Changing From Lantus To Tresiba - Advice Please!

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TheClockworkDodo

TheClockworkDodo

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Type 1
@KookyCat and anyone else who has changed from Lantus to Tresiba, please could you let me know how you did it? - eg, did you just have Lantus one day and the same amount of Tresiba the next? Did you have to wait a certain number of hours between the two so they didn't overlap? Did you have to reduce the dose of Lantus before starting the Tresiba or have a lower or higher dose of Tresiba the first time you had it?

I am finally getting Tresiba on my next prescription (yay!). And my consultant told me there was a procedure for changing over from Lantus and that my first two doses of Tresiba should be closer together than usual because it's cumulative. If this is right, how do I do that, if I want to end up having it the same time - surely I'd need to do first three doses closer together or do two closer doses and then miss a dose?! He also told me I should have exactly the same amount of Tresiba as I'm currently having of Lantus - I'd read elsewhere that Tresiba doses should be lower, and given how small a dose of Lantus I'm on, how sensitive to meds I am, and how easily I hypo I'm a bit dubious about whether he's correct.

I'd really appreciate any advice or information anyone can give me - thanks. For various reasons I'm likely to be doing the changeover on the very last day my very last Lantus pen is viable (Monday week) so I want to make sure I know what I'm doing before then.
 
Thanks for your help, both of you - just found another thread about Tresiba and yes, Newbs and Flutterby are both on Tresiba as well as Kooky. Hopefully at least one of them will see this thread some time in the next week!
 
Hi Juliet

I've been on Tresiba for a couple of months now after switching from an uneven split (morning and evening) Levemir dose. Regarding the switch over I was told to take the single Tresiba dose in the morning and yes, was started on a lower dose than my combined Levemir. I found the switch was relatively painless but did involve some tweaking upwards in the first week. I too was told it was cumulative but I probably had more flexibility than you with higher doses to play with. I'm now fairly settled on 20 units which is 4 units less than the combined Levemir.

I've found it to have a much steadier more even profile even though the Levemir itself wasn't bad. It's not perfect as no long acting basal can be (a pump is the best bet) but so far it's the best I've had. Hope it works out well for you. 🙂
 
Thanks very much, Matt, that's really helpful. I'm only on 5 units Lantus so suspect I may need about 3.5 units Tresiba! I was planning to stick with evening injections unless there's a particular reason for injecting Tresiba in the morning, but I can tweak the timing over the first couple of weeks and see. I found I couldn't inject Lantus in the morning as it caused too many hypos later in the day, but I may find Tresiba is different from that point of view, of course.

Did you just stop injecting Levemir one day and inject Tresiba the next?
 
My consultant advised to inject it in the morning (I didn't question it) and I have seen it mentioned in a few places online but I wouldn't have thought it mattered.

Yes, it was a straightforward changeover. I've only had 3 different basals in 30 years so any change for me is done with some trepidation even when there are issues with the existing one. However I was pleasantly surprised at how well the swap worked.
 
Sorry Clockwork, only just seen this. I switched from Lantus to Tresiba last year and yes I went straight in as it were. I was advised to do a 20% reduction in dose to accommodate its slightly longer potential profile. I actually did a bit less on instinct and that was right for me at that point although it changes throughout the year. I went from 8 -10 units of lantus which had me up and down like a yoyo to 5 of Tresiba and then let it settle for a few days. No major issues really, i did have a hypotastic day a couple of days in but I suspect that was the Lantus leaving the building (good riddance I said as I waved her goodbye). I've said before (I think) that Tresiba has been considerably better for me than Lantus, it's not a magical panacea or anything just much much more stable, and Lantus was never very happy in me. I did have to adjust my ratios though because Tresiba will not compensate for anything, it's not nearly as aggressive as Lantus. I'll explain a bit more or I'll try. Lantus was really aggressively peaky in me so I had no real choice but to keep my ratios lower than they needed to be otherwise a rapid peak and a lantus peak would meet and a have a hypo party. I also had to stick to no more than 2 units of rapid, otherwise the rapid and the Lantus would gang up on me then too. I don't have to do that with Tresiba. I'd also be able to accommodate some snacking with Lantus (without rapid), can't do that on Tresiba, but again I'm fine with that. Tresiba also allowed me to gain a few kilos and go from dangerously underweight to OK by virtue of the fact that it didn't interfere with eating in the same way, which was a relief 🙂

I'd love to say my Tresiba dose is very stable, but it isn't really I still go between 5 and 7 depending on which way the wind is blowing, and I still have hypo days, but they're not as bad as before. In summary it's all within parameters I can cope with now, and finally I can actually sleep. I spent 18 months plagued by overnight hypos and a total inability to sleep for more than 2 hours at a time, so that was a blessed relief too. Oh and much was made of the double duration business with Tresiba, which made me wonder at first why on earth they thought it would be better for me. That's the reason for the dose reduction because it's a longer flatter profile. so I've noticed that it takes me a while longer to work out if My dose is too high. With lantus I'd be off the cliff and in hypo town by the six hour mark if my dose was too high. Tresiba is more difficult to judge for me because I'll gradually start to see hypos build over a week or so. Not a problem really so much as a bit confusing at first. The other and last thing because I'm waffling now is Tresiba won't help with exercise peaks either. On Lantus when I exercised I didn't get a blood sugar peak, but I did always go hypo afterwards. On Tresiba I get the blood sugar peak, which then trickles down and I don't usually get a hypo afterwards. Again I think it's the less aggresssive nature of the beast in me, so that might not be an issue for you. Really will shut up now. Hope it goes well, and you find Tresiba a bit more nurturing than Lantus 🙂. Let us know how you go, I like a bit of comparative analysis :D
 
Thanks Kooky, that's really helpful, was hoping you'd see this as we seem to have similar reactions to things, with the EDS and ME clashing with the diabetes in a similar way.

