# Levemir to Tresiba?



## Lizzy78 (Nov 25, 2019)

Hi all. Hope you are well.

I saw my consultant last week, who has now said he wants to switch me from levemir insulin to tresiba. I have only been diagnosed a year so this is my first big change in my diabetes management. Does anyone have any experience of this switch? Has it been positive/negative? Any advice would be appreciated? 

Cheers.


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## Robin (Nov 26, 2019)

Lizzy78 said:


> Hi all. Hope you are well.
> 
> I saw my consultant last week, who has now said he wants to switch me from levemir insulin to tresiba. I have only been diagnosed a year so this is my first big change in my diabetes management. Does anyone have any experience of this switch? Has it been positive/negative? Any advice would be appreciated?
> 
> Cheers.


Hi Lizzy, I know there are people on here who have switched to Tresiba, but I can’t  think of anyone specifically who went from Levemir. I think @Kaylz swapped to Tresiba from Lantus.
I went the other way, and switched to Levemir because I thought it would help with my nighttime dip. I'm not sure it has solved the problem completely,  but it has helped to be able to adjust the two doses up and down independently of each other.
Tresiba is supposed to have the advantage of giving a very flat profile (I say 'supposed to' because I don’t think any insulin actually does everything it says on the tin) but the disadvantage is that it takes three days for any adjustments to take effect. Presumably your team think it would help your particular blood glucose pattern to have a smoother basal? All I can say is, try it and if it doesn’t suit you, or you think your basal control has got worse on it, you can always ask to swap back to levemir.


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## Kaylz (Nov 26, 2019)

Sorry @Robin I have no experience with a switch in basal as I was lucky enough (if you can say that) to be diagnosed not long after it was approved for use in Scotland so as it was the Professor dealing with my case he put me on it straight away even though the DSN's had basically no knowledge of it at the time  I know @Bloden  is also on Tresiba but not sure what she used before, @TheClockworkDodo also uses Tresiba but again not sure what she switched from either, there are quite a few of us on it and I am probably biased as its all I've used and have experience with but I like it, if you enter Tresiba in the search bar and have a look through you might find a thread about switches, sorry I couldn't be of more help  xx


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## Robin (Nov 26, 2019)

Kaylz said:


> Sorry @Robin I have no experience with a switch in basal as I was lucky enough (if you can say that) to be diagnosed not long after it was approved for use in Scotland so as it was the Professor dealing with my case he put me on it straight away even though the DSN's had basically no knowledge of it at the time  I know @Bloden  is also on Tresiba but not sure what she used before, @TheClockworkDodo also uses Tresiba but again not sure what she switched from either, there are quite a few of us on it and I am probably biased as its all I've used and have experience with but I like it, if you enter Tresiba in the search bar and have a look through you might find a thread about switches, sorry I couldn't be of more help  xx


Thanks, Kaylz, I'd forgotten you started out on it.


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## Amity Island (Nov 26, 2019)

Lizzy78 said:


> Hi all. Hope you are well.
> 
> I saw my consultant last week, who has now said he wants to switch me from levemir insulin to tresiba. I have only been diagnosed a year so this is my first big change in my diabetes management. Does anyone have any experience of this switch? Has it been positive/negative? Any advice would be appreciated?
> 
> Cheers.


Hi Lizzy 78,

I switched from 20units Lantus to 20units Tresiba (taken each morning) a couple of years ago. It has given me a really good steady basal over 24hrs, unlike the Lantus which dropped off towards 24hrs. Adjustments in Tresiba take 48hrs to take effect, for example, if it was Tuesday morning and I decided to change (not that I ever do btw now i'm settled) my Tresiba dose that morning, this wouldn't have any effect to basal until same time Thursday morning onwards. Also, it took me a good while because of this to get my basal steady, which in hindsight, I should of just switched to exact same dose (someone at hospital said Tresiba requires a smaller dose than other insulins so I initially started on a much lower dose) so in the interim I had to take lots of extra (Humalog) with each meal to keep blood sugars in range.

The good thing about Tresiba beside giving a good steady basal is you don't have to worry about taking it at precisely the same time each day, you have hours of leeway on taking your next dose. Very clever!

Downside is, as I found out this year when I climbed Mount Snowden, you can't adjust it from one day to the next. So I ended up eating (extra carbs) my way up and down the mountain. For the next 48 hours, I was on 50% of usual Humalog due to increased sensitivity from the vigorous exercise. Same goes for illness, cant up the Tresiba dose if your blood sugars are running high, you need to do this with extra bolus at meal times to keep in range.

