Tresiba opinions

I have switched to tresiba from levemir.
All opinions welcome. Prefer any concerns of this medicine. And what is this medicine all about. How does it work. Because I am confused. 48 hrs instead of 24? Still take it daily? Only even numbered units on the pen? Why? I used to take 25 of levemir. Do people gain weight? How much insulin do you have to take? Do you need to lower your short acting? How much? How long did it take to get used to this medicine tresiba? Did you have more lows? Did you feel comfortable? Thank you for all your replies in advance.

I was on Basaglar for a while and switched to Tresiba. The dosage for me was about the same +/-1 unit. You only take Tresiba once per-day.

I understand its confusing when they say it last 42 hours. It has to do with how long it takes to start working and the curve / tapper off of the insulin effect.

You must have the u200 if it’s only even numbered units. If you’d like to fine tune your doses to single units then you’ll have to ask your doc to prescribe the u100 instead. It doesn’t really matter which you use… the pens are calibrated to deliver the correct amount dialed up whether they’re u200 or u100

Yes you will take it every day even though it lasts longer than 24 hours… you should theoretically take the same amount of daily units that you took with any other long acting, although of course it may end up requiring adjustment…

In my opinion tresiba is light years ahead of any other insulin on the market. It’s good stuff.

2 Likes

Hi, @J1112. I used Tresiba back in 2016 for several months as I took a break from my usual pump therapy.

It can be confusing at first. The insulin duration published by Novo Nordisk is 42 hours. You do take it once per day, however. That means that after the first day, the Tresiba action curve will reflect the 24th-42nd hour’s action from the previous day. But that’s okay.

This suggests that you are taking a concentrated form of Tresiba labeled U200. That means there are 200 units of insulin per milli-liter (mL) of liquid in the vial. There is also Tresiba U100 which contains 100 units of insulin per vial liquid. If you needed the finer dosing control of single-unit increments, then you need to get a prescription for U100 Tresiba.

That’s why the manufacturer supplies a pen calibrated in even number units only. U200 insulin is often prescribed to people who have insulin resistance and need to take larger doses of insulin. This usually means that U200 is prescribed to people with type 2 diabetes.

Any insulin can cause weight gain. Finding the correct dose size that controls blood glucose but does not cause weight gain is the balancing act that you need to strike. Your doctor or diabetes educator could help with this.

This is an individual experience and there is no “one right answer” to this question. I am a type 1 diabetic and took about 19 units of Tresiba for my daily dose. Your needs will likely be different than mine.

The insulin therapy that you use is called a basal/bolus regimen. The Tresiba provides the long acting background or basal insulin. It is intended to metabolize the glucose output of the liver, nothing more or less. The idea is that if you miss a meal, your blood glucose will remain steady and in range.

Your short acting or bolus insulin is intended to metabolize the glucose effect from the food you eat. The ideal basal/bolus therapy will not feature basal or bolus insulin doing the work of the other. Basal and bolus insulin both have separate jobs.

That’s nice theory but does not always work out in practice. Insulin therapy is not “set it and forget it” dosing. For it to work well, you will need to be able to assess its performance and make appropriate changes when needed. This is a skill that takes some time to acquire but should be the goal of any one who uses insulin. Your doctor and diabetes educator are there to help you learn this skill.

Within a week or so I was comfortable with dosing Tresiba. I have been dosing insulin for over 30 years at that point and already a had a lot of experience with how to make it work for me. I didn’t experience any more lows with Tresiba than any other insulin.

The one thing I really liked about Tresiba is that it’s very flexible as to when you take your dose. I was taking mine before bed. When I forgot to take my dose at bedtime, I just took it the next morning and I observed no problems with my overall control. I did not go low or high when that happened.

Good luck. If I didn’t use an insulin pump, I would definitely use Tresiba as my basal insulin.

