Does tresiba work best at night, mornings, or doesnt matter? My daughter is on tresiba and she spikes at night . Of course I’m gradually increasing her dosage but I still dont see a major difference. I know some people split the dosage . She was 214 at 8 pm , gave her tresiba and by 4am she was 288
I don’t think the insulin works differently at night, per se, but our endo told me that lots of people’s bodies need more insulin at night. Night is when kids do most of their growing, and when everyone does most of their healing and repairing, and that’s when most hormone surges happen, too, if you’re going through puberty or menopause, for example. And all of those things use more insulin.
You might ask your endo about splitting doses (ours wasn’t a fan), whether a pump might make sense, or whether you might just need to tweak her basal more than you have and that would take care of it.
Good luck, and let us know what the dr. says. Sharing is how we all learn! 
@stixxs512 a perfect dose of Tresiba would keep your blood sugar steady, not drop, not rise, that’s what basal insulin is supposed to do. Tresiba is supposed to be “flatter” than lantus, and so according to the lit, it “should not matter” when you take it as long as it is the same time every day Then we laugh then we remember that every one of us experience this t1d a little differently.
Tresiba has a half-life 2x that of lantus. splitting the dose would be “problematic” the first 12 hours. not saying you can’t but those first 12 will need you to be on top of her rising blood sugar because it would only be half her required rate.
overnight basal requirements tend to be higher (for me, ,much higher) than daytime basal requirements. So it was always a difficult thing to take basal insulin (at best, a steady constant basal rate) because I was either crashing during the day or rising at night. No middle ground, ever. I had to pick the least crappy one, and for me either way were both bad. That’s the actual reason why I pump. I can program hourly basal adjustments and not have to be picking the lesser of 2 evils. Just throwing it out there. You can make ANYTHING work with effort. If she is steady between meals during the day then IMO don’t mess with the amount of Tresiba. One thought is to take the right amount of tresiba for daily use, and add a medium insulin to cover nighttime. This would be in the form of NPH or some other ~8 hour insulin. Another thought is… since she is growing anyway, go for steady overnights but feed the insulin during the day…
cheers good luck!
@stixxs512 , I agree with what @Joe wrote that splitting your daughter’s dose may be more problematic than taking one every 24 hours at the same time of day. Degludec (Tresiba) appears to be the “flattest” of the several choices for background/basal insulin, and appears in most people to last closest to 24 hours.
You didn’t mention her BG before supper which I’ll assume was around 5 PM, and as I recall, you give her Humalog with meals. I suggest, rather than adjusting her Tresiba that you hold that steady for at least 3 days, and give her a little more Humalog with her meal - do not increase the Humalog too rapidly.
The Tresiba you gave her at 9 PM should have been working well before midnight, so I’d concentrate first on getting her post-meal 214 lower [150 ?] first and then begin gradually increasing Tresiba. Of course, in that the Tresiba will last 24 hours, you will need to observe her closely all day for any “going too low”. This is a long, slow process.
I will take all the suggestions. Thank you. I was definitely thinking I need to concentrate on her bolus first
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Hi, I’ve been using Tresiba once per day in morning, plus Humalog before breakfast and lunch, and a combo of Humilin & Humalog before dinner. My one daily sweet treat is a small bowl of ice cream each evening. the high fat content of the ice cream was making my blood sugar go too high before bed/overnight, so my endo recommended a small dose of Humilin to correct that and it’s working. This is a complex insulin scheme and your child might do better with the pump if you can arrange that. I’ve been a T1D for almost 50 years with frequent trouble getting my employer health plan to cover what I need. So I’m hesitant to switch to the pump which I assume is more expensive than shots and may not be covered. As it is the plan changes which insulins and cgms they cover and don’t cover each year. Hopefully you don’t have that problem. Tresiba shouldn’t be split. It took me several weeks to get the dosing right after switching from Levemir. I find it indeed to be the flattest, without the dawn phenomenon spike I used to get with Levemir (which I did split). Tresiba in my opinion is far superior to any other basal insulin available. Good luck !
It seems that my daughters overnight spikes are improving. She is on novolin for dinner which has 100% helped the spikes overnight. Theyve gone away. Still taking tresiba at 8pm. Shes spiking again between breakfast and lunch and her bolus has been increased little by little but that’s not helping much . She doesnt spike between lunch and dinner at all.maybe shes more insulin resistant during breakfast???
@stixxs512 it is not unusual for a person with T1D to require a higher insulin-to-carb ration in the morning than later in the day. At breakfast, I take almost two times the insulin than I need for the same carb count at my evening meal.
When you say “spike between breakfast and lunch”, does this mean that she is still “high” immediately before lunch - like about four hours after breakfast? If this is so, you may need to provide more insulin at breakfast. On the other hand, if she is back-in-range just before eating lunch, I would not adjust her breakfast dose - just play it safe for a while.
Yes high immediately before lunch. She eats breaksfast between 830 and 9 and eats lunch between 1230 and 1
Exactly as Dennis says, it’s very common to need more insulin at breakfast than later in the day. Check with your endo about how much to change the insulin:carb ratio at breakfast, and then give it a few days to settle in. Good luck!
@stixxs512 , that is about 90% certain indicator that she needs insulin with breakfast. Do keep in mind at lunch time thither could be a small amount of her breakfast dose still active in her body.