Hi has anyone changed from glargine to tresiba? I’m sick of night time lows, my diabetic nurse put my glargine down only to see my daytime blood sugars go up,blood sugars are always high now, even though I’m having more novorapid, can’t seem to get my sugars right. was thinking of changing to tresiba as it’s supposed to keep you stable through the night.
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Glargine v tresibir
- Thread starter Denise62
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rebrascora
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Hi
I think it is important to consider if your basal needs are the same day and night or if you perhaps actually need less basal insulin through the night than you do during the day. If that is the case then Tresiba is unlikely to sort it out because it will just give you a very uniform amount day and night and if you want to avoid night time hypos then you would need to keep the dose low which would mean you were high through the day as you are now and having to fire fight with bolus insulin.
The two options I would suggest are
1. Look at the timing of your Glargine dose ie when you take it.... morning and if so, when ie. as soon as you wake up and before you get out of bed or after you get up and get washed and dressed and perhaps get a coffee? Similarly, if it is an evening dose, do you take it early evening or just before you go to bed? It can make a significant difference just changing the timing of the dose. This is because Glargine peaks at about 5-8 hours and then slowly tails off, so if you are taking it at say 7pm it is going to be at it's peak activity when your body most likely needs it least.... hence you hypo in the night but then it tails off during the day just when you need more from it. Taking it at 11pm instead could make a big difference or taking it the moment you wake up in the morning and before you get out of bed. I actually set an alarm to wake me an hour before I intend to get up so that I can inject my morning basal and then drop back off for an hour's snooze to give it time to get going before I get up. I am on split dose Levemir though and I need 22-24 units in the morning but just 3-5 units at night, so my day and night basal needs are quite dramatically different.....
". So my second suggestion would be to ask to try Levemir rather than Tresiba if you can't balance your needs with Glargine by changing the timing. I absolutely love my Levemir for enabling me to adjust the doses in real time to suit what my body needs..... So if I have had a very active day I will dial my dose back a couple of units in the evening to prevent a hypo overnight and if I have been sedentary for a day or two I dial it back up again and it responds in real time..... no waiting 3 days to see the full effect of any change before you can change it again.
Those would be my thoughts. If you let us know when you take your Glargine and what time you experience hypos and highs, we might be able to suggest when would be the best time to take it to try to cover your body's needs.
Do you have Libre sensors? They certainly make spotting problems and seeing how any adjustment you make works, so much easier than just the odd finger prick here or there. In fact I think Libre has been the single biggest factor in enabling me to get my Levemir doses as close to what my body needs as I can. They are a great bit of kit.
I think it is important to consider if your basal needs are the same day and night or if you perhaps actually need less basal insulin through the night than you do during the day. If that is the case then Tresiba is unlikely to sort it out because it will just give you a very uniform amount day and night and if you want to avoid night time hypos then you would need to keep the dose low which would mean you were high through the day as you are now and having to fire fight with bolus insulin.
The two options I would suggest are
1. Look at the timing of your Glargine dose ie when you take it.... morning and if so, when ie. as soon as you wake up and before you get out of bed or after you get up and get washed and dressed and perhaps get a coffee? Similarly, if it is an evening dose, do you take it early evening or just before you go to bed? It can make a significant difference just changing the timing of the dose. This is because Glargine peaks at about 5-8 hours and then slowly tails off, so if you are taking it at say 7pm it is going to be at it's peak activity when your body most likely needs it least.... hence you hypo in the night but then it tails off during the day just when you need more from it. Taking it at 11pm instead could make a big difference or taking it the moment you wake up in the morning and before you get out of bed. I actually set an alarm to wake me an hour before I intend to get up so that I can inject my morning basal and then drop back off for an hour's snooze to give it time to get going before I get up. I am on split dose Levemir though and I need 22-24 units in the morning but just 3-5 units at night, so my day and night basal needs are quite dramatically different.....