1 Like

Thanks everybody, and thanks for the explanation on the different pens. It’s been about a week since I started, and I’ve experienced many lows. At first I didn’t understand lowering my humalog as my doctor suggested. Then I reduced my bolus dose by half and even still many lows. I fell backwards in a chair at home, I woke up another morning contorting and having a hypoglycemic reaction in my sleep. Thankfully someone was there to help me. Now I have reduced my bolus dose from half to another half. I have eaten 2 full meals no snacks today, and only taken 3 u of humalog all day. I used to take 8 u per meal when I was on levemir. I am just a little nervous about taking the wrong amount of humalog, because I’m not really sure how tresiba is acting or working. There have been times when I’ve eaten and my sugar goes down after, even when low. It seems to be having a more powerful effect, and my humalog seems to be much more sensitive since taking it. So I don’t want to keep eating and eating you know, that’s not really my style. So ex., I woke up this morning 52, took no bolus, ate, then it went up to 172, so I took 3 u humalog. And then finally went about my day. Since then it’s been 100,123, and 112. Eating lunch and not doing anything else. So finally I seem to have the correct sliding scale with the humalog. I’m interested in figuring this out. It’s like the way things were in the beginning for me, but I’m still a little nervous is all. All these years relying on the medicine to fix things always every time, it seems like perhaps I can not worry so much every time I think of eating or having something. It seems to have more control with lowering the blood sugar after eating. It’s interesting for sure and my doctor seems to love it. So I will give it a chance. I’m just a little surprised at how different it is from the way I’ve been used to thinking.
Thanks everybody so much and all the best.

1 Like

Wow - sure sorry to hear about those lows. Sounds frightening and dangerous!

I took a break from using my pump for about 6 months and used tresiba once a day and Humalog for meals - just like you’re doing now. I started using roughly the same amount of Tresiba as the Humalog basal on my pump and kept my meal blouses the same. At first I had quite a few lows, but rather than reduce the mealtime humalog, I reduced the Tresiba dose. I had to play with the dose a bit but when I got it right things worked really well.

Has your doctor discussed changing (reducing) the Tresiba? It seems to me that your covering part of your meals with Tresiba and you’re reducing Humalog to compensate. Ideally the Tresiba covers only the glucose your liver is releasing continuously 24 hours a day and the the Humalog is used to cover the glucose from your meals. On the other hand your Levemir dose might have been too low and your larger mealtime humalog was making up the difference. But that’s why you should talk with your endo about reducing Tresiba and follow her/his instructions.

I really like Tresiba. The dosing time is very flexible and its very consistent day to day. I’m back on my pump now and I’m using Tresiba to cover half my basal and the pump to cover the other half. I’m seeing a big improvement in my between-meal BG consistency compared to using basal Humalog alone.

Good luck!

1 Like

Hi Paytone,
What you said makes a lot of sense, and I am going to talk to my doctor on Wednesday. After last night, after 112 and eating dinner , my sugar was 137 then 140. But today again I woke up with paramedics by my bedside. I only took 5 u humalog all day. Something’s just not right and I can’t figure it out. The paramedic said to me I need to eat more complex carbs like rice and pasta. I had a salad some fish and some crackers for dinner, and then some dark chocolate for snack. All in all, from dinner to bed about 60 to 70 carbs. So I am terribly confused. Thanks again everybody.

I just got off email with my doctor and she said to lower my tresiba to 15. Sounds good. Thanks again Paytone.

One of the best ways to get the balance right between the Tresiba (basal insulin) and your Humalog (bolus insulin) is to conduct some basal tests. That involves missing a meal and watching what your blood sugar does. Ideally, when you miss a meal your blood glucose will remain in a fairly tight range, say +/- 15 mg/dL (0.83 mmol/L) from the average.

Gary Scheiner, author of Think Like a Pancreas, a certified diabetes educator and T1D himself, runs a clinic where he advises people on these kind of issues. I recommend that you read his advice on how to accomplish a basal test and interpret the results. Gary also offers remote consultation (for a fee) using phone/email/Skype as the situation allows. I have no connection, financial or otherwise, to this service except as a satisfied user.

From my not-fully-informed perspective with your unique situation, I suspect that your current basal insulin dose is too high for you. Your best goal would be to learn as much as you can about how insulin works in your body so that you can make educated guesses as to what dosing move to make and when. These kind of decisions are needed much too often that doctors cannot keep up with that.

People who adjust to insulin best develop an experimental mindset. They make a hypothesis, set up an experiment, run the experiment, draw a conclusion and then make a new hypothesis, a virtuous loop. It’s a great way to teach yourself what’s best for your body. It will involve keeping some notes to help you think things through.

A doctor’s advice is nice but to really be effective, the doctor would need to move in with you and advise you 24/7. That’s not practical, of course, so the next best thing is for you learn how to adjust insulin doses yourself. Your doctor can still help with many other issues. Insulin dosing for diabetes is a moving target. You will never discover the perfect dose that will endure forever. Your body’s needs change. You need to learn to change with it!

