Maybe he could switch to Lantus. Tresbia lasts for 40 hours? Longer than Lantus?
I agree that if you have a problem with different basal needs, Tresiba is not the answer. But the problem with Lantus is that it can also have really difficult hour ranges, like 16 hours or 18 hours for some people.
If you can find a basal that gives you 12 hours or 8 hours, those are much easier to fit into a daily schedule with multiple doses that you can keep at a consistent time, while adjusting the amount higher or lower for morning or night.
The nice thing about Levemir is that the duration has been shown to be dose dependent, to you can more easily figure out how long it will last for you. I am not sure if that is true of Lantus.
Interesting. I was given some Tresbia to ‘try out,’ but I never did. Good to know about the different basals details.
In terms of basal, one of the biggest impacts we saw when switching from MDI with Lantus to the pump was the ability to effectively and automatically counter the Dawn Phenomenon (DP).
The other thing I really like about the pump vs MDI/Lantus is the ability to “on the fly” easily provide a temp basal when in the middle of the day you suddenly realize there is a persistent UP or DOWN that does not appear to be food/bolus related.
I find my system to be, overall, less chaotic on a pump…at least this time around. People had to work on me to make the switch back from MI to a pump because I had the fear of God in me about pumps. The first time around with a pump I didn’t have a Dex. It almost killed me. System was far too dynamic and the settings were all wrong and there was MUCH operator error and underestimation of the amount of system complexity. Dexcom changed my whole understanding of the system. Blew my mind the first time that I saw Dex data. I’ll never understand the point of having a pump without having the data that is wholly necessary to operate it safely/effectively. But, I know people have varying perspective about this.
We did first year MDI. Second year pump w/ fingersticks. Third year added CGM but still all bolus from fingersticks. Starting this past January (2017) we bolus from CGM and only use fingersticks for calibration or if a question on the CGM.
While on the pump with no CGM (second year), we would have 8~10 fingersticks per day - typical. When doing basal testing to determine proper basal rates for various times of the day - many fingersticks.
I never had a greater concern on the pump then when on MDI. Either way - we were going to know the BG.
I am very happy with our entire Medical Team. They were incredibly helpful upon initial diagnosis, stabilization and education. They were incredibly helpful with the switch from MDI to the pump. They actually did not have to get very involved when adding the Dexcom CGM but they still were very supportive.
That all being said - the Dexcom CGM is great. I could not possibly say enough good things about it.
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So sorry, I don’t have a lot to add about splitting doses as it’s been 27 years since I was using MDI for my greatest plan. I will say and firmly believe, each one of us is different and what works for me might not work for you. And what works for me today might not work for me next week.
The standard plan usually has people needing more basal overnight and less during the day. But as I have learned, that is a guideline not fact. And you maybe one who just needs more during the day and less at night. Problem with MDI is so very hard to get those doses correct which is where a pump can work it’s magic.
Another standard guideline is most people only need one to three different basal profiles. Again, that varies and sometimes we can over do it. When you have 8+ basal rates set, they kinda pile up one each other. I currently have 3 but have had more and have had less.
Not saying a pump might be the answer. It is not for everyone and it is a lot of work. But it does help those that need different insulin rates throughout the day. Good luck sir and keep asking questions. And I heart to heart chat with your doctor might be in order. You both have to be on the same page with what is important for you and what your goals are. You live with not him/her. Whenever I have to find a new doctor, those goals, frustrations and feelings are discussed up front so they know where I am at and where I want to be.
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Another option may be to consider Metformin.
I am long time T1D with great A1C and use insulin pump, but diagnosed with cancer a few years ago. I found studies that showed metformin appears to reduce risk for cancer, heart disease and potential weight loss. My oncologist strongly supported it.
You are indicating that without eating, your BG is rising during the day, which means your liver is dumping the glucose. Metformin may reduce this.
Normally a liver would only dump glucose when it is needed.
Since starting metformin a few months ago, my total daily basal insulin has been reduced, and I’ve lost a few pounds.
At one point I found a good explanation of how metformin works to stop the liver from causing rise in BG, but can’t find the link now.
Many doctors, including mine are resistant to prescribe metformin for T1Ds, but mine agreed to let me give it a try. I think I have seen others on this site also talk about T1D and using metformin with good results.
What he means is that with that much insulin it’s impossible almost to lose weight in fat form - I’ve been on a strict calorie controlled diet for 8wks now (900-1000and low carbs and I’ve lost
Anyway as an update to my original post - using my CGM I’ve been able to get my tresiba morning down to 20 units and it has had no effect on my nighttime which still remains flat for the night at 90 - which is great - I may try 18 units
My liver kicks in at 6-7am and I need to take 5 humalog every 3 hrs until 2pm as it calms down at 5 generally - to keep readings below 140 and that’s with day fasting
I then take 6 units of bolus hunalog in the evening as I don’t eat carbs for breakfast or lunch but generally eat equivalent of two slices of bread for dinner
All seems to be working fine - I’m going to ask doctor about levemir to stop me having to stick myself every 3 hrs during the peak period
My cgm average is 135 currently so I should fingers crossed get a a1c of about 6.3
Reducing the tresiba I’ve started losing weight finally quit fast actually 8lbs