Tresiba night time lows daytime highs? Go back to Lantus?

Type 1 and LADA
#1

Hi all,

Looking for some guidance been on Tresiba for about a year coming from Lantus where I was on that for about 12.

Recently we reduced my Tresiba dose to 18 units from 20 due to night time lows.

I was running low almost every morning unless I didn’t work out the night before. I would be going to bed at 180-200 and still would go low.

If I didn’t go the gym the lows didn’t happen as often but still did.

During the day with the 20 I was pretty good.

Now on the 18 the night time lows better but I am running high 12pm and later.

Is my option to just take Novolog to combat the daytime peaks?

I don’t remember having this much issue with Lantus but I am also using the Freestyle Libre so I have never tested this often before.

Any recommendations on staying at 20 and somehow preventing nightime lows? From everything I looked up Tresiba is hit or miss with people.

#2

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.

#3

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.

#4

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!

#5

did you have issues with Lantus?

#6

@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).

#7

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.

2 Likes
#8

if I am getting a drop 5 hours after a bolus I am assuming it is a Basal issue? Also does injection site play a role with Tresiba?

#9

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?

#10

I use Novolog…used to use Humalog…which is faster and do both last the same duration?
I am on MDI (Tresiba/Novo)

#11

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.

From the University of California, San Francisco Diabetes Education online site:

08%20PM
28%20PM

Lyspro = Humalog
Aspart = Novolog
Glulisine = Apidra

The action of all three of the rapid acting insulin analog formulations are roughly the same but your experience may vary.

#12

How much of a drop should one expect after the 2 hour mark? So between hours 2 and 6?