon

Going back to the original post, I agree that tresiba is an excellent basal insulin for MDI, I have found it much better than Lantus in almost all respects, and better than Levemir based on the long duration. But for me, it has not eliminated the need for dealing separately with dawn phenomenon. That’s great if it does for you, but I’d guess there are plenty like me who deal with DP separately from basal. See, for example, this thread:
https://forum.tudiabetes.org/t/do-you-take-when-feet-hit-the-floor-insulin

There are lots of discussions about MDI and pumping advantages and disadvantages. @Dave44 you might find there’s quite a lot of good information on “old” threads, and easily searchable too!

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Those are two beautiful overnight lines you posted! I hope that Tresiba continues to perform well for you. I used it for five months last year when I took my first MDI break in 32 years of pumping.

It did a very good job with my dawn phenomena for a while but then performed worse than my pump. I experimented with using my pump + Tresiba in an “untethered” regimen. That combination worked very well.

I realize your post is about the benefits of Tresiba versus Lantus and Basaglar. I’ve never used Lantus or Basalgar but I agree that Tresiba is a major step forward in basal insulin. One benefit I did experience from Tresiba is that it didn’t appear affected much by the time of day it was delivered. If I forgot my evening dose, I just took it when I remembered the next morning and my BGs didn’t seem to suffer much.

I’d be interested in updates from time to time, if you can. Good luck!

My theory is it’s a major step forward because it’s the first basal that lasts at least 24 hours for most people and it’s completely flat - what Lantus promised to be but never was. The problem I think is that for many a completely flat basal, while not causing hypos, makes things more difficult on MDI. It makes it difficult to cover any variability in basal needs, DP, protein and slow-digesting foods. It means more injections would be needed to address these issues or supplementing it with R or NPH since there’s no ability to have a variable basal profile, set temporary basal rates or extend boluses. I’m not trying to make the case for pump vs. MDI here, but I’m wondering if for some people such as myself who eat a lot of foods that digest later and don’t have perfectly flat basal profiles, the curve and peak of Levemir or Lantus can be used to an advantage over the flatness of Tresiba.

I too switched from Lantus to Tresiba last year and overall agree that Tres is an improvement. I have found that Tresiba basal dose has to be “dialed in” precisely to provide a stable basal effect. For me, 1 unit up or down makes a difference. Once I’m at the right basal dose with Tresiba it does everything I hope for in a basal. With Lantus I was always having to tweak my dosage up or down and never got it reliably dialed in to combat overnight lows.

Will not dive into the pumping vs MDI comments, but will say MDI fits my lifestyle better. I can usually find time to glance at CGM and take a correction bolus if needed to stay in a reasonable BG range. Might change my tune some day but planning to surf along on MDI for as long as it works well.

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I eat very high carb. And usually have to split my bolus, like 65/45 (15 minutes before a meal and then 1hr 1/2 - 2hrs later the rest of the bolus). As usually higher carb meals take longer to digest. However part of that could be because my basal was never lasting through the afternoon. Fruit is nice to bolus for, as long as you can nail your carb counting, you are set. No highs two hours later as fruit digests so quick! I never really thought of using the peak of a basal to control sugar levels at times. But it is interesting. Only problem I see with that is if you can’t eat by a certain time, or you are doing more exercise during that time of day, you could run into some problems maybe.

Thanks! I really hope it continues to perform for me!

It did a very good job with my dawn phenomena for a while but then performed worse job than my pump.

I don’t really care for the sound of that haha I hope that doesn’t happen to me!

Have a question for you, maybe dumb, but why do you all on pumps take breaks to MDI? What is the purpose? Just curious.

And I will try and keep this thread updated.

What do you mean by this? It was still creeping up in the early morning hours (3am)? Or when you got up in the morning?

Absolutely. There are ways to use them for that. When doing MDI, I ended up using both Levemir and Lantus and it worked great.

I need more at night. Lantus lasts 18-20 hours for me, and Levemir lasts 12 hours for me. So I used Levemir at night to cover the higher needs at night, and it ended in the morning so it would not give me higher amounts during the day. Lantus in the morning, Levemir at night was how I did it.

For some people Tresiba may be great, but for me it sucks because of varying basal needs from one day to the next, and different needs for daytime and nighttime.

For me, Lantus kind of sucks by itself because the 18-20 hour span for me doesn’t work well on our planet with 24 hour days. Levemir is good because the 12 hour span span for me is easy to negotiate on a 24 hour day.

If you use Levemir, the span is dose dependent. If you use around 0.2 to 0.4 units per kilogram of body weight, it will be about 12 hours, which can be awesome. More than that will make it last a bit longer, which may not work so great for you…

At the time I experimented with Tresiba last year, I had pumped virtually non-stop for 32 years. When the initial highly positive user reports about Tresiba started to come out, I began to think about my overall insulin treatment regimen. What if something prevented me from using pump therapy? Wouldn’t it be a good idea to try an MDI regimen without the stress of some external emergency?

