While Tresiba is known as a basal insulin with a flat action profile, it is not “flat” for the entire 42 hours of average duration. Taking Tresiba every 24 hours overlaps the reduced tail of the previous day’s dose. This additive effect yields a dependable steady state of insulin when taken every 24 hours.
As I’ve said before, I have personally witnessed the timing flexibility of Tresiba. When I forgot to take my Tresiba bedtime dose, I just took it the next morning and resumed my bedtime dose that same day.
Since I started this thread, here’s a recap and update. I switched from Levemir 2x/day to Tresiba 1x/day. Decided to go with dosing in the morning. Have been using 14units of L every 12 hours so switched to 28units of T. Results - have had serious lows during the day since the switch. Good thing I dose in the AM instead of at night. I cut dose to 25 yesterday, still had very low in the evening. So this morning, I’ve cut dose down to 20.
Several folks report that they started with a lower T dose when making the switch. That seems true for me, too. Instructions say to adjust dose after 3 days, but NO way could I wait that long to drop the dose.
Anyway - I really like only having 1 dose daily. And it seems more effective in my body than L.
Thanks for the help.
I agree with your action to cut the dose before three days elapsed. When it comes to hypos, especially severe ones (<54 mg/dl or 3 mmol/L), you need to take action immediately. I found it better, however, to wait three days when increasing the Tresiba dose. My instinct and impatience wanted to increment every day on the way up but I think waiting for three days is good practice.
absolutely correct…we are PWD and so many of us do not make much insulin …we should be taking our insulin every day as prescribed…the consequences, Gastroparesis, loss of limb, blindness, DKA , death etc…are really really not worth it … WE ARE LUCKY that there is an insulin like Tresiba that is a bit more forgiving…but we still need to take it every day…
I’d love some clarification on this. I even called the Tresiba company and they couldn’t answer it! But I know the people here can give me a good answer…
Suppose Tresiba lasts for something like 42 hours, or whatever. But you take it every 24 hours or so.
As a for-instance, if Lantus lasts 22 hours (just as an example), and you take it every 12 hours, you have to cut your dose in half.
For Tresiba, is the 24 hours dose just a fraction of what you actually need for 42 hours? If I take it every 24 hours, am I actually only taking only 24/42 of what I need, and that is why it doesn’t stack?
That kind of would make sense to me. Every day I would only be taking 24/42 of what I actually need for 42 hours, so over the course of days and days, that amount works out.
So for Lantus, if I take a half dose every 12 hours, 1/2 + 1/2 = 1, or one day.
For Tresiba, 24/42 + 24/42 ~close to 1.
So, maybe my way of understanding it is that you are kind of taking 1/2 doses of Tresiba every 24 hours. Does that make sense? Or does my post now make NO sense?!?
No, you’re just getting off in the weeds. This is a really easy topic to overthink. You are taking X amount of actual units each day… there’s no secret math trick.
X amounts of units are also wearing off each day…
The fact that each of those units lasts longer than a day is neither here nor there… it doesn’t matter…
think of it this way— you start on Monday and take 20 units. They wear off on Wednesday. On Tuesday you took 20 units that wear off on Thursday, on Wednesday you took 20 units that wear off on Friday, and so on… it doesn’t matter how long the units last it only matters how many you take each day
If you’re pumping an insulin for basal that lasts 3 hours do you need 8x as many units to get through the day? Because 8x3 = 24? Of course not… and the reverse applies just as well to an insulin that lasts longer than 24 hours. You need how many units you need, every day-- how long that insulin lasts does not enter that equation in any way shape or form
In your example, all 20 units don’t wear off two days later. They wear off gradually over 42 hours. I think you explained it better than the Tresibsa people.
Yes of course my example is simplified to illustrate the point and isn’t exactly scientifically accurate but it’s the concept that’s important. You take X units each day, some of those units wear off day 1 and some wear off day 2, of course
And some of the units in my body right now are today’s units, some are yesterday’s, some are from the day before… some but all that matters is that X units are going in, X are going out each day and the amount of insulin in my body remains in a pretty constant state of equilibrium…
The mental block is that people think of basal in terms of units per hour or units per day. I take a lantus dose and divide by 24 to get my units per hour, and equate that to pump numbers in terms of units per hour.
Yes I was pretty concerned about it at first too… but it’s beautifully simple really it’s just our overactive minds over complicating it really
Here’s a good visual I stole from Allen… (I trimmed it a bit to just show the point)
As you can see, the first day or so you’re really not getting the full “x amount /day” because it’s stretched out over several days… but the ultimate effect is a nice and steady coverage that has minimal troughs and peaks
It’s just a conceptual model… also pretty well illustrates why taking it every other day would be largely ineffective
If you look at the curve for Tresiba, you’ll notice a grey section that covers the first 24 hours of action followed by a white section covering the 18-hour tail.
Once you take the second 24-dose, for the next 24 hours you experience the grey 24-hour curve of today’s dose + the white tail from the previous days dose.
Of course, this is an idealized curve that will vary from person to person and from day to day.
Just figured I’d post this here to illustrate what works for me. I tried everything I could think of with Lantus, (once in PM, once in AM, twice daily, varying doses between AM and PM) and could not get dialed in. I was either low at 3AM or quite high overnight. That is the graph on the left.
I switched over to Tresiba, one dose daily in AM and have been happy with the results, the graph on the right. I’ve got some room to tweak bolus but feel like Tresiba basal was a huge help. FYI I started at 17 units in AM and upped the dose 1 unit every 4 days until my BG control improved at 21 units daily. My total daily (Humalog bolus on MDI) is actually a little lower than I was using with Lantus. With Lantus I was doing frequent correction bolusses.
What a great discussion here … and your last post in this thread … vonderbar. I’m going on an insulin pump break due to a portage trip … that because I may get dumped in water … I don’t want to kill off yet another Animas pump (I have a few that people have sent to me since they’ve abandoned ship since J&J pulled out of the pump business due to bully MM). So, the graphs (thanks @Terry4 ) have really helped me alot. I’ve got about 4 more units left in Ziggy my Ping (I only use on average about 24 units TTD or 14 units basal ) … so I’m insulin sensitive even after 50+ years as a T1D. Now back to looking at more threads. Once again, Tudiabetes has come to my rescue (it taught me how to use an insulin pump back in 2008 - due to no CDE able to speak English to teach me how to use a pump properly … but I’d had experience with MDI 3 years prior to jumping onto a machine that goes … PING!!!