Any other questions just ask.


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## trophywench (Nov 26, 2019)

If you can't adjust it and your BG goes up or down at that time of the month and many ladies BG does - isn't that a drag having only bolus insulin to adjust with?  What about extra hot (or indeed cold, I've never needed that one) holidays?


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## TheClockworkDodo (Nov 26, 2019)

I changed to Tresiba from Lantus rather than Levemir, I'm afraid, so I don't really have anything to add which hasn't been said already.  I certainly like it better than Lantus, but I'm actually thinking about asking to switch to Levemir, because I'm still spiking and plummeting a lot, and I think my basal needs are too complicated for the flat profile of Tresiba.  As people have said, with Tresiba (and indeed Lantus) it takes three or four days for adjustments to take effect, so I often spend three or four days fending off hypos or hypers.


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## TheClockworkDodo (Nov 26, 2019)

Btw, I was quite nervous about switching, especially as I was moving between two basals which are quite long lasting, but I actually found the switch from one to the other very easy.


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## Bruce Stephens (Nov 26, 2019)

In case you'd rather stay on Levemir, the NICE recommendations seem to regard twice-daily detemir (Levemir) as the preferred basal insulin. See https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations#insulin-therapy-2 (as always, unless it's not tolerated, or something else is preferred by the patient, or if it doesn't seem to be working well enough).


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## Bloden (Nov 27, 2019)

Nicely summed up @Amity Island.  

Hi @Lizzy78.  I changed from Lantus to Tresiba because Lantus was causing lotsa probs. Everything amity island said rings true for me too, except I lowered my basal when I first started on Tresiba (I looked online for advice, not sure where, it was a while ago now) which was the right thing for me. I think I was on about 16 units of Lantus. I take 11-12 of Tresiba.

Have a look on this forum for @KookyCat’s posts on Tresiba. Her posts were very useful, I seem to remember.

Tresiba suits me much better. The only thing that could be a problem is the slow reaction to a dose change. It isn’t a problem for me cos I know it’s going to take 48 hours for the dose change to kick in, so I’m ready for it. 

Good luck!


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## Thebearcametoo (Nov 27, 2019)

My daughter went from Lantus to Tresiba and likes it better but it does have that big lag when you increase or decrease dose and it can be less responsive if you do exercise only on some days but as the results are pretty predictable as long as you allow for that with more carbs or less bolus at the appropriate times then it’s manageable.


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## Lizzy78 (Dec 4, 2019)

Thanks all for your replies. I'm making the change tomorrow so a bit nervous. I think my DN wants me to have a flatter line overall. In terms of exercise I try to walk for an hour each day and do a little swimming at the weekends. I'm a bit concerned about losing the flexibility of the dose change that levemir gives, but I can only give Tresiba a go and see how I get on.


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## Kaylz (Dec 4, 2019)

Lizzy78 said:


> Thanks all for your replies. I'm making the change tomorrow so a bit nervous. I think my DN wants me to have a flatter line overall. In terms of exercise I try to walk for an hour each day and do a little swimming at the weekends. I'm a bit concerned about losing the flexibility of the dose change that levemir gives, but I can only give Tresiba a go and see how I get on.


its easy enough after you know how you react to counteract any more vigorous activity with a reduction in bolus insulin, it is a good basal and doesn't have to be taken bang on the same time everyday, good luck  xx


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## Lizzy78 (Dec 4, 2019)

Cheers Kaylz. I'm hoping it gives me a bit more stability. Will be good to cut out my nightime injection, as I plan to take in the mornings when I get up.


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## Amity Island (Dec 4, 2019)

Lizzy78 said:


> Thanks all for your replies. I'm making the change tomorrow so a bit nervous. I think my DN wants me to have a flatter line overall. In terms of exercise I try to walk for an hour each day and do a little swimming at the weekends. I'm a bit concerned about losing the flexibility of the dose change that levemir gives, but I can only give Tresiba a go and see how I get on.



Hi,
Please let us know how it all goes over the coming weeks and how you manage your bolus adjustments with your swimming. Also, if you are using a Libre? once your Tresiba dose is established, can you let us know if strenuous exercise which lowers your bolus doses effects the background blood sugar also? 

I avoided any exercise whilst I was establishing the initial Tresiba dose.

Good Luck


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## everydayupsanddowns (Dec 5, 2019)

Lizzy78 said:


> Thanks all for your replies. I'm making the change tomorrow so a bit nervous. I think my DN wants me to have a flatter line overall. In terms of exercise I try to walk for an hour each day and do a little swimming at the weekends. I'm a bit concerned about losing the flexibility of the dose change that levemir gives, but I can only give Tresiba a go and see how I get on.



