Splitting Tresiba dose?

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Flutterby

Flutterby

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Relationship to Diabetes
Type 1
Has anyone successfully split their dose of Tresiba? I can't figure out how it would help given that Tresiba is supposed to last over a long period of time. My problem is that I am high all morning but from late afternoon my levels are seriously dropping causing a lot of distress. I am on 12 units and I inject at about 7.30am. If I were to split the dose surely I would be putting insulin in at a time I don't need it. I would probably split it 7 or 8/5 or 4

Please advise if you have experience of doing this. My DSN is ok about it.
 
Splitting the dose of an ultra long acting insulin like Tresiba is utterly pointless, because after a few days your level of insulin will be exactly the same all day as if you took it once a day. Your DSN clearly has little grasp of physiology, and the nature of Tresiba.

You’d probably be better simply switching your dose of Tresiba to the evening rather than the morning, then the slight ‘hump’ in the absorption trace of Tresiba works from in the early morning rather than the afternoon. There isn’t a lot of difference, but on a relatively low dose it should make a difference.

I split my Levemir dose 2/3 in the morning 1/3 in the evening, which works for me, but Levemir lasts a fair bit less than 24 hours, unlike Tresiba which hangs around like an unwelcome guest for around 25.

The ideal, of course, is a pump, where you can vary the basal dose during the day according to your needs.
 
There’s no point splitting it because of how long it lasts. What it sounds like is that you need to alter your dose of fast acting to allow for either different insulin to carb ratio or different insulin sensitivity at different times of the day. Are you on injections or pump and a meter or a CGM?
 
Tresiba isn't suitable for splitting due to it lasting for so long, it was new in my area when I was diagnosed but the consultant dealing with me wanted me on it so end of, I take mine just before 10pm and my levels are generally ok although there is a dip everyday at 12pm xx
 
Good morning @Flutterby, I switched to Levemir as my basal insulin in order to be able to split it.
It made a big difference and things became more manageable (but not as good as on a pump)
 
My DSN is well aware of the way Tresiba works and yet has discovered more than one patient in whom splitting the dose has made a positive difference. Like most of you, I can't understand that but I have left her a message to say I am struggling. Levels just fell away at 3am. I have been on Tresiba for years and have not experienced this before, it is very disconcerting and my confidence is at an all time low.. thanks for your answers. I was just hoping to find an encouraging story.
 
Thebearcametoo said:
There’s no point splitting it because of how long it lasts. What it sounds like is that you need to alter your dose of fast acting to allow for either different insulin to carb ratio or different insulin sensitivity at different times of the day. Are you on injections or pump and a meter or a CGM?
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I have reduced my basal dose at teatime but have now reduced it again. I am on mdi with a bolus wizard meter and libre.
 
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DSN said stick with the changes, see how it goes. She said not to get too obsessed with all the information from Libre and to have an afternoon snack if needed.

I also had my counselling session today which is bringing up stuff from when I was in hospital as a child in the 70s and 80s. Things were very difficult for me and they frequently made me more ill. It is hard talking about it but necessary for improvement in my mental health which has been very poor of late. I think this is making this blip harder for me.
 
Flutterby said:
DSN said stick with the changes, see how it goes. She said not to get too obsessed with all the information from Libre and to have an afternoon snack if needed.

I also had my counselling session today which is bringing up stuff from when I was in hospital as a child in the 70s and 80s. Things were very difficult for me and they frequently made me more ill. It is hard talking about it but necessary for improvement in my mental health which has been very poor of late. I think this is making this blip harder for me.
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When I first got my Libre I did find a lot of worrying spikes and dips, but now try to focus on the overall patterns. Not always easy to do.

As you say things would have been very different when you were diagnosed, which must have made things so much more difficult to manage effectively. I am glad that you have got the support of the counsellor and have the chance to work through issues.
 
Have you considered (or tried?) a shorter duration basal like Levemir that you can take 2x a day without it overlapping too much?

I’ve always been a bit confused by pharma’s quest for the longest and flattest insulin profile for basals, when the main benefit of a pump for me was being able to fine tune and accurately tailor my basal profile to my needs.

Hope the counselling is helpful for you and you are able to get full benefit of the support you need.
 
Flutterby said:
Has anyone successfully split their dose of Tresiba? I can't figure out how it would help given that Tresiba is supposed to last over a long period of time. My problem is that I am high all morning but from late afternoon my levels are seriously dropping causing a lot of distress. I am on 12 units and I inject at about 7.30am. If I were to split the dose surely I would be putting insulin in at a time I don't need it. I would probably split it 7 or 8/5 or 4

Please advise if you have experience of doing this. My DSN is ok about it.
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It's not an easy question to answer. Simply because the manufacturers of Tresiba will not deal with questions from users of their products e.g Diabetics. I've been down this route before. Tresiba will only, refer you to your own consultant. However, consultants have had no involvement with the development, manufacture or distribution of Tresiba degludec. So where do you get an answer? This loophole needs to be closed. It is my understanding that tresiba works in a queue system, thus splitting the dose in theory would make no difference, however, Dr Bernstein recommends splitting the dose for Tresiba. He either knows something the manufacturers don't, has had patients who have benefitted from it or this is just wishful thinking. I personally only take Tresiba in the morning, once a day. I always get a blood sugar rise every morning whether I eat or not. I always need some extra bolus with my breakfast bolus dose. Plus my morning ratios are much higher also. 1.4 units of humalog to 10g carbs.
 
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everydayupsanddowns said:
Have you considered (or tried?) a shorter duration basal like Levemir that you can take 2x a day without it overlapping too much?

