Tresiba

[Lisa65]

I emailed the practice nurse this morning to tell her I am doing the carb counting course on Friday and to ask if she would prescribe rapid insulin as we had previously discussed.
She just called me back and it so happened that the DSN was doing her monthly visit, so we all had a chat.
They aren't keen on me injecting Abasaglar twice a day (I did this because it wasn't lasting the full 24hrs) she said it's not licensed for twice daily use, so they want to swap me to Tresiba, which I have no problem with.

I still have to give it a couple of weeks on just Tresiba so we can see how things are on that, and hopefully get the dose right, but she said they will then give me Trurapi and to start with 1 or 2 units of that before carb containing meals.

Finally getting there!

They do seem to be obsessed with minimising the number of injections, when I have no issues jabbing myself as often as needed. I guess should I need to give myself correction doses etc in the future I just won't tell them!

 

[everydayupsanddowns]

Hope you get on well with the Tresiba @Lisa65

And yes! There seems to be this weird thing that it’s the number of jabs that’s the main thing… when that’s so far down my list of priorities it hardly registers at all!

 

[louisew]

I emailed the practice nurse this morning to tell her I am doing the carb counting course on Friday and to ask if she would prescribe rapid insulin as we had previously discussed.
She just called me back and it so happened that the DSN was doing her monthly visit, so we all had a chat.
They aren't keen on me injecting Abasaglar twice a day (I did this because it wasn't lasting the full 24hrs) she said it's not licensed for twice daily use, so they want to swap me to Tresiba, which I have no problem with.

I still have to give it a couple of weeks on just Tresiba so we can see how things are on that, and hopefully get the dose right, but she said they will then give me Trurapi and to start with 1 or 2 units of that before carb containing meals.

Finally getting there!

They do seem to be obsessed with minimising the number of injections, when I have no issues jabbing myself as often as needed. I guess should I need to give myself correction doses etc in the future I just won't tell them!

I’m on Tresiba and Novorapid fast acting. I asked to be prescribed bolus because I was having to take a lot of basal to keep my blood sugar lower during the day and going too low at night. She agreed because I was ‘sensible’ which I was a bit affronted by. But I get it now. You do have to be careful with bolus and work out how to use it. But now instead of 24 units of tresiba, I’m only on 6 and take 2-3 units of bolus for meals, around 60g carbs a day. And I have a ‘normal’ hbac1

 

[Lisa65]

I’m on Tresiba and Novorapid fast acting. I asked to be prescribed bolus because I was having to take a lot of basal to keep my blood sugar lower during the day and going too low at night. She agreed because I was ‘sensible’ which I was a bit affronted by. But I get it now. You do have to be careful with bolus and work out how to use it. But now instead of 24 units of tresiba, I’m only on 6 and take 2-3 units of bolus for meals, around 60g carbs a day. And I have a ‘normal’ hbac1

I intend to be super cautious at first as the idea of rapid insulin is a bit terrifying!
I'm glad it's working well for you 🙂 I also think I'm using more basal than I actually need, because I get such big spikes after carbs and they take so long to go back to normal levels. So the basal is probably covering some of those unnecessarily. I might end up picking your brains at some point if that's OK!

 

[rebrascora]

No need to be too worried about "fast acting" insulin. Trurapi is bio similar to NovoRapid which is anything but "rapid" for many of us. It takes 4-5 hours to have it's full impact and I used to have to wait 75 mins between injecting and eating breakfast for it to arrive in my blood stream about the same time as my breakfast was starting to release glucose, and whilst that is quite extreme it certainly isn't fast or rapid for most people.

 

[Inka]

I intend to be super cautious at first as the idea of rapid insulin is a bit terrifying!
I'm glad it's working well for you 🙂 I also think I'm using more basal than I actually need, because I get such big spikes after carbs and they take so long to go back to normal levels. So the basal is probably covering some of those unnecessarily. I might end up picking your brains at some point if that's OK!

I find basal more scary as you’re injecting a large number of units in one go. Just start off very cautiously and build up to the amount of bolus insulin you need. I use Novorapid and like it. It works well for me, and I can even inject it just before I eat for my evening meal.

 

[Lisa65]

I find basal more scary as you’re injecting a large number of units in one go. Just start off very cautiously and build up to the amount of bolus insulin you need. I use Novorapid and like it. It works well for me, and I can even inject it just before I eat for my evening meal.

I wasn't scared of basal until I read about a couple of forum members having "lantus lows"!
Now I make sure I have glucose tablets in every bag and pocket, just in case 😱

 

[Bloden]

I wasn't scared of basal until I read about a couple of forum members having "lantus lows"!
Now I make sure I have glucose tablets in every bag and pocket, just in case 😱

I used to get “Lantus lows” - 3 hours and 6 hours after injecting - and then it would only last for 16 hours. I was switched to Tresiba which I really liked - no peaks whatsoever (so no “Tresiba lows”). This was before I switched to a pump.

I hope you like it too @Lisa65. Enjoy the course!

 

[helli]

I think there are two phenomenon which are referred to as Lantus lows.
- the profile of Lantus is not completely flat. There is a peak of activity after about 4 to 5 hours after injecting. This is "usually" predictable. I adapted my injection tine to ensure I was awake when this occurred and was able to react.
- the mechanism glargine-type insulins such as Lantus uses to extend the life to "up to" 24 hours uses some sort of crystalisation. Very occasionally (and completely unpredictably), this crystalisation does not work so all/most of the dose becomes active at once. This can be very scary. It has been reported multiple times but it is rare. I was using Lantus every day for 12 years without this ever occurring.