". So my second suggestion would be to ask to try Levemir rather than Tresiba if you can't balance your needs with Glargine by changing the timing. I absolutely love my Levemir for enabling me to adjust the doses in real time to suit what my body needs..... So if I have had a very active day I will dial my dose back a couple of units in the evening to prevent a hypo overnight and if I have been sedentary for a day or two I dial it back up again and it responds in real time..... no waiting 3 days to see the full effect of any change before you can change it again.
Those would be my thoughts. If you let us know when you take your Glargine and what time you experience hypos and highs, we might be able to suggest when would be the best time to take it to try to cover your body's needs.
Do you have Libre sensors? They certainly make spotting problems and seeing how any adjustment you make works, so much easier than just the odd finger prick here or there. In fact I think Libre has been the single biggest factor in enabling me to get my Levemir doses as close to what my body needs as I can. They are a great bit of kit.
rebrascora
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Would it be inconvenient to try taking it at 11pm-12. The later the better, depending upon when you go to sleep obviously.
Most of us experience what is called Dawn Phenomenon in the morning which sometimes kicks in in the early hours but for others like myself it starts when I get out of bed which we refer to as Foot on the Floor. I need my basal insulin to be getting up to full strength to tackle that, which is why I inject my morning dose an hour before I get up as that works well with Levemir for me. It might be that injecting your Glargine early on a morning rather than late at night would work better for you too, then it is tailing off almost to nothing when you are most at risk during that 3-5am period, but I would try dropping it back as late as you can in the evening first and see how that works. Start on the low dose you are on now and then try gently increasing it until you start getting close to low levels during that danger period. If you still hypo through the night then try taking it early morning instead and you would probably need a larger dose straight away especially if you skip the evening dose, so you effectively run dry of basal overnight during the change over to morning dosing. I would recommend you schedule that change for a day off work when you can keep a close eye on your levels.
The alternative option would be to split the Glargine dose and take a ver small dose at night and more during the day. I don't think splitting Glargine works as well as splitting Levemir but it might be worth discussing with your DSN. If you are not confident about adjusting your doses yourself then you should run these options past your DSN before implementing anything. I will see if I can find a profile of the activity of Glargine to show you the peak, but as with anything diabetes related, not all individuals will respond to insulins the same and most of us have very different basal needs which vary throughout the day and night. There will no doubt be some people who need more insulin at night than they do during the day, but it sounds like you are probably not one of those. Fiddling about with your basal and fine tuning it to your body's needs is a bit of a dark art but with practice (and Libre) you can get pretty good at it.
Most of us experience what is called Dawn Phenomenon in the morning which sometimes kicks in in the early hours but for others like myself it starts when I get out of bed which we refer to as Foot on the Floor. I need my basal insulin to be getting up to full strength to tackle that, which is why I inject my morning dose an hour before I get up as that works well with Levemir for me. It might be that injecting your Glargine early on a morning rather than late at night would work better for you too, then it is tailing off almost to nothing when you are most at risk during that 3-5am period, but I would try dropping it back as late as you can in the evening first and see how that works. Start on the low dose you are on now and then try gently increasing it until you start getting close to low levels during that danger period. If you still hypo through the night then try taking it early morning instead and you would probably need a larger dose straight away especially if you skip the evening dose, so you effectively run dry of basal overnight during the change over to morning dosing. I would recommend you schedule that change for a day off work when you can keep a close eye on your levels.
The alternative option would be to split the Glargine dose and take a ver small dose at night and more during the day. I don't think splitting Glargine works as well as splitting Levemir but it might be worth discussing with your DSN. If you are not confident about adjusting your doses yourself then you should run these options past your DSN before implementing anything. I will see if I can find a profile of the activity of Glargine to show you the peak, but as with anything diabetes related, not all individuals will respond to insulins the same and most of us have very different basal needs which vary throughout the day and night. There will no doubt be some people who need more insulin at night than they do during the day, but it sounds like you are probably not one of those. Fiddling about with your basal and fine tuning it to your body's needs is a bit of a dark art but with practice (and Libre) you can get pretty good at it.
