Levemir to Tresiba?

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The problem with long acting insulin is that it is long acting - once in, you can’t get it out. Like others, my basal requirement is lower at night, so my Levemir dose in the evening is almost half the dose I use in the morning. That’s about as close as I get to the control with a pump, but I’m fiddling with basal doses at the moment because of frequent lows, probably because I need to reduce overall because of weight loss - there’s less of me to insuliise.
 
Thanks everyone for your input.

I haven't asked about a pump but the consultant said we might discuss it at my next appt.

The Tresiba does give a flatter line, but I'm just not liking the fact it's so inflexible. I am going to go in and see the DSN on Monday to discuss it, but I'm definitley swaying towards asking to go back on the levemir.
 
So went to see my DSN this morning. She has switched me back to levemir. To start with 8 units tomorrow morning, nothing tomorrow night and then back to 2 doses on Sunday. She said a lot of people have been switched to Tresiba recently, with a lot of people in a similar situation to myself- coming back to them saying it just doesn't suit. So I'm hoping the transition goes smoothly over next few days.
 
Hope the switch back is a smooth one @Lizzy78
 
Amity Island said:
Hi, sounds like you'll be moving back onto your previous insulin. I don't think the diabetes nurses have any real idea how exhausting it is when a basal isn't right. I'm interested in how they will advise going back to a 24hr insulin. Will it be started 48hrs after last dose of tresiba? Or is there a half life for tresiba and would a supplement of other basal insulin be required 24hrs after taking last dose of tresiba then onto full dose of basal 48hrs later. Good luck and I hope you start getting back to usual asap.
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I am guessing the 2nd option you have mentioned. 8 units of levemir 24 hours after my last Tresiba dose, not to take anything in the evening, and then back to the 2 doses 48 hours after last Tresiba dose.

I'm a bit anxious about it to be fair. Just hoping I don't have too much basal on board tomorrow.
 
Lizzy78 said:
I am guessing the 2nd option you have mentioned. 8 units of levemir 24 hours after my last Tresiba dose, not to take anything in the evening, and then back to the 2 doses 48 hours after last Tresiba dose.

I'm a bit anxious about it to be fair. Just hoping I don't have too much basal on board tomorrow.
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Hi Lizzy,

This info is really useful for anyone who switches from 48hr Tresiba Degludec basal insulin to a 24hr Basal insulin, thanks for sharing.

The advice you've been given seems right, to have half dose of an additional (24hr insulin) to cover for the half life of the tresiba the day after last dose of tresiba, then onto a full dose when tresiba has ran out (48hrs later).

Regarding being a bit anxious, I completely understand, I too would be a bit anxious which is why I was so keen to learn the strategy you've been given. I've thought about this scenario many times ever since I went onto Tresiba.

All you can do for that overlapping day is have sweets at the ready or be ready to either add in some extra bolus insulin with each meal and/or make some corrective bolus doses depending on which way it goes.

BTW, just thought I'd add this, officially tresiba state it's a 43 hr insulin. However, in my experience it seems more like 48hrs. If it is 43 hrs then there will be a 5 hr period of missing basal. They may say 43hrs to stop people considering taking tresiba only every 2 days, which just wouldn't work smoothly.

Kind Regards
 
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Amity Island said:
They may say 43hrs to stop people considering taking tresiba only every 2 days, which just wouldn't work smoothly.
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I imagine it's not perfectly flat so you get a better profile with a bit of overlap. Levemir's a bit more than 12 hours, but taking two doses a day makes it overall better.

And I agree, it makes sense to be attentive while switching over and eat or give a bit of bolus insulin as needed. (Much as we do when changing time zones, for example.)
 
Hi all.

Just thought I'd give you a wee update. I am now switched back over to my levemir and feeling so much better for it. Not one nightime hypo and a pretty flat line since (apart from succumbing to yet another urine imfection). I am split dose, with 13 units and 11 at night. I think this is what I missed the most, being able to make that evening adjustment as I seem to dip by 2-3 mmol during the night. Hopefully things stay steady for me now.

Thanks again for all your advice and support during a tricky period for me.
 
Such a shame that the HCPs had to mess with your insulin regime without any real justification and put you through that for nothing, but good that you are now back on Levemir and stable.
I tried Fiasp instead of NovoRapid a few months ago, but that was not nearly as disruptive as changing basal, in fact, a straight swap. Didn't find any improvement (ie no faster acting) so I am back to NR now but at least that was my choice to try something different. It seemed that this change was foisted upon you without them considering the upheaval it causes and for no obvious gain.
 
