Changed from Lantus to Tresiba

8 posts, 5 contributors

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Alan Shepherd DAFNE Graduate
St Luke's Kilkenny
5 posts

I have recently been moved over to Tresiba instead of Lantus as my background Insulin. I was experiencing a lot of hypo's (especially during the night) with the Lantus.
My previous Lantus dose was 32units before bed, my consultant has asked me to start of 16units also before bed of the Tresiba.
I am finding that my first blood test in the morning has usually jumped from between 5 & 8 the night before (without having eaten anything since 6pm) to between 12 & 16. A correction does of my humalog generally has me ok again within a couple of hours.

My question: should I increase my BI does before bed as I was taught to do with my lantus to counteract this? I understand that the Tresiba graph is a much flatter constant graph than that of the lantus so I am a bit puzzled as to why it is causing BG spikes during the night and not at other times.

Thanks in advance for any help on this topic.

JenniferFlan... DAFNE Graduate
Wythenshawe Hospital, Manchester
1 post

Hi there I am most certainly not an expert but I do also have this problem and have been told to check my BG at about 3am in the mornings as you coukd be having night hypos, sleeping through them, then your kidneys throw out sugar which makes you go higher in the morning , I would just check a couple of 3am BG readings before uping your dose as you could make the problem worse , hope this helps ☺

Alan Shepherd DAFNE Graduate
St Luke's Kilkenny
5 posts

Many thanks Jennifer for your comment. I have checked a few 3am bloods and it seems to be stable, even starting to go high at that stage. I have been looking at a few posts online and one suggested that because Tresiba insulin has such a flat line compared to Lantus that it is not dealing with this "dawn phenomenon" in the same way that the Lantus does. Lantus peaks five or six hours after injecting to deals with the pre-getting up rise in bloods. Think maybe it's time to go back to the Doc!! Thanks again for your help.

beckymatulko DAFNE Graduate
Pennine Acute Hospitals
1 post

I have only recently done the DAFNE course and myself was having the same problems with highs in the morning after changing from Lantus to Tresiba. Anyway, they told me to change it as you would normally so 10-20% so maybe 1-2 units.

I personally don't think it's for me as my sugars have been everywhere since I've been on it! Hope this helps! If you're still unsure I'd ask your diabetic team Very Happy

Alan Shepherd DAFNE Graduate
St Luke's Kilkenny
5 posts

Thanks very much Becky for your comment. Interesting that your tests are all over the place too with the Tresiba and you're getting the morning highs. If there is one thing I really hate about diabetes it's setting my alarm for three in the morning for a blood test :-(. As you suggested I am going to organise a visit with the diabetic team during the week and will keep you posted. Thanks again! FYI my A1C was 6.2 on the Lantus with, admittedly, a few lows which I do not think were unmanageable, reluctant to give up on a 6.2 long term result.

Peter DUAG Committee Member
University College London Hospitals (UCLH)
104 posts

Hi Alan, Agree that the 3am alarm calls are a drag. You could invest in a Libre to get a picture of exactly what's happening overnight. Yes it is expensive but the addition visibility you obtain makes it worthwhile (in my opinion). At least cost has been reduced a little if you have a recent Android phone which supports NFC communications in which case the separate reader is no longer mandatory. IOS version is due next year.

Alan Shepherd DAFNE Graduate
St Luke's Kilkenny
5 posts

Hi Peter, thanks for that. I agree that the extra insight from a CGM would be invaluable. I have been looking at a few CGM devices recently and my diabetes nurse also recommended the Libre - I am, however, a die-hard iOS fan!! Oh the struggles we diabetics have to endure.

BrettC DAFNE Graduate
Worcestershire NHS
1 post

I've only recently moved from lantus to tresiba. However my results have been positive. I use Freestyle libra all the time because I was always worried about night time hypos. With lantus, to get a reasonable morning time level, i tended to go low at about 3/4am. I changed to tresiba and my levels now seem to be flat throughout the night. Even the morning rise is less than before.
In terms of amount of insulin, I use exactly the same amount as i did with lantus.
I agee with becky, adjust your doses by 10-20% as guided by DAFNE until you are getting a flat response.
Now I find tresiba is flat, I have moved to taking my tresiba to about 7pm, rather than before going to bed, this has enabled me to improve my evening levels as well which always tended to rise. I suspect that was because of the lantus and tresiba were running out of steam.