I’ve always been a bit confused by pharma’s quest for the longest and flattest insulin profile for basals, when the main benefit of a pump for me was being able to fine tune and accurately tailor my basal profile to my needs.

Hope the counselling is helpful for you and you are able to get full benefit of the support you need.
Click to expand...

Thank you Mike, I have previously been on Lantus and Levemir with varying degrees of success. I suffered greatly from a local reaction on injection sites with both of these and when I was offered Tresiba some years back I jumped at the chance. No problems really until recently with quite dramatic issues.

I really lost my confidence and found myself highly anxious at meal and injection times. It's been an unpleasant experience.

Having reduced Tresiba by half a unit a couple of days ago things looking better. Yesterday was awful with massively elevated levels but I suspect my anxiety and counselling appointment added to that.

Today it's been a flatter profile around 9-11 and has dropped to 7.5 pre tea so I am happier. I will probably tweak my breakfast bolus slightly but one step at a time. I want my confidence back first.

I am paying for my counselling so that I am not limited to a few sessions. I think it will be helpful, I certainly felt better for it yesterday.

I'm with you on the confusion, sadly although things have improved massively we cannot hope to replicate the natural response of the body.

Thank you for your response and kind words.
 
Amity Island said:
It's not an easy question to answer. Simply because the manufacturers of Tresiba will not deal with questions from users of their products e.g Diabetics. I've been down this route before. Tresiba will only, refer you to your own consultant. However, consultants have had no involvement with the development, manufacture or distribution of Tresiba degludec. So where do you get an answer? This loophole needs to be closed. It is my understanding that tresiba works in a queue system, thus splitting the dose in theory would make no difference, however, Dr Bernstein recommends splitting the dose for Tresiba. He either knows something the manufacturers don't, has had patients who have benefitted from it or this is just wishful thinking. I personally only take Tresiba in the morning, once a day. I always get a blood sugar rise every morning whether I eat or not. I always need some extra bolus with my breakfast bolus dose. Plus my morning ratios are much higher also. 1.4 units of humalog to 10g carbs.
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Thank you for your interesting response. I can only imagine that some doctors/DSNs do have personal experience of success with splitting the dose. We are all different.

Like you, I get a rise in BG in the morning. I think most of us do because of how the body works. I had zero carbs for breakfast yesterday and still it went up. I have a much higher bolus ratio in the morning compared to later in the day.
 
Flutterby said:
Thank you Mike, I have previously been on Lantus and Levemir with varying degrees of success. I suffered greatly from a local reaction on injection sites with both of these and when I was offered Tresiba some years back I jumped at the chance. No problems really until recently with quite dramatic issues.

I really lost my confidence and found myself highly anxious at meal and injection times. It's been an unpleasant experience.

Having reduced Tresiba by half a unit a couple of days ago things looking better. Yesterday was awful with massively elevated levels but I suspect my anxiety and counselling appointment added to that.

Today it's been a flatter profile around 9-11 and has dropped to 7.5 pre tea so I am happier. I will probably tweak my breakfast bolus slightly but one step at a time. I want my confidence back first.

I am paying for my counselling so that I am not limited to a few sessions. I think it will be helpful, I certainly felt better for it yesterday.

I'm with you on the confusion, sadly although things have improved massively we cannot hope to replicate the natural response of the body.

Thank you for your response and kind words.
Click to expand...

Ah OK, I did have an inkling that you’ve been on other basals before, but I wasn’t 100% sure.

Have you ever considered an insulin pump? Or would you be interested in one? That would certainly give you all the options you could possibly need for basal coverage, and they are proven to reduce hypoglycaemia in many (most?) users.

Could well be worth thinking about. And you’d be using your bolus insulin for everything (the basal is trickled I’m in tiny tiny squirts) so shouldn’t have reaction to cope with.

Hope the counselling is very beneficial for you and helps you work through some of that early stuff that can really drag you down without you realising it.
 
I have thought long and hard about a pump. I was refused one some years back when I asked but after my first stroke they suddenly offered one. The trouble was that the stroke left me with cognitive issues such as really struggling with new information, decision making, learning etc. I function well in familiar situations but suffer extreme brain fog otherwise at the drop of a hat. Basically I am not keen. It's something I consider often. My diabetes is also highly brittle which worries me with only short acting insulin on board in any instance of pump issues. I am a bit of a worrier!
 
What makes you think it’s the basal that’s responsible and not that your body is responding differently to your bolus?
 
Thebearcametoo said:
What makes you think it’s the basal that’s responsible and not that your body is responding differently to your bolus?
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Because it's also been dropping in the night around 5am. Although in fairness I think it's both. I have reduced my bolus dose as well as Tresiba. I am still getting acceptable levels most of the time. Acceptable is around 8 on waking and between 7-10 through the day. It did drop after tea again last night so I am keeping a close eye on it all. My focus is to get my confidence back, see my DSN again and then iron out any blips such as any spikes.
 
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It is often wrongly assumed by many people, including Drs., that the effects of a long acting insulin are constant through out the period over which it acts. This is not true and there are variations in its effect over time.

This is the reason that 24 hour insulin might be split into two injections. The questions "Is this a good idea?" or "Is there a better way?" or "How would this be done?" are not questions that I am able to answer.
 
I'm splitting my Tresiba to 2/3 in the morning and 1/3 in the evening prior to sleeping and it worked fine for me after some time dealing with the dawn phenomenon (DB) and having to correct it with short-acting insulin.
 
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