It would be interesting to know exactly what your consultant/DSN was trying to ‘fix’ with this change. Otherwise I think it’s quite hard to know if it’s working as expected and/or how to make the insulin(s) work best for you.

Were you having any particular basal-related challenges Lizzy? Or did you get the impression they just wanted a general improvement and thought they would try this as it had worked for others in clinic?

Good luck with the changeover and keep us posted!


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## mikeyB (Dec 5, 2019)

I agree with Mike above. Seems an odd change to make. I switched from Lantus to Levemir just to get that flexibility in dosage adjustments. Tresiba just has the same profile as Lantus, so i can't see the benefit. Still, no great harm in trying it out I suppose. Best of luck, and let us know how things go.


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## Lizzy78 (Dec 5, 2019)

He said they wanted me to have a flatter line overall in my basal and that my pattern was showing on my libre of peaks and troughs. He said the degludec would give me more stability with my basal. He said it would be reviewed at my next appt in 6 months.


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## TheClockworkDodo (Dec 5, 2019)

Hmm, I'm afraid the pattern on my Libre is one of peaks and troughs even though I'm on Tresiba, or perhaps because I'm on Tresiba.  If I drop it half a unit I still have peaks and troughs, just higher peaks - and if I put it up half a unit I still have peaks and troughs, just lower troughs.

I hope the change works for you - but if it doesn't don't hesitate to ask them to switch you back!


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## Flo15 (Dec 12, 2019)

Lizzy78 said:


> He said they wanted me to have a flatter line overall in my basal and that my pattern was showing on my libre of peaks and troughs. He said the degludec would give me more stability with my basal. He said it would be reviewed at my next appt in 6 months.


Hi, Just wondered how you were getting on with tresiba?, I may be going on it next week from Levemir but am a bit anxious about it.


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## Lizzy78 (Dec 30, 2019)

Hi all..so an update.

I'm finding the switch tough. I was on 23 units of levemir, split over 2 doses. My DN started me on 18 units of Tresiba but this has appeared to introduce me to night time hypos. I reduced the dose to 16 last week, but still having problems with sugar dropping between  9pm-1am. Hence why I am still awake at this hour. During the day, my sugars are averaging around 10 on this dose, so I am high during the day, and low at night. To be honest I'm pretty exhausted now. I never had an issue with rapid night time drops with levemir, and I'm also not liking the fact that its taking 2-3 days for any dose change with Tresiba to take effect. It's probably the worst time of year to be changing my basal insulin with xmas and being out of routine. But I'm struggling a bit. I am going to call my DSN in the morning but I'm not really sure they are in a position to decide if I can go back on levemir. Any advice would be greatly appreciated.


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## Kaylz (Dec 30, 2019)

Have you basal tested since starting the Tresiba?
xx


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## everydayupsanddowns (Dec 30, 2019)

Was your split on Levemir even, or did you take less at night?

suddenly getting early-hours drops certainly doesn’t seem ideal. Certainly worth asking your team about what to do next, what the switch was supposed to achieve and how long to leave it before switching back.


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## Lizzy78 (Dec 30, 2019)

I took a unit or 2 less at night. I called my DSN and he has said to reduce the Tresiba to 14. He has said i could switch back to levemir if I wish but he doesn't want to do it until next week as they are closed a couple of days this week. I have tried to basal test but having to treat the low sugar at night, which is then keeping me high during the day. It's like I'm more insulin sensitive at night?


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## Kaylz (Dec 30, 2019)

The Tresiba shouldn't be affected by sensitivity because it is quite a flat profile, have you considered changing your basal to morning? I know a few have had to change the timing of their basal to morning after switching to Tresiba and its made the world of difference so that's also worth considering xx


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## Amity Island (Dec 30, 2019)

Lizzy78 said:


> Hi all..so an update.
> 
> I'm finding the switch tough. I was on 23 units of levemir, split over 2 doses. My DN started me on 18 units of Tresiba but this has appeared to introduce me to night time hypos. I reduced the dose to 16 last week, but still having problems with sugar dropping between  9pm-1am. Hence why I am still awake at this hour. During the day, my sugars are averaging around 10 on this dose, so I am high during the day, and low at night. To be honest I'm pretty exhausted now. I never had an issue with rapid night time drops with levemir, and I'm also not liking the fact that its taking 2-3 days for any dose change with Tresiba to take effect. It's probably the worst time of year to be changing my basal insulin with xmas and being out of routine. But I'm struggling a bit. I am going to call my DSN in the morning but I'm not really sure they are in a position to decide if I can go back on levemir. Any advice would be greatly appreciated.


