Okay, so Mom started Tresiba last Monday…so it’s been a week ( 22 units in the am) and so far…let’s just say that her blood sugar has not been stable. I have read so many positive things about Tresiba but to be honest…I am starting to doubt a couple of things now. It could be that she has been using it for only a week and things will settle soon. However, I was expecting humalog in conjunction with Tresiba to be more effective than Lantus. However…her sugar has stayed in the upper 200’s 3/-6 hours after a meal. I also made sure while my mom starts off using Tresiba, that we don’t experiment any new kind of meals/ food etc. I was really excited initially but now I am a bit confused. In my honest honest honest opinion…it almost feels like Lantus worked better.
My mother had a small snack around 6, only 4 grams of carbs and her sugar was in the super upper 200’s…I was hoping the background insulin would have taken care of this.
I’m not saying her sugar remained in the 200’s every single day but I’ve noticed it’s been high more than a couple of times this past week, during fasting and a few hrs after meals, ( this happened before with Lantus but with certain kinds of food…etc beans, pizza etc- which she hasn’t ate while on Tresiba). She has already lost so much weight from uncontrolled sugar levels and now…it’s like a repeat all over again, somewhat.
I really hope this is just an adjustment phase ( HUGE SIGH).
Thanks guys for the suggestions, advice and just the time to read this post. You guys are awesome, hope all of you are doing well.
I don’t know your moms history so sorry if this sounds silly…
Are you learning how to adjust her doses appropriately? No insulin is magic… Even the best requires hawklike observation and adjustment to make it work even halfass well. Tresiba works well for me, maybe not for everyone. I hope it gets better. Keep trying, it’s not easy, I can’t imagine how tricky it is to manage for another person…
Yep, 1 unit for each 10 grams of carbs(humalog). Her doctor said to use 22 units for Tresiba. This ratio has worked very well previously with Lantus( there were very few moments when it didn’t due to extremely slow carb foods etc). However, I played it safe in terms of foods/meals when she started tresiba. She hasn’t eaten anything bizarre or new that would spike her insulin as much as it has. She’s eaten the same things while on Lantus and her blood sugar would drop within 2 hours into the low 100’s- sometimes even an hour. My mother’s doctor told us 22 units for Tresiba should be fine but it may also be, she needs a higher dose. I’m going to perhaps give her 23-24 units in a short while. However, my mother did mention how tresiba doesn’t leave the burning sensation effect like Lantus did, so that’s a positive.
My mother’s doctor said to not bolus for snacks at all in order to prevent hypos and that snacks under 5 grams don’t need bolusing…which is where basal comes in. Is this true ? She had said Tresiba will take care of carbs within 5 grams of carbs…clearly not lol.
She does bolus for meals though. I bolused once for a snack and she ended up in the er ( hypo of 50, if only I knew it could have been treated with OJ at home). I read about so many ppl bolusing for snacks where they don’t end up in hypo…but I’m afraid she will. Especially after her doctor told me so many damn horror stories abt stacking.
Switching from one insulin to another, like diabetes in general, is never straightforward. Switching insulin is never a simple “substitute 1 unit of insulin B for every 1 unit of insulin A you’ve been taking, and you’re good to go.” RE Tresiba, I’ve read that some people need a higher dosage of Tresiba compared to the basal insulin they had been using, where other people need a comparatively lower dosage. And remember that once your basal insulin is “tuned in”, it is likely that all the other factors (like ISF, I:C, etc.) will need to be adjusted, as these all depend on an accurate basal rate in order to be accurately determined.
And I’ve never heard of not needing to pre-bolus for every carb consumed (unless used to treat a low, of course). Maybe not if your I:C is 1:150, but I suspect your mother’s I:C ratio is much higher than that, perhaps in the 1:20 (or even higher) ballpark. Using this as an example, only 5 carbs would require 0.25 units, which is still a significant amount of insulin.
Basal insulin’s job is not to correct high BGs after eating. It keeps BG steady absent any other factors. I highly recommend that you read Think Like a Pancreas by Gary Scheiner.
I wish you and your mother the absolute best! Hang in there!