You can do this! It’s not rocket science. It just requires some specific discipline, a certain knowledge set and logical thinking. I highly recommend that you pick up the book I referenced above. Skills learned using this book will be highly useful to you for the rest of your life.

3 Likes

I am really interested in hearing more about your using Tresiba untethered with pumping. My DD is about to get her first pump but we also really like tresiba. I would like the extra peace of half Tresiba in the background. Not sure how that would work with the tslim x2’s basal IQ. Any info appreciated.

I don’t have specific experience with this type of regimen (combination Tres+pump), but it seems clear to me that you could make it work. Like @Terry4 says though, if you’re still working on getting the basal needs established, do that first.

It’s a persistent challenge to figure out what system of insulin delivery and bg monitoring will provide the most adaptability for the inevitable and constant surprises with bg, and what works best in the tradeoff between data, time, attention, response, insurance provisions, convenience etc. Ydmv.

Oh also, Scheiner’s book, and several other good book references turned out to be available at my clinic’s little library. Some hospitals have a reference library but they don’t advertise it, some have budgets for reference books like this and will lend out informally to patients. In my experience, they love it when you show interest, use the resources, or ask about specific things they might get.

Like I said in the beginning, I use the pens. I am in the process of getting a CGM machine, which I think would be very helpful as they show directions that the blood sugar is going in with arrows. But I do not use a pump as of right now. But, by all means if any who do use a pump wish to comment feel free to do so. And thanks for all who have replied so far. It has been very helpful for me.

When I did a search online for the difference between tresiba and levemir, one website specifically mentioned that tresiba can cause low blood sugars and to have a sugar supply handy. It did not mention the same for the levemir. Of course levemir if taking too much or if mismanaged with other insulin’s can cause low blood sugars, I’m not saying that, but it specifically stated that levemir has less of a chance to cause low blood sugars or hypoglycemic reactions. In another study that I looked at from ncbi.nlm.nih.gov about patients switching from glargine or detemir to degludec, it stated that patients who switched to degludec (tresiba) had decreased blood glucose levels and thus reduced daily dosage totals. I find this extremely interesting and important for patients to know. My doctor when originally gave me the tresiba, told me to increase the dosage that I was taking with levemir. I am starting to have some doubts. My children too. I don’t feel I was given the correct information from my doctor about this medicine. I will see my doctor on Wednesday, will see how it goes. I never really had a problem with levemir, but apparently doctors keep trying to talk bad about it to me. I feel there is a difference between all of these. I just can’t pinpoint what exactly.

FWIW, I use the same dosage of Tresiba as I did Levemir. I use Tr 1x/day, and I used Lev 2x/d. I Iike Tres for the convenience and “stability” but it wouldn’t be the end of the world to go back to Levemir. For my situation, both are way better than lantus, but of course ydmv…

My daughter uses 2/3 the amount of Tresiba than she did levemir.

Hi Sproket1

There’s nothing really complex about using Tresiba with my pump. But Tresiba delivers the same amount of insulin per hour over the full 24 hour period. That defeats one of the pump’s big advantages - the ability to vary basal on an hourly basis. In order to retain that advantage, I cut the Tresiba dose in half and use the pump to deliver the rest. I increase or decrease what the pump is delivering hourly so I maintain the pump’s advantage and still retain a good portion of Tresiba’s steady, consistent day to day performance.

Unfortunately this may not work with Basal-IQ. That system is based on turning the basal off completely when it predicts an impending low blood sugar event. But the pump can’t control the basal coming from Tresiba so you lose a lot of the value from Basal-IQ. It can shut off the basal coming from the pump, but that may not be enough to stop the impending low blood sugar event.

I’m facing that dilemma now myself - stop using Tresiba and use Basal IQ, or skip Basal IQ. I went back to using my pump to deliver 100% of my basal for a couple weeks, and as I suspected, the consistency of my basal blood sugars suffered. That alone created more low blood sugar events. Next I will probably stop Tresiba and try Basal IQ for a few weeks and then decide.

I really liked Tresiba. Unfortunately it’s no longer on my Rx formulary so I had to switch to Toujeo which for me just doesn’t work as well.

I took 56 units Tresiba as compared to 75 units Toujeo and my carb coverage ratio on Humalog went from 1:6 to 1:3 after switching to Toujeo.