Hi Lizzy,
Thanks for your latest....
I too found it very difficult (a tough time) getting the dose right, turns out I ended up on exactly the same dose as I was on on the lantus (20 units). I ended up going private because the local dsns and consultant just didn't know what they were doing in terms of Tresiba. btw I've always taken my basal in the morning. The biggest down side (which is also a plus side) is the delay in changing doses. It takes precisely 48hrs for a change in dose to take effect, so there wouldn't be a lot of point in changing any nearer than 3 days apart, Tresiba recommend 5 days (I think). So a change on Monday at 9am would start to come through on Wednesday at 9am. So Wednesday would be the day to check blood sugars over 24hrs. If anything can be learnt from that 24hrs, then potentially if needed, a change in dose could be started on the Thursday at 9am. This wouldn't then give any effect until Sat 9am. It's very frustrating waiting, cos in between you are really suffering with trying to balance blood sugars anyway possible.
I get drops sometimes, but only when I still have active bolus insulin running which can last up to 6hrs (Humalog). The Tresiba, for me at least is very reliable and very flat at all times of day, which can be clearly seen during basal tests.


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## everydayupsanddowns (Dec 30, 2019)

Amity Island said:


> The Tresiba, for me at least is very reliable and very flat at all times of day, which can be clearly seen during basal tests.



I think that would actually be a downside for me. Because having been on an insulin pump I’ve recognised that I need hardly any basal between midnight and about 3am - which probably explains all the years I had lows overnight on Lantus!


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## Amity Island (Dec 30, 2019)

everydayupsanddowns said:


> I think that would actually be a downside for me. Because having been on an insulin pump I’ve recognised that I need hardly any basal between midnight and about 3am - which probably explains all the years I had lows overnight on Lantus!


Hi Mike,
I agree completely, not all insulins suit all people, it may be completely wrong in this instance and unworkable. I suppose you've got to try these things


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## Lizzy78 (Dec 30, 2019)

Yeah I take the Tresiba in the morning, pretty much same time. For each dose I have tried it's the same pattern, running high during the day and dipping at night. My concern with the Tresiba aswell is the fact it's not as flexible as the Levemir. As it's been the festive period, I haven't been exercising as much. I paddleboard, wild swim and walk pretty much every day, and will be resuming this again soon. Looking ahead to the summer aswell, I also holiday in hot climates, and liked the flexibility to change my basal accordingly, rather than have to wait 3 days to see the reaction.


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## Lizzy78 (Dec 30, 2019)

I am going to be on the reduced Tresiba dose until next Monday at least, so I will just need to see how that goes. But I think in my own head I have already made my mind up. I'll then have to go through the conversion back to levemir if that's what my team and I decide will be the best, so not sure how smoothly that will go. This has definitely not been the best of times since my DX last year. Feeling pretty exhausted with it all.


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## Amity Island (Dec 30, 2019)

Lizzy78 said:


> I am going to be on the reduced Tresiba dose until next Monday at least, so I will just need to see how that goes. But I think in my own head I have already made my mind up. I'll then have to go through the conversion back to levemir if that's what my team and I decide will be the best, so not sure how smoothly that will go. This has definitely not been the best of times since my DX last year. Feeling pretty exhausted with it all.


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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## Lizzy78 (Dec 30, 2019)

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.



It's the nights that's have been exhausting me. I know that I might eventually find the right dose of the Tresiba, but I keep leaning towards the flexibility of levemir. I know it's probably just because I am used to the levemir aswell. I just need to sleep. 

I'm not sure what the process would be if I switch back..obviously the Tresiba will be in my system for up to 3-4 days. It's going to tie in just at the time I am returning to work aswell. All fun and games.


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## Kaylz (Dec 30, 2019)

If the lows are happening at night when you take your Tresiba in the morning couldn't you consider doing it in the evening? Then IF you do continue to go low at least you'll be awake and could snack at that time? xx


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## Robin (Dec 30, 2019)

Kaylz said:


> If the lows are happening at night when you take your Tresiba in the morning couldn't you consider doing it in the evening? Then IF you do continue to go low at least you'll be awake and could snack at that time? xx


But if all the Tresiba daily doses last for 2-3 days, and overlap, there shouldn’t be any lows, caused by the Tresiba, I mean. My money's on Lizzy being like me, and her liver shutting up shop for the night, and only trickling out a fraction of what it does during the day.