I go to bed about 10pm I’m so scared of messing on with my insulin, I’ve been on glargine for a very long time and the thought of trying a different insulin terrifies me. I’ve had the libre for 8 months now and it has caused me so much stress, I’ve been type 1 for 42 years and never had as much bother as I’m having now. I’ve been really depressed lately with my diabetes, it’s taking over my life. I’m really struggling.
Inka
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I agree with @rebrascora You’d probably be better off on a twice-daily insulin like Levemir where you can adjust the daytime and nighttime doses separately.
Another option is to put your glargine back up to the dose you were on before (to try to stop your highs) but look at changing the time you take it. Some people find the morning works better than the evening for their glargine injection.
Why is the Libre causing you stress? Is it seeing the highs?
rebrascora
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Oh, I am so sorry to hear that you are struggling mentally as well as with your diabetes management and that your confidence is so knocked. Libre can be an amazing bit of kit but you have to understand how to use it and it's limitations. Did you do the Libre Academy modules or have any training before using it?
Have you ever had an intensive education course like DAFNE (Dose Adjustment For Normal Eating) It is so much more than the title suggests and you get a whole week of intensive support from a highly qualified DSN and diabetes dietician who go through your results each day and discuss with you what you can learn from them and what you can do to fix any problems and/or understand what is causing problems. There was a lady on my course who had been Type 1 for 50 years and she benefitted enormously from it having been suffering like you from nocturnal hypos and high daytime levels for many years and just on tiny amounts of insulin. She ended up getting an insulin pump, but the DAFNE course certainly opened the door to that.
Have you ever had an intensive education course like DAFNE (Dose Adjustment For Normal Eating) It is so much more than the title suggests and you get a whole week of intensive support from a highly qualified DSN and diabetes dietician who go through your results each day and discuss with you what you can learn from them and what you can do to fix any problems and/or understand what is causing problems. There was a lady on my course who had been Type 1 for 50 years and she benefitted enormously from it having been suffering like you from nocturnal hypos and high daytime levels for many years and just on tiny amounts of insulin. She ended up getting an insulin pump, but the DAFNE course certainly opened the door to that.
Had no training for libre, done the modules but there was a lot I didn’t really understand, nobody went through it with me, think it gives you to much information, so I worry when I see the highs the graphs,the time in target etc, my control has deteriorated over the past six months, I lost my mam in November, then found out I have to have a full knee replacement, which I can’t have at the moment until my hbaic comes down, so feel under pressure to get my sugars right. I’m terrified of having it done. I’m down to do a Dapne course but not until November. Should of done it years ago. Will have to see doctor about maybe changing the time of my glargine or trying Levimer.
nonethewiser
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There is online course equivalent to dafne one, don't have link so search for it, could be called Bertie if not mistaken.
Leadinglights
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- Type 2
I wouldn't worry too much about your knee replacement as they are usually very straightforward and recovery pretty quick, a friend was back within 6 weeks to driving, walking and doing stairs with no problem. Better than my surgery for a ruptured patellar tendon which I am still struggling with 8 months down the line.
Bruce Stephens
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Leadinglights
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No she wasn't but probably a bit overweight.
Thankyou, yeah I react to much to the trend arrows. Just frightened to change. Been on glargine for a long time ( maybe 20 years plus) My insulin dose would have to change on levimir, and that would be stressful and don’t think I could cope with anymore stress. Lost all my confidence. I was reading you don’t have to change your dose with Tresiba and it’s supposed to stop you having night time lows. When I read all the posts on this site everyone seems to be so much more educated than me, feel as if I’ve been left behind. 42 years is a long time and I struggle with change, but I am doing Dapne in November so really hoping that will help. Just feel so lost at the moment.
Thankyou so much for your advise, it means a lot. I will start to do my bolus 15 mins before eating, I get the biggest spike after breakfast and its smaller after lunch and tea. The libre is good for alerting you of highs and lows. Hopefully I will get there eventually. Thanks again.
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