So, I decided to go on MDI to identify a solid alternate plan I could use, if needed. I learned two important things from this five month trial: Tresiba is the basal insulin I would use and combining Tresiba with a pump works nicely for me. This untethered regimen permits extended disconnection time from the pump with no ill effects.

By the way, some pumpers simply enjoy the change going pump free for psychological and emotional reasons.

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Ok, that all totally makes sense! Having never been on the pump I didn’t really understand.

Ah, yea it is totally awesome to have the ability to switch back and forth! And nice to have something that actually works like it is intended.

Doing that would negate one of THE MAIN reasons I pump–the ability to reduce IOB & basal to a very, very low value, for extended exercise. If I had a long acting basal insulin, that goes out the window. I can’t wrap my head around wanting to do that. AS AN ALTERNATIVE, what I do when I’m in Vegas and want to spend every day at the pool for about 3-4 hours, I leave my pump in the room safe, take a Humalog pen with me poolside, and I’m good for that period of time when I MIGHT, I stress MIGHT need a bit more insulin during my time down at the pool. When I get back to the room, I shower and hook back up. All is good.

So, please explain why you would want to forgo the convenience (read: SAFETY) of being able to reduce your on board insulin for periods of activity. Or, aren’t you active? In that case, I see your point.

So you are saying it is hard to excersise on MDI? Well I can assure you it isn’t! I excersise like crazy! In fact back in October I hiked 3 mountains in one day that consisted of 10 miles and 5000ft of elevation gain. No problem at all! The key is being prepared. Stopping basal isn’t necessary.

I understand backing off on the basal rate to prepare for exercise. That is a nice feature of the pump.

But there are many more ways to play this game. The untethered regimen, like most things with diabetes, comes in many different gradients. One may put the entire basal load on the injected Tresiba, in this instance, or you could share the burden in other proportions, like 90%/10% Tresiba/pump, or maybe even 50%/50%.

So with the untethered tactic, you still could benefit from a reduced pump basal. Or you could under-bolus the prior meal to compensate. Or you could enjoy a nice pre-meal snack to manage the exercise. There are a multitude of solutions to manage BGs for exercise.

But my description of the untethered regimen upthread is simply as a back-up plan. If I had to use it for a while, I’m certain I would be tinkering with it.

I’ve mostly been active as a daily walker. My first year in Portland I put over 1000 miles walking on my Fitbit. Since last summer, unfortunately, I’ve become less mobile due to plantar fasciitis and achilles tendonitis. I’m making some gains the last month or so with stretching and starting physical therapy. Exercise is the magic catalyst for an impaired glucose metabolism.

When I started pumping many years ago, some doctors were reluctant to prescribe pumps since a pump delivery or absorption failure meant that the user was without any background insulin that could hold off DKA. So, if you want to talk about safety, the untethered regimen is safer than pump only due to its two distinct insulin delivery paths.

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Agree. I found that on MDI, I had to load up on carbs before, during, and/or after (sometimes many hours after) exercise. If I didn’t do the balancing act right, then I paradoxically gained weight despite the exercise. I find the balancing act somewhat easier with a pump, but that’s not to say either regimen is better-suited to exercise (regular or not). So much depends on each individual’s unique response to exercise and recovery – something that can change radically over the years.

I’ve never been able to get this right on the pump or MDI. Temporary basals are theoretically great but I’d usually find I still needed to eat (probably because I never planned enough time ahead before exercising) and then would end up going high later from reducing my basal.

You must plan ahead more than an hour, for a temp reduction in basal to help you avoid activity lows. You know that. :slight_smile: So to characterize temp basals as “theoretically great” is a disservice to the option while pumping, to protect oneself from activity lows.

You’re right, I’m not the type to plan ahead and so for me the advantage was theoretical. I’m only speaking from my experience and for me temporary basals rarely prevented lows and caused me problems later on. I know this isn’t true for everyone and that for many this feature can be a life-saver.

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My 16 year old daughter switched from Levemir 2x/day to Tresiba in October. We haven’t looked back. During the first month, we realized that the second day? injection was wearing off in late afternoon before her 6pm dose and she’d travel high. We have overcome this by splitting the dose and putting half in each thigh - this seems to help it absorb better and covers longer with no gap.
She requires more basal through the day than night, so we adjust the basal to suit her perfectly through the day, then she slowly drops at night. We compensate for this by going to bed a bit higher than in range, and she wakes up in perfect range. We love Tresiba. It has worked so much better for her than Levemir. Everything is much easier and far more predictable.

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So I’d thought I do an update on how well Tresiba is still working for me. So far my dawn phenomenon is a thing of the past. And this is quite amazing for me as I had serious problems with this!

Also what I am finding strange is I need to keep lowering my nightly dose. Started out at 15 units. I am down to 10 units as of right now. Going down to 9 units starting tonight. Also, using less Humalog.

You can see my last night graph had quite a few lows.

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Tresiba was already out by the time I was diagnosed. I’m still honeymooning, but it has worked really well so far. Gotta love the constant medical advancements!