Tresuba long actin insulin

[May Rhymer]

Hello,
Advice needed please.
My husband has been type 1 for 30 years, he is currently on degludec long acting insulin. However, he feels the insulin does not provide sufficient 48 cover, consequently, his levels go high.
Does any one experience this?
He has asked his Diabetic nurse to change him back to his previous 44 lantus insulin, however, she refuses to do so.
Many thanks.

 

[Kaylz]

Sorry, I'm not quite sure what you mean?

Do you mean he doesn't feel like it lasts 48 hours? If so that's because it's supposed to be taken every 24 hours

Or do you mean he takes 48 units and that isn't enough? In which case it would indicate he'd need to increase the units he takes

 

[May Rhymer]

Sorry, I wasn't that clear.
He takes it every 24 hours, however, given it only lasts for approximately 42 hours, rather than 48 hours, the second day, the insulin is weaker for a few hours. Hence, his levels going higher.
Hope this makes sense!

 

[Kaylz]

I'm sorry but no it doesn't really make sense, if the dose is correct for him and given every 24 hours there shouldn't be a period of the 2nd day where his blood sugars are higher as the insulin isn't running out or any weaker

I'd look at other factors that may be having an effect on his levels as Tresiba doesn't do what your asking about hence any dose adjustments taking a minimum of 3 days to show it's true effect

 

[rebrascora]

I think it is more likely that the profile of Tresiba (basically a flat line) is not suiting your husband and he just has greater basal insulin needs at those times of day than the Tresiba provides. That is not to say the tresiba is running low at those times but just that he needs more. It is actually very common that people need more basal insulin at some times of the day and less at others.... People who have insulin pumps can attest to that as they often have different basal settings for different times of the day.
The answer would be to change to either increase his Tresiba dose to cover that period when his levels go higher and risk hypoing at other times or inject corrections of quick acting insulin when he goes high to bring his levels down again.
OR...
Try a different basal insulin which might suit him better..... Something like split dose Levemir which would allow him to adjust his daytime and night time dose independently to find a better fit. Just as an example, I need much less basal insulin during the night than during the day, so I inject just 6 units at night but currently 18 in the morning..... but everyone is different. The Levemir just gives you more flexibility in finding what works for you.

 

[Robin]

Sorry, I wasn't that clear.
He takes it every 24 hours, however, given it only lasts for approximately 42 hours, rather than 48 hours, the second day, the insulin is weaker for a few hours. Hence, his levels going higher.
Hope this makes sense!

I'm sorry but no it doesn't really make sense, if the dose is correct for him and given every 24 hours there shouldn't be a period of the 2nd day where his blood sugars are higher as the insulin isn't running out or any weaker

If it lasts as little as 42 hours in some people (and Googling it, that’s what the consensus of opinion on health websites seems to be) then surely there will be a period between 42 hrs and 48 hours when you’ve only got one day's worth in the system, if you take it every 24 hours. So what I'd do is to take it either at a time when your husband's basal needs are less (as @rebrascora says, the body’s needs fluctuate over 24hrs) or at a time when he’s eating a meal and can compensate with a bit of extra short acting to bridge the gap.

 

[May Rhymer]

If it lasts as little as 42 hours in some people (and Googling it, that’s what the consensus of opinion on health websites seems to be) then surely there will be a period between 42 hrs and 48 hours when you’ve only got one day's worth in the system, if you take it every 24 hours. So what I'd do is to take it either at a time when your husband's basal needs are less (as @rebrascora says, the body’s needs fluctuate over 24hrs) or at a time when he’s eating a meal and can compensate with a bit of extra short acting to bridge the gap.

Many thanks all for making sense of this issue. You have offered good advice and support, much appreciated.

 

[DaveB]

I agree that something like Levemir might be better. I inject 17 in the morning and 8 at night which gives me good flexibility. Lantus would give you the 24 hour coverage but not the flexibility of a split dose. I think you need to ask the nurse why she is refusing the Lantus?

 

[Amity Island]

Hello,
Advice needed please.
My husband has been type 1 for 30 years, he is currently on degludec long acting insulin. However, he feels the insulin does not provide sufficient 48 cover, consequently, his levels go high.
Does any one experience this?
He has asked his Diabetic nurse to change him back to his previous 44 lantus insulin, however, she refuses to do so.
Many thanks.

Hi May,

I also use tresiba degludec.

From my understanding, the way tresiba works is quite clever. There is no overlap, even though it's taken everyday with the ability to last at least 42hrs or more. It forms a single queue, so matter when it's taken it always adds this insulin at the end of the queue not alongside it. This provides the same rate of release of insulin consistently. So everyday should be the same. It might just be that your husbands basal needs are not flat and vary during the day. This is why some diabetics prefer to go onto an insulin pump which can tailor their changing basal needs.