Having some real challenges with an extremely high basal sugar rate and wondering if anyone had similar and how it got fixed - doctor is trying to help but no luck so far
I’m a 47 yr old 220 lb diabetic 6ft so a little overweight (15lb) my evening tresiba should be 20 units my doctor thinks - however on that my morning fast is 350 - when I ramp up the dose to 32 it creates serious lows at night but still goes high in the day (and it’s a very low carb diet)
The only half workable solution I have is 24 tresiba and additional 5 units of hunalog as my basal but it’s difficult to maintain
Doctor hasn’t explained why my basal is so high - says it isn’t insulin resistance but high glucagon production from my liver which gets me concerned
Just tried trulicity for 1month as it is meant to reduce the glucagon production. The 0.75m dose did the trick - got me to a stable 140 without the extra hunalog but still on 24 tresiba
Doctor now increased me to 1.5 of trulicity and rather than bringing it down further it appears to completely stop working as I am back at 24 and 5 units every 5 hrs
Doctor has no idea why that is
Anyone had similar experiences - particularly such a high basal sugar output - very frustration as I can’t eat anything as on the high dose of trulicity but it doesn’t appear to be doing anything !
I don’t think 24 units of Tresiba is a high dose. When I read “very high dose” I was thinking hundreds of units! I have Type 1 and my basal dose has never been lower than 18-20 units (currently it’s about 35-40 units as I’m overweight).
Are you taking Humalog with each meal? The purpose of basal insulin is to keep your blood sugar steady between meals and overnight. If 24 units of Tresiba is doing that for you but you are still going high during the day, it sounds like you need to take Humalog to cover meals. Even very low-carb meals need insulin to cover them if your body is not making enough.
I have a lot of confusion. Your doctor has suggested a basal dose of 20 units, but it is not clear what you previous dosing has been. And then you increased it up 32. That is a jump of ore than 50%. It isn’t surprising you had lows. And then you were still high during the day. You believed this indicated that your basal was still to low, but in fact you have have experienced a severe low overnight and counterregulated thus causing you to be high upon waking. If you had a CGM you could monitor your overnight levels. And if you have a harsh counterregulation that can cause you to be insulin resistant a day or two afterwards. So I would recommend trying to restore yourself to normality and then doing careful basal testing to properly establish your basal rate.
And the Trulicity. That is a GLP-1 drug that helps your postprandial response.by reducing glucagon production after meals. It doesn’t really help overnight highs (which I call Darn Phenomenon (DP)). A better drug to help DP would be Metformin. And I have to tell you the GLP-1 drugs are often not durable meaning they may stop working after a time. In my experience with two different GP-1 drugs they only worked for 2-3 weeks and even though they worked really well at first, they later were useless. Most people get a couple of months at least and even if one GLP-1 stops working you can switch to a different one (there are a bunch).
And finally I would like to point out that bad DP can also be caused by sleep apnea. If you have sleep apnea that alone could cause morning highs.
Thanks for responses - hopefully this will explain better - my previous long term dose was 32 of Lantus - doctor always complained this was too high and should be 20 based on my exercise and size was not good for me and was also why I retained weight-and had lots of early morning hypos - on 32 Lantau - I got a steady 100-120 - except morning low of 40 - but during day it was good
I eat low carb diet - zero for breakfast and about 15 for lunch and dinner from vegetables or high fiber bread - so controlling that is easy - only creates small bumps
My Cgm clearly shows it’s not lack of bolus causing high - as the steady rise back to 300 happens 5 hrs after my compensating 5 units of hunalog every 5 hrs while on 24 units of tresiba ( replaced Lantus as part of this change)
Trulicity was attempt to get down the basal rate - we’ve also done fast tests in day and night - all point to needing a high basal injection
I’m considering just ignoring my doctors resistance and going back to 32 tresiba - but getting my reading to be higher before I go to bed so that the low early morning is avoided -
Some people find that their basal dosing goes down with Tresiba, but it is really unlikely that you would drop from 32 units down to 20 units. Since Tresiba is so flat you really need to set a basal rate to try to achieve a dose that can keep as close to normal without lows. You may find that moving the timing of the injection between morning and night can improve things. On Tresiba I find that if I set my dose as high as possible to tamp down my DP without going low during the day I have the best balance. It isn’t perfect, I still have some overnight and morning highs and I will get a few mild lows before lunch and dinner, but it is a reasonable balance. But I would not tolerate a morning low of 40, I would decrease my basal.
Personally, I would not just up my dose to 32 units, I would recommend a slow adjustment of your dose, making 5-10% changes and the looking for 3-5 days to see how it works. During that time as you increase the dosing from 20 units you should continue aggressively correct highs.
ps. My Tresiba dose was about 10% lower than my Levemir dose.
Yeah, based on what I’ve read here, Lantus --> Tresiba doesn’t tend to result in dramatically lower doses. Some like me have slightly lower, but some are the same and some slightly higher. Seems like the general bet is to start at the same or slightly lower doses and adjust slowly from there.
Also, agreed with Jen that 32 units doesn’t seem like a super high dose. And no one’s body particularly cares about what some formula says it should need—it needs what it needs. Formulas and whatever are good starting points and then we have to figure out what actually works for us.
My Lantus to Tresiba dose ended up being the same after a ramp up period. I took 80 units Lantus in 2 injections (40 units pm, 40 units am). When I transitioned to Tresiba, my Endo said to start at 60 units of Tresiba and increase 5-10 units per 2 week period as needed up to my former Lantus TDD dose until my basals stabilized. Took me about a month, but I am using 80 units of Tresiba, and my basals are FLAT!. The only variations I have are due to stress, food, sleep, etc… Playing the curves on Humalog and exercise as possible solves the spikes for me.
Ok took 2 and a half wks but seems to all have worked out - 15 units of tresiba at night and 16 in the morning and I get a flat 110-120 reading through the day. Stopped the trulicity as was making me sick - and keeping the humlalog to about 10-15 a day with low carbs
Will see what my doctor says I am sure he will complain it’s far too high - I will have to remind him it was him who forced me down to 24 units a year ago and created all the problems in the first place - before all this started I was on 28 Lantus for years with no problem - I should have ignored him when he convinced me to reduce it