As @Bloden mentioned, the other downside to Lantus is that it does not last a full 24 hours. For this reason, some people split the dose (although some DSNs seem to believe this is not "allowed"), I just made up the gap with extra Bolus (NovoRapid in my case ... which was not as Sluggish for me as others).

 

[louisew]

No need to be too worried about "fast acting" insulin. Trurapi is bio similar to NovoRapid which is anything but "rapid" for many of us. It takes 4-5 hours to have it's full impact and I used to have to wait 75 mins between injecting and eating breakfast for it to arrive in my blood stream about the same time as my breakfast was starting to release glucose, and whilst that is quite extreme it certainly isn't fast or rapid for most people.

My blood sugar starts dropping pretty quickly after injecting, and I’m cautious because it’s only in the 5s or 4s before I eat and bolus. Also when I’ve been active, it often goes up when I’m active but drops maybe an hour later, so I have to account for that too. My tresiba dose keeps me very stable overnight.

 

[sololite]

If its of interest, I was switched to Tresiba from Levemir a month ago and I found I needed about 25% less units and my overnight control has improved. I've been split dosing for 5 years and so found the one injection a day of benefit as occasionally I want to go to bed very early and occasionally find myself out late and without my pen.

 

[Inka]

What was your a.m/p.m split on Levemir @sololite ? I’m pleased Tresiba is working well for you.

 

[Lisa65]

If its of interest, I was switched to Tresiba from Levemir a month ago and I found I needed about 25% less units and my overnight control has improved. I've been split dosing for 5 years and so found the one injection a day of benefit as occasionally I want to go to bed very early and occasionally find myself out late and without my pen.

I've only been using it two days but so far it seems to be working well. I was taking 30 units of abasaglar split into two doses and I've started on 18 units of Tresiba. The baseline is a little higher than I would like, but the line is nice and flat.

 

[sololite]

What was your a.m/p.m split on Levemir @sololite ? I’m pleased Tresiba is working well for you.

Hi @Inka . My split was even at 8am and 10pm. I'm now taking 25 units at 8am. Life has been busy and I've not done a basal test on Trisiba yet. Regards, Chris

 

[Inka]

Hi @Inka . My split was even at 8am and 10pm. I'm now taking 25 units at 8am. Life has been busy and I've not done a basal test on Trisiba yet. Regards, Chris

Thanks for that @sololite I think maybe if somebody takes a fairly equal split of Levemir then any change to Tresiba works smoothly.

I use a pump but I do have pump breaks and then use MDI. I currently use a twice daily isophane insulin, but my split is very unequal with much more basal a.m. than p.m. For this reason, I wonder how Tresiba would work in that situation as it has a pretty flat profile. I think this has also concerned @rebrascora and others too. It’s the logic of it - I can’t envisage how it would work.

 

[Bruce Stephens]

I use a pump but I do have pump breaks and then use MDI. I currently use a twice daily isophane insulin, but my split is very unequal with much more basal a.m. than p.m. For this reason, I wonder how Tresiba would work in that situation as it has a pretty flat profile. I think this has also concerned @rebrascora and others too. It’s the logic of it - I can’t envisage how it would work.

That's my worry, yes. I take more than twice the dose in the morning. So with a longer acting basal insulin the best I could do with basal testing is to get a dose that worked OK overnight, presumably meaning daytime carb counting and so on would be completely screwed.

 

[Inka]

Pretty much exactly the same for me @Bruce Stephens My morning basal is at least double my evening basal, and at one point my split was 2/3 and 1/3. This is why it’s wrong to remove the choice of twice daily basals.

 

[Lisa65]

So far I don't like the Tresiba as much as Abasaglar, I have been on 24 units for the last three days and my readings are higher than with Abasaglar, I'm also getting foot on floor which I didn't get before.
I should be able to get the Trurapi next week though, so I can experiment with that, maybe 1 unit first thing in the morning or something to stop FOTF?
I feel like I don't want to keep on increasing Tresiba, I understand it works differently to Abasaglar and I'm not likely to get a "lantus low" but I feel uneasy injecting a lot in one go.

 

[Inka]

As far as I understand it, Tresiba builds up into a kind of steady state, with each dose topping up that steady state. The graph below shows it quite well @Lisa65 So, I think it needs each dose change leaving alone for a few days to allow it to get to this state before making any changes. What the graph also shows it that it has a flat profile of action - which some people seem to think is great, but others, like me, not so much as my insulin needs aren’t flat:

 

[everydayupsanddowns]

So far I don't like the Tresiba as much as Abasaglar, I have been on 24 units for the last three days and my readings are higher than with Abasaglar, I'm also getting foot on floor which I didn't get before.
I should be able to get the Trurapi next week though, so I can experiment with that, maybe 1 unit first thing in the morning or something to stop FOTF?
I feel like I don't want to keep on increasing Tresiba, I understand it works differently to Abasaglar and I'm not likely to get a "lantus low" but I feel uneasy injecting a lot in one go.

I suspect it might be worth waiting until you can get the Trurapi, to have both meal/correction and background/basal needs covered. It would also mean that any tweaks you make are in the context of your system going forwards, rather than making it work basal-only, and then having to start again when you have the rapid insulin to add in?