Consultant warned me that my control would not me as tight with the Tresiba - I think he is working on some strange parallel universe definition of tight control as with Lantus I'm up to 15ish every day mid-morning and down to 3ish every lunchtime at the moment 🙄 I want to be able to increase my morning bolus to lower the former without the daily risk of the latter turning into a coma.

I'm used to changing doses frequently so that shouldn't be a problem! Usually down to 4 units Lantus in winter and up to 8 or 9 in summer, so just swinging between 5 and 7 would be an improvement on that.

My problem with sleep is not that I don't, but that I do. Far too heavily, all though the night without waking up once. I don't know whether this means my bgl's too high or (more likely) too low at that time, but I don't think it can be good for me, either way. I know Tresiba's not going to be a miracle cure or anything, but I'm really hoping it will mean my overnight readings are more stable than I suspect they are at the moment and that I can sometimes wake up actually feeling like I've slept all through the night!
 
I've been offered Tresiba too - at the time I said "No, Lantus is fine!" 🙄 But since the clocks went back my BGs have been all over the place and I've suddenly remembered that I'm plagued with random little trends in the colder months, with the finger of blame pointing towards Lantus (I must start keeping better records!).🙂

Anyway, good luck with the changeover, Juliet. Let us know how you get on, plz.🙂
 
Thanks, Bloden. I have noticed several people having problems with swinging readings at the moment and mostly it seems to be Lantus which is to blame - maybe combined with the rapid drop in temperature we had this month (did you have that over there too?). I am usually better in the winter than the summer, and love it when the clocks go back, but it hasn't had the usual positive effect on me this year, I am still all over the place (... or at least my readings are 😛).

I'm staying with my internet-less parents next week as we have someone coming to do some fencing & I'm leaving R to deal with him as I can't cope with any noise, so I can't start the Tresiba until I get back, just in case I have any problems with it. I'll let you know what happens when I do start it though 🙂
 
Just rediscovered this thread ...

I've now been on Tresiba for 5 months. I no longer have red blotches all over my leg, and I haven't had twitching muscles for ages 🙂

I'm still hypo-ing like mad, but I do think the hypos are a bit more predictable. I don't have the feeling that I am probably hypo-ing in the night without waking up, which I used to have with Lantus. I'm also having fewer readings under 2, which can only be a good thing.

I am having slightly more high readings (ie the occasional inexplicable 10 or 12), which is I suspect what the consultant meant about my control not being as tight. I also still get the swinging high mid-morning, unfortunately - the only thing which seems to stop that is going to bed straight after breakfast, so it does look as though that is caused by my ME and there is nothing I can do about it but make sure I get enough rest.

The amount of Tresiba I need seems to be much more stable than the amount of Lantus, though I haven't yet had summer to contend with! So far though I've been fluctuating between 4.5 to 6 units rather than between 4-9 units.

Not had an HbA1c done yet, so I'll let you know whether it's made a difference to that when I do. I suspect my first one on Tresba will be rather higher than usual, but over time it may be easier to get my blood sugar stable and therefore get a lower HbA1c.

It's certainly not perfect, but I am very happy to be off Lantus 🙂
 
Hey Clockwork
Long time no see, nice to see you 🙂

Glad you're finding the Tresiba a more manageable beast than Lantus, I was soooo relieved to get off the Lantus that even having to change my ratios didn't phase me. Tresiba isn't perfect, I'm still the hypo queen of these parts, but it's all much more manageable and logical which helps. I have more readings in the low teens now too, Im oddly quite happy about that because it proves to me that the Tresiba isn't mounting a takeover bid. Weird I know but the most trying part of the Lantus experience for me was I couldn't get any consistency with the rapid injections. I knew it was the Lantus, can't tell you how I just knew but it made me sound like I was verging on serious mental breakdown when I tried to explain. Anyway I ramble, nice to see you round these parts again, glad you're enjoying Lantus liberation and long may it continue :D
 
Nice to see you back, sorry to here you are still having struggles, but that you are happier with your changes.
 
Little update - just to say my first HbA1c on Tresiba was 49, which is slightly lower than last couple of ones on Lantus - I'd expected it to have gone up, so very pleased. Though I'd prefer it to be 49 because all my readings were 6.6 rather than because half of them are 2.6 and half are 10.6 or whatever 🙄 Still, with Lantus half of them would have been 1.6 so still an improvement ...

The only thing is - while I'm having fewer hypos and less low hypos (both relatively speaking, am still hypo queen of the south!) I have noticed I've started having hypos which are difficult to shake off - I've had several which have taken 2 or 3 lots of glucose to get rid of, and a couple of them have lasted over an hour. Most of these seem to happen around bedtime, so 23-24 hours after injecting the last dose of Tresiba, just before the next one. Diabetes nurse at surgery thought it might - ironically - be because Tresiba is so stable and lasts longer compared with Lantus, so it's hanging around in my system and prolonging the hypos. Anyone else had this with Tresiba?
 
@KookyCat and anyone else who's changed from Lantus to Tresiba - did you find it changed how your blood sugar reacts to the weather?
Normally I need twice as much insulin in summer as in winter, and weather like this would mean I was struggling to keep my bgl down all day. This year I'm using less Tresiba now than I was in the winter and I had three hypos a day for the last 2 days (and only managed to keep it down to one hypo today by eating Hobnobs between meals). But my waking levels are around 8 (until it got hot they were around 4-6) - not sure whether I should be putting the Tresiba up to deal with this (while putting all my bolus doses down) or down to deal with the hypos ... :confused: I don't think the waking levels are high following night-time hypos because I'm not waking with a splitting headache every day.
 
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