J112 what are basing the Humalog dose on? Do you have a calculated carb coverage ratio? Are you using it on a sliding scale? Or as a correction?

Personally I found the University of California San Francisco Diabetes Education Online an great help in calculating your insulin needs to begin with and then continuously fine tune from there. https://dtc.ucsf.edu/types-of-diabetes/type1/treatment-of-type-1-diabetes/medications-and-therapies/type-1-insulin-therapy/calculating-insulin-dose/

#1 Calculate your Total Daily Insulin Requirement (this is your body’s total insulin need for the day of both basal and bolus insulin-most doctors will recommend 50% basal and 50% bolus to start with)
#2 Calculate your Carbohydrate Coverage Ratio (this is how many units of insulin are needed to “cover” each gram of carbohydrate you consume and is most often taken before you eat)
#3 Calculate your High Blood Sugar Correction Factor (this is how many mg/dl of blood sugar is reduced by one unit of ex. test high 3 hours after a meal, take an additional dose of insulin to bring it back into your target range)

Take your basal insulin around the same time each day for the best effect. Make sure you understand how the Humalog performs in the body namely how fast it starts working, how long its peak effect is, and overall duration. This is important to know so you can avoid “insulin stacking” which can tank your blood sugar very quickly. https://www.aafp.org/afp/1998/0115/p279.html

Good luck!

In my experience it is more potent than Levemir, at least in the first 10 hours or so after injection, so you probably need less of it, not more. I don’t know why doctors are speaking badly of Levemir though, it is not inferior to Tresiba, it just has a different profile that is better for some people and worse for others.

1 Like

lumi73- hi. I had a nutritionist say to me once 1 u of humalog for every 12g carbs. For a correction dose take 1 u to lower it 30 points.
With the humalog I am on a sliding scale. Since taking the tresiba the amount of humalog I am taking was first cut in half, and now is cut in half again. The things you are saying about calculating total carbs covered ratio and total daily insulin requirements, and correction dosages make perfect sense and I am going to do that when I see my doctor on Wednesday. Thanks.
Scott, I know. They say it doesn’t really last 24 hours, it’s older. I have no idea.

Update today: I took 10 units of humalog all day. When on levemir I took 24 u of humalog all day. For breakfast my sugar was 123. Ate a turkey bacon 2 eggs and cheese sandwich on 2 slices whole wheat bread. Took 4 u of humalog. I made a mistake though based on my sliding scale I should’ve taken 2. I got confused. 3 hours later my sugar was 63. I drank a full cup of orange juice and half a 20 oz bottle of Pepsi. 3 hours later my sugar is 145. An hour later it’s 114. I eat lunch. Take 2 u of humalog as per my sliding scale. Ate Leftover tortellini from night before. A full amount, there was plenty of leftovers.3 hours later sugar is 135. All’s good. 3 hours later sugar is 184 before dinner. Take 4 u humalog as per my sliding scale. Ate chicken, rice, and corn. At least 50 carbs total in the meal. At least. 2 hours later my sugar is 60. Ate 2 glucose tablets right away. Then decided heck with it ate a 9 oz. slice of NY style cheesecake. From the supermarket so I am not aware of how much carbs or fat, but it’s NY cheesecake you know. An hour and a half later I’m at 85. Right now. I am honestly afraid to take my medicine, the tresiba , and afraid to sleep. I have kids in the house. I mean they’re still kids not little but still kids. And it’s just me. They have school in the morning and I’ve been freaking out about this. I can’t understand why this is happening. I am eating and still.
Scott Eric I know what you are saying it’s different medicine and is having a stronger effect or something, but I have also reduced my tresiba by 10 u and I’m still worried. I don’t normally force myself to eat like cheesecake when I don’t feel like it you know. I have literally been going crazy. I wanted to believe in this, I wanted to give it a chance, I feel normal but I don’t feel normal at the same time. In my opinion for the amount of medicine that I have reduced by, and the foods that I am eating, this should not be happening. I can’t wait until Wednesday I am writing down a whole list of things and questions to ask. This is too much. I’m not sure this is going to work for me. Of course I can change back to the levemir if I want to.
Thanks to everybody. You’ve all been really helpful.

It doesn’t for most type 1s, but that’s not a problem because it can be taken twice a day at different doses, and most type 1s do not have basal needs that are the same all day and night.