Trouble with Tresiba (Degludec)

Guys, I have been using Tresiba for a couple of months now and my blood glucose levels are not in bad shape. My A1c has stabilized at 5.8. However, I consistently enter this long phase of hypos between the hours of 3 am. to 7 a.m. Numbers range from the low 50s to below 70. I’d check levels using my meter because I have lost the ability to sense hypoglycemia so I needed to make sure the cgm was accurate. I have some oj when I catch the lows by 3:30 a.m. but nothing changes until after 7 a.m. when I am actually up and can have some coffee and milk or more oj. This happens like clockwork! Any ideas?

I was on Lantus (16 to 18 units) and experienced rare nighttime lows. At breakfast, sugars ran from 80 to 100. With Tresiba, I am taking 18 units at noon, as I did with Lantus. This schedule works well for me and was an attempt to evade dangerous nighttime lows. I’ve had full blown seizures.

Lastly, when I was on Lantus I could have a light snack and not need to bolus. With Tresiba, I can’t get away with that. By the time Novolog peaks I am on the rise. It’s easy to forget that the basal insulin has a different job than the bolus insulin but Tresiba has me taking much more Novolog. Please chime in and share your experiences with Tresiba. I’d surely appreciate any feedback. Thanks!

I use 20 units of Tresiba in the afternoon, generally before dinner. I never go hypo at night.

When do you take your Tresiba ?

I take 18 units at noon.

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Do you have a time period during the day when you are more resistant to insulin than others?

Not really. obviously if the carbs are excessive then I do have a hard time bringing down those levels. Otherwise, I can’t seem to figure out what’s going on. I tried 16 units of Tresiba at noon. I wound up getting high readings from DP.

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While Tresiba doesn’t have a steep peak like other insulins do, it does have one between 8ish-14ish hours (see page 14). https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/203314lbl.pdf

You might try dosing 2-3 hours earlier for several days and see if that helps.

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I’ll read the article. Thank you so much!

(Updated) I have read this but somehow got stuck on the idea that it has no peak time. Obviously the link goes to the fda document in the form of a pdf file. I missed that. Thanks again!

I use the fast acting insulin to bring down my numbers. The Tresiba is to allow my cells to use sugar as they need it during the day.

So if I look at it that way, I don’t use Tresiba to control my numbers. I just remember to use it.

Yes, that’s why I mentioned the differences in my post. However, at the hours mentioned my guess is that the Tresiba is causing the lows. I rarely take insulin past 8 pm unless it’s necessary. The lows never happen to me when I lower Tresiba to 16 units but I always end up with higher readings during the night.

It isn’t this simple for most type 1s though. Insulin needs, both basal and bolus, vary throughout day and night and can be affected by numerous factors including diet, activity level, the weather, stress, sleep quality, etc. You may find this works well for you, but part of the logic behind AP/loop systems is that basal isn’t a static number for most people and insulin needs change every second of the day.

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You may be better off taking a split dose of Levemir or Lantus where you can take less at night and more during the day or vice versa. Tresiba isn’t a good fit for everyone and I had the same experience you are having.

I like Tresiba, although I had no problem with Lantus. I like only having to give Tresiba once in 24 hrs. I give 11 units between 6 and 7:00 in the morning.

I will drop at night so I eat something before I go to bed now. Usually some organic apple chips so that my glucose level is around 120 before bed. This keeps me from dropping too much in the early morning hours. The 11 units keeps my dawn phenomena at bay most of the time. If I wake up around 6:00 but want to sleep a bit more I will give a unit of Novolog if I am above 90. My glucose levels can rise rapidly between 6:00 and 7:00 am if I don’t inject.

I can give 10 units of Tresiba, so that I don’t drop as much in the early morning, but the rise around 6:00 am is more rapid.

I absolutely agree with you. I’m currently taking a break from the pump so I have to figure this out. Thanks for sharing!

As suggested to me earlier, I will try taking Tresiba at an earlier time but will probably have to take a lower dose to avoid nighttime lows while asleep. I’ll try snacking before bedtime if necessary. One unit of Tresiba makes a huge difference for me as well. Thanks!

This was my experience as well with Tresiba. I had to take significantly more bolus insulin in the evenings especially (I did my dose at 9 am each day, but I didn’t find switching to the evening to help any), and sometimes even the extra insulin didn’t seem to even work very well. I suspected it was some sort of insulin resistance. If I bumped my Tresiba dose up, I’d have resistant lows in the early morning hours (4-7 am).

I started using Metformin XR 500 mg/day with dinner, and that helped significantly with the evening spikes. I also decreased my Tresiba dose by 1 unit while using Metformin.

I kept gaining weight while on Tresiba as well (around 15 pounds total in 1.5 years). The weight gain slowed after I made many lifestyle adjustments, switched off birth control, and went on Metformin. It still didn’t stop though. My doctor recommended that I switch back to Lantus.

So I did. I take Lantus 2x/day (9 am & 4 pm). I dropped Metformin a few weeks after switching to Lantus. I had to increase my basal by 1 unit, but I’m not having the insulin resistance in the evenings anymore. I lost weight immediately after switching from Tresiba to Lantus, but the weight loss has slowed a bit. I feel better overall and my control is just as good (but I don’t need Metformin to get there and I’m not gaining weight anymore).

Tresiba was a very bad fit for my body type. I wish I had switched back to lantus sooner. I just didn’t think that insulin could cause weight gain.

Lots of people seem to love Tresiba, but I personally wouldn’t recommend it to anyone - though I have in the past before I realized the problems it was causing.

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Your experience is similar to my current dilemma I’ve gained 15 pounds in the past 2 years I’ve been on Tresiba and insulin resistance is insane. I wouldn’t go back to Lantus though since I always had terrible lows on it that left me afraid to sleep (none of that on Tresiba). At first Tresiba and Afrezza were keeping me really super stable but my recent A1C is 7.3 up from my last A1C in February of 6.2 so I really need to do something.

I’m trying Metformin again but if that doesn’t help enough in the next month or so I’m thinking of asking my endo to prescribe me Levemir.

MichelleM. Consider to move the tresiba time to 8 or 9 a.m. and reduce from 18 to 16 units is a reasonable response. Alternative is 17 units. This is a very low dose. The lower the dose the more a tiny change can effect BG.

If using U-200 switch to U-100 and keep delivered units as described.

Good rationale is that it is better to let A1C rise a bit than risk SH. BG below 58 is SH.

It may take a while to normalize and shake out. Do not decision make back upward from merely one day of data on the next day or two.

The same thing happened to me. I would lower the dose. Tresiba is strong stuff and the doctors don’t give much sense on the whole overlapping thing of tresiba. It stays in the body longer. You should be careful mixing it with other insulin’s, the short term. This is tricky. It happened to me a lot. So much so I was worried without knowing what to do. I switched back to levemir.

I had tried Basaglar and it didn’t seem to work for me. I found an extra pen leftover from my first attempt to try (due to insurance) and decided to try it again. I’m taking 18 units at noon and so far my time in range is pretty good. Who knew? Basaglar has been getting bad reviews but it actually works for me. I have steady numbers (80s - 100s) during the night and morning lows aren’t so bad (mid 70s). Basaglar seems to be less potent than Lantus in my case but it is actually working for me. I’ll continue to see what it does for me before I return to using my pump.