You say your mom’s ratio is 1:10 which would mean a .5 unit dose for a 5 gram snack, that’s not an insignificant dose. What delivery mechanism are you using, pens, pump or syringe? It may be that you can’t give her a .5 unit dose which in my mind means no dose at all to prevent a hypo (this is why I started on a pump), but then you either accept the high or adjust the size of snack so you can bolus accurately for it.
As was already stated, it’s best to dial in the basal first (watching her fasting BGs) and then play with the her bolus calculations to cover the carbs she’s eating.
How long before a meal does she bolus? That can make a big difference! For example, in the morning I need to wait 45-60 minutes after my bolus before eating.
she uses an insulin pen, Humalog. I’ve been looking into the pump because I feel it may be more convenient for her but she is completely against it…she says she prefers the pen instead.
I second Rose’s comments 100%. Basal insulin doesn’t deal with food. Only bolus insulin can do that safely with any chance of effectiveness. Expecting basal insulin to control post prandial BG is like expecting diet and exercise to cure a broken bone. Not what it’s for.
Also, as she points out, each individual physiology is . . . well, individual. Your response to a given regime may be the same as the next person’s, or altogether different. Managing diabetes has to be empirical and based on what you actually observe happening, regardless of the results someone else gets (or doesn’t).
And, as pointed out earlier, you need to get the basal dialed in correctly first. Otherwise results are going to be erratic and will eventually have you climbing the wall in frustration.
Depends on what her blood sugar is prior to meals…I was told to wait 10 minutes if her blood sugar is under 110 and to wait a half hour if it is between 115-140 and an hour if it’s over 150.
I am on Tresiba now for about 3 weeks switching from Toujeo. I’ve used Lantus and Levemir prior to that. Remember Lantus definitely has a spike in its profile whereas Tresiba does not. It sounds like she used her Lantus basal to cover some of her food snacks. I used to do the same thing. Tresiba doesnt work like that from my experience with it. I havent tried a higher dose to use it that way and I wont cause thats not the right way to do it. I used to always have lows and had to eat to keep my BS up which I hated. It can be a pain to bolus for everything she eats all the time but I feel so much better with less insulin until I need it. Lantus is horribly unpredictable in which I can clearly see now that I’m on Tresiba. It does sound like she might need a bit more units of Tresiba though, I am experimenting with that myself since I like to have a bit more basal just so I’m not totally on the edge.
[Trying to control my ire at yet another snippet of a not-so-wise, one-size-doesn’t fit all “formula”.] I suspect you were given more bad advice. It takes as long as it takes for each individual and how long one should wait after bolusing is not so proportional (if at all) to BG before beginning to eat. If you want to minimize spikes after eating, ideally you should correct BG down to “normal” (we arbitrarily use 100 as “normal”, as do a lot of folks), then bolus for the carbs to be consumed, then wait until you see the bolus insulin begin to work (i.e. begin to start lowering the BG just a bit) before starting to eat. Insulin, much like most other medications, can’t perform miracles (like a functional pancreas can). I think at this point in your journey, your expectations of insulin are too high. As the title of Gary Scheiner’s book implies, we need to learn to “think like a pancreas.”
I’m not sure I’d term pumping (versus MDI) “more convenient”. It is certainly significantly more complex and much more difficult at first. But it is that very complexity that provides better control for a great number of people. For example, you can’t set variable basal rates (many specific basal rates reflecting specific needs for specific doses of basal insulin for different hours of the day) with MDI. You get what you get after the one or two basal injections you utilize per day (and, for many people, Tresiba leads the pack in providing the most even and consistent basal action compared to the other basal insulins available). You can’t set temporary basal rates with MDI like you can with a pump. But a pump doesn’t “automatically” provide these benefits; making a pump work for you means you have to consistently and diligently do a great deal of work to effectively utilize the features that an insulin pump offers.
