A tactic often used with Lantus and Levemir is to split into morning and night injections in a attempt to match the peaks to your needs. I don’t know if this is possible with Tresiba due to its longer time of action.
My daughter takes 30 units at night but she splits it 10/10/10 in 3 different locations. We find this helps a lot with it lasting longer and working more evenly.
Not sure if I can help a ton, but I’m also battling with my Tresiba dose, so I’ll send along some things I’ve done so far. I’ve been on it since February, and just increased to 18u. I was previously on Lantus, but was taking 15u of it. I find that every time I switch my dose of Tresiba, I have morning lows, but steady days, until I then battle highs during the evening and have to increase Tresiba yet again.
Through trial, I have found that if before bed I am in the 200 range, I will eat a small snack, up to 20g of carbs, and bolus for the snack + 1 unit of Novolog for the 200 number (to only drop me to 150). This usually puts me at a normal number an hour or two later and I stay pretty steady overnight. Before when I wouldn’t eat, I would be 180 before bed, then drop too low in the morning, like 62. I’ve been pretty steady lately and haven’t had the low morning issue, but this worked when I was. When I was normal before bed (say 94) and knew I would drop in the morning when this issue was happening, I would have a 10g carb snack without Novolog which kept me from dropping lower overnight.
I hope this helps some! It’s has been a roller coaster for me as well. I’m still having issues with spiking after meals no matter what I eat, most days. For the past couple of days I’ve eaten lower carb meals, which has helped some, but I’m still not over the spikes entirely. I hope you can find some answers, it’s frustrating for sure!
@airtas yes! I was always up and down with it, with a lot of extremes. I only had a couple days that I can remember being completely steady all day. I expected at least one low a day on Lantus, if not more. If it hadn’t been for my hypophobia about 8 months ago, I would have possibly been able to adjust Lantus more and split the dose to make it more steady, but I couldn’t shake that. I had a bout of lows over a whole night where I couldn’t bring my blood sugar up, despite eating/drinking 120g of carbs already! It took me up until this year to not over treat my lows. I think if I were to switch from Tresiba to something else, I might try a split Levamir dose. Lantus did it’s job, but I was always a rollercoaster compared to what Tresiba is doing (although it’s not perfect either).
I recently decided to split my dose of Tresiba into morning and night shots to combat dawn phenomenon and it has worked pretty well. I wouldn’t like to go back to Lantus because it didn’t really work that well for me, kinda like @daisy707 said.
Tresiba has peaks and waves like any other insulin but they are a bit more subtle so splitting the dose makes those peaks overlap a bit more so my dawn phenomenon is usually taken care of and I do remain more stable but I find that I have to play around with the dose quite a bit to keep my BG’s in line.
It may not be a basal issue. Bolus insulin may still be acting at the 5-6 hour mark, post-meal. It may mean that your bolus dose was too much. What bolus insulin do you use?
Are you on multiple daily injections (MDI)? Or do you use a pump?
The published onset, peak, and duration times are an average across the study group. These times will vary from patient to patient and in one patient from day to day.