Lizzy78 said:
Hi all.

Just thought I'd give you a wee update. I am now switched back over to my levemir and feeling so much better for it. Not one nightime hypo and a pretty flat line since (apart from succumbing to yet another urine imfection). I am split dose, with 13 units and 11 at night. I think this is what I missed the most, being able to make that evening adjustment as I seem to dip by 2-3 mmol during the night. Hopefully things stay steady for me now.

Thanks again for all your advice and support during a tricky period for me.
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That’s great news Lizzy

Glad to hear you are feeling much better about things, and more able to adjust to suit your needs.
 
i'm on tresiba since 3 days, switched from levemir to have the flat reading during the entire day i am on 6 units only, went down from levemir 10 units.
i can say the all-day reading really improved, all day at 100 not more and 140 after 2 to 3 hours post meal.
My GP decided as well to have the rapid insulin after meal not before, explanation that since i am very active during the day (personal trainer) my system is using the premeal insulin very fast not allowing to reduce the BG and stabilize it after the meal, so far its very effective.
still need answers on, how long for Tresiba to work (i have been told 10 hours, not sure) and what is the best time to take it to have an effective fasting reading
 
billyblue said:
i'm on tresiba since 3 days, switched from levemir to have the flat reading during the entire day i am on 6 units only, went down from levemir 10 units.
i can say the all-day reading really improved, all day at 100 not more and 140 after 2 to 3 hours post meal.
My GP decided as well to have the rapid insulin after meal not before, explanation that since i am very active during the day (personal trainer) my system is using the premeal insulin very fast not allowing to reduce the BG and stabilize it after the meal, so far its very effective.
still need answers on, how long for Tresiba to work (i have been told 10 hours, not sure) and what is the best time to take it to have an effective fasting reading
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basal should keep you steady but as a personal trainer and possibly doing different things each day I wouldn't really say it was the best for you as its not flexible, it doesn't take a certain amount of time "to work" Tresiba is one that doesn't really have a "peak" and can last for up to 42 hours hence why its not very flexible and takes 3 days for adjustments to be made, I take mine at almost 10pm and have done for over 3 years BUT as I say not flexible so if I do more one day I need to adjust bolus doses for up to 24 hours after
 
billyblue said:
i'm on tresiba since 3 days, switched from levemir to have the flat reading during the entire day i am on 6 units only, went down from levemir 10 units.
i can say the all-day reading really improved, all day at 100 not more and 140 after 2 to 3 hours post meal.
My GP decided as well to have the rapid insulin after meal not before, explanation that since i am very active during the day (personal trainer) my system is using the premeal insulin very fast not allowing to reduce the BG and stabilize it after the meal, so far its very effective.
still need answers on, how long for Tresiba to work (i have been told 10 hours, not sure) and what is the best time to take it to have an effective fasting reading
Click to expand...
Hi,
When newly diagnosed patients start a basal insulin, the dose is worked out using their body weight and is usually started with a conservative dose then gradually increased. During that initial time, the gap in insulin needs is taken up with additional quick acting (bolus) insulin on top of that taken for each meal. You've switched basals, and tresiba deguldec according to their official prescribing data is switched at same dose, like for like (not everyone will be the same though). It's 48 hours or a bit more to steady state. If you've been on it 3 days then it's fully functional. I find the easiest time to perform a basal test is by missing breakfast, this then has the overnight readings (libre) to see as well. Tresiba is long acting, their data says during trials it lasted min 42 hrs before ending. Dose changes if required, are to be done no nearer than 3 days apart. If you're doing regular, like every day exercise and training then the tresiba dose that works for you during that time should keep you basal level. If you decide to miss a few days training, you may find your basal needs will increase slightly. You can't adjust tresiba on the days that you're not excercising, so you may have to take extra quick acting with each meal.
 
Making a change of insulin used to be quite a thing.

Before the days of synthetic insulins, back in the 70s, you had to be "careful". Making sure you were at home, not doing anything special, better at a week-end, mind how you go etc.

I did a switch back in 1971. Was sick on day 1 and hypoed on day 2. More recently, I have switched a few times with no bother.
 
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