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## Lizzy78 (Dec 30, 2019)

I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?


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## Kaylz (Dec 31, 2019)

Well its up to you, I find extra exercise is best dealt with by reducing following bolus doses but then I've only ever used Tresiba so its the only basal I know how to deal with xx


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## Amity Island (Dec 31, 2019)

Lizzy78 said:


> I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?


The advice I was given by two diabetes consultants was Tresiba is for people with sedentary lifestyles, or at least those with little activity. On that basis alone, Tresiba isn't the best option for anyone wanting to take part in regular sport or fitness activities. That's not to say sport and fitness activities can't be done, but it requires eating extra carbs without boluses every 20mins or so, which isn't ideal if it's something being done regularly. Plus it requires about a 50% reduction in all boluses for up to 48 hrs after the session.


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## Amity Island (Dec 31, 2019)

Lizzy78 said:


> I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?


I add. You will probably already know this but it is an important point. There is a threshold of activity which takes you into increased insulin sensitivity after the exercise. I got caught out once last year when I didn't think i'd gone over this level of exertion and not realised and ended up taking effectively double the bolus I needed (hence I should have taken 50% of usual dose). It was what I thought was a gentle cycle but I must of exerted myself more than I thought. For this reason, if I am going to do exercise, I make sure I do exert myself enough to ensure I know for sure that I will be on 50% bolus reductions after. Normal walking type exercise never increases my insulin sensitivity afterwards.


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## SB2015 (Dec 31, 2019)

Lizzy78 said:


> I think no matter whether I took it in the A.M or P.M, the whole idea of Tresiba is to give a flatter profile through the day? As I say I am going to be on the lower dose again for the remainder of the week, will see how that goes. But I'm not sure I want to be on a basal where I am tied into a specific dose for at least 2-3 days. What about when I get back out paddleboarding/swimming? My choice would be to reduce dose 2-3 days in advance, or eat God only knows how much to keep levels up during activity?


Apologies if you have already answered this before, but if the basal insulin is causing issues on MDI, have you considered asking for a pump?  I got very frustrated with MDI as I had a very varied week, like @everydayupsanddowns I had big dips overnight (and now know that I hardly need any insulin in the early hours) and was finding the variety of exercise I was doing very difficult to manage.  Whilst it took quite a bit of work at the start, once I had my pump matched to my needs (which are set on an hourly basis) life became a lot easier.  It also gives me the facility to turn down my background  insulin which will react within an hour, and deliver the Bolus in a variety of ways to suit different foods.


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## Lisa66 (Dec 31, 2019)

Just catching up with this. I did try Tresiba last year, after lots of up and downs and enquiries on the forum. I have to admit I didn’t stay on it for that long as it just didn’t seem to suit me. To start with I was impressed seeing a much flatter line on my Libre, but I can be very active one day and not so the next, with no real pattern. So while some people can tweak with their bolus I personally found it just didn’t work for me...I just didn’t feel quite right on it. So I went back to playing around with split dose of Levemir. The DSNs were fine with this.

We are all so very different, with so many different things affecting our control...it’s just a matter of finding what we each feel happy and confident with. As others have said maybe it’s worth enquiring about a pump. I hope you find something that works for you soon.


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## mikeyB (Jan 2, 2020)

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.


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## Lizzy78 (Jan 2, 2020)

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.


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## Lizzy78 (Jan 3, 2020)

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.


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## everydayupsanddowns (Jan 3, 2020)

Hope the switch back is a smooth one @Lizzy78


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## Lizzy78 (Jan 3, 2020)

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.



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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## Amity Island (Jan 3, 2020)

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.



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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## Bruce Stephens (Jan 3, 2020)

Amity Island said:


> They may say 43hrs to stop people considering taking tresiba only every 2 days, which just wouldn't work smoothly.



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.)


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## Lizzy78 (Jan 3, 2020)

Thanks guys for the support. I'll keep you posted on how it goes.


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## Lizzy78 (Jan 14, 2020)

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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## rebrascora (Jan 14, 2020)

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.


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## everydayupsanddowns (Jan 16, 2020)

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.



That’s great news Lizzy

Glad to hear you are feeling much better about things, and more able to adjust to suit your needs.


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## billyblue (Jan 26, 2020)

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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## Kaylz (Jan 26, 2020)

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


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


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## Amity Island (Jan 26, 2020)

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


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.


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## C&E Guy (Jan 27, 2020)

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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