I’ve been on a pump for over 25 years. I have had Medtronic, OnmiPod and the latest is the TSlim. They offer control, but you have to constantly work with it. But, I have gastropersis and that throws a whole new wrench in the mix. Even with a pump, blood sugars are so brittle. So, I got so tired of "the up and downs of the blood sugar readings even with all of the changes of the rates in the pump, since my stomach is so unpredictable, that I asked my Diabetic Care Team what they thought about trying me on Tresiba and Humalog. To tell you the truth for me that combination works better than the pumps. I have had more level graphs (I wear the Dex Com) on this combination than with the pumps. I have been on this for a month now and yes it is a little more inconvenient to bolus with the meal, but with the pens it’s not that bad. I have a glucose meter that calculates the insulin for me just like a pump would and I have the Humlog pen that gives insulin in .5 units. It also feels so nice not to have to worry about tubing or knocking the omnipod off my body.
I know Tresiba is a flatter (doesn’t have a spike) than the shorter insulins. For me this is working. I wouldn’t give up, it takes a while to get the results you want, but if you work at it, and we all want a instant result, it will happen if this is the route you want to take.
I am really new to the community, with my T1 diagnosis for only 6 months now, but all I know is Tresiba.
It is the ONLY insulin I take.
I do not bolus (yet). I have an extremely LC diet (15-30 c daily).
I did not know what MDI or bolus meant until finding this forum.
I am also taking Metformin ER, 500 mg X 4 daily.
My doctor had me adjust my Tresiba levels by two units every three days to find my level: it took about 8 weeks to find my (then) optimal level. In this manner, I was able to gain control over my BG, but I do believe I am still getting highs 105-130 for meals. I have only seen it spike higher when very ill.
So, then, I learned how to adjust up if I am sick, or under extreme stress (moving mom into nursing home and traveling for it).
Whether the way I learned to use Tresiba is the “preferred”, or “incorrect” method, I do not know. It’s only my experience.
I’m just wondering how a transition from MDI to a stand-alone long acting insulin actually works? What factors have to be considered, and is bolusing with Tresiba ok? I’m certain it’s an individual thing, though?
Perhaps the method I was taught is not the only way to use Tresiba?
It’s not a perfect drug, but you have to adjust your units to find the right level.
Just wanted to give my perspective-- for whatever it’s worth.
No when you start using bolus it will be in addition to tresiba— tresiba would not fit that role at all.
If you’re only seeing levels of 105-130 after meals you’re probably not there yet, although if you’re LADA you will almost certainly get there eventually— you’d take an additional shot before each meal, with the dosage determined by the carb content of the meal… Likely humalog, novolog, or Apidra. I’ve also had good results with the inhaled bolus insulin afrezza
Tresiba will always just be a once daily longing acting insulin— some people might take it twice a day instead, but it will never fill the role of a bolus insulin, it’s at the extreme opposite end of the insulin spectrum
What Sam19 said. The following is a somewhat oversimplified explanation of things:
Tresiba, along with Lantus and Levemir, are long-acting insulins used for basal control. They are designed to mimic what a healthy pancreas does to maintain a normal background BG range when no carbs are being consumed.
Rapid-acting insulins, like Humalog, Novolog, and Apidra are used to mimic the short bursts of larger amounts of insulin that a normal pancreas provides in response to carbs and larger BG excursions due to stress, coming down with an illness, etc. These rapid-acting insulins are used to correct high blood sugars and to “cover carbs” in order to lessen (or if you are good about calculating I:C ratios and know how the protein and fat content of what you eat affects your BG in the relatively short run, eliminate) post-prandial spikes.
It is ill-advised to use long-acting basal insulin (Tresiba, Lantus, Levemir) to cover what should be covered by the rapid-acting insulins (Humalog, Novolog, Apidra).
That being said, increases in BG due to coming down with something, being ill, being at certain points in your menstrual cycle, being under more stress than usual, etc. are times when adjusting your basal insulin is the correct thing to do, just like you did.
I guess I meant, taking Tresiba as the long-acting insulin–
I use it as a stand alone insulin. I DONT YET use a fast-acting insulin with Tresiba.
So from my original experience this med is good enough --albeit with support from Metformin-- to NOT need to bolus with fast acting insulins?
When I said bolus with Tresiba, I meant adding a fast acting insulin alongside Tresiba. Sorry for the confusion.
I didn’t realize – because of my limited experience-- that Tresiba could be used as part of an MDI regimen.
And I was wondering how transitions from MDI, suck as Tinsyl’s mom needs, to a stand-alone insulin would be accomplished-- or if it is even necessary or not recommended to do so?
