Dose of tresiba w novolog

Type 1 and LADA
21

Thanks Sherry Ann. I will look at the site for the pump, since I have never looked at a pump at all. In the Fall of 2019, I asked the Tudiabetes group whether I should try a pump or not, and many members responded. I explained what my control was like and also why I was concerned about wearing a pump. The result of the poll was overwhelming to not get a pump.

I doubt that my control could get better on a pump, but I might be able to back away a bit from the time and dedication it takes to have this kind of control.

My biggest question is whether insulin is given according to what the Dexcom reads? My Dexcom is often at least 20 points off either higher or lower than my finger stick result. If the pump gave me insulin when then Dexcom was misreading my actual glucose level, I would either go higher or lower than I would want. Am I misunderstanding the way this works?

Also, I am a poor sleeper and have been for decades. I am afraid a pump will make the ability to sleep even more difficult. I also am highly sensitive to tags in clothes, so I think I will be sensitive to a pump. I am a little person without much fat, and don’t have a lot of space on my body, although I am well aware that little kids wear pumps.

I have thought about trying a pump just to see what I am missing, but pens are just so darn easy. I would never go back to vials and syringes though.

I have given hundreds of thousands of injections in 63 yrs, but my skin remains unmarked and I am lucky to have no skin that has been affected by insulin or injections. Even my finger tips remain in good condition.

I was afraid to wear a Dexcom, but I love it now. When worn on my arm, I forget it is there.

I must also say that I am technically challenged, because I don’t like spending time trying to figure out how things work. I have no patience or interest in it. I would much rather read a book or garden.

Sorry for the long answer, but I have been giving my decision to not pump a lot of thought.

Edit: SherryAnn, in what way would a pump make my life easier?

22

Hey Marilyn.
Most likely your control won’t be better, but you might be Able to relax a little and allow the pump to do its thing.
I found that I sleep better because I know it will shut off if I go low, and if I go high it will correct it.

I really like mine at work when I just can’t look at it or take injections or corrections. I generallly draw a flat line when I am sleeping or anytime I am not eating.
Even exercise keeps me pretty flat.

It’s not for everyone and putting the pump somewhere can be annoying.

Every once in a while, I will take a pump vacation if I’m going to be swimming a lot or just at the beach.

I am always so happy to go back to my pump though. It’s just a relief in the constant supervision of my glucose that I can back off just a bit.

There is no way I could take business trips etc and sleep by myself if I didn’t have a loop.

I wish there was a way you could take it for a test run just to see. It’s not for everyone though

23

Yes, Timothy, I probably should try one. What about my problems though with my Dexcom readings being off so often? I don’t want to go low because the CGM is saying I am higher than I actually am. What do you do during the first 24 hrs when the Dexcom readings can really be off by large amounts?

My insomnia isn’t caused by my Dexcom alarms. I just don’t sleep well for a few weeks at a time, and then I start sleeping again only to repeat the cycle. I follow all the rules for good sleep. Getting older isn’t helping.

24

Yes you have more than one thing going on. I don’t have sleeping issues except when I’m really worried about something. I’m actually a heavy sleeper and alarms don’t wake me except that dexcom one that jolts me out of bed.

My dexcom doesn’t give me weird readings in the first 24 like some others. I wear it in my arm where it seems to work really well. But the reality is, that I have my basal settings programmed. If I turned off the ciq, my pump will just deliver that. When ciq is on, it makes small corrections to it.
So having it off for a while doesn’t make that much difference except at night, when I really want it.

But maybe we have different tolerance for being off.
I woke this morning at 110 but my fingerstick says 99.

That’s good enough for me. Besides I don’t know which one is really off.

25

You are correct, Marilyn, that the pump probably would not give you any better control than you have now. Your A1C is phenomenal! However, a pump may make your interaction for that control easier. For example, if I am in a public place and suddenly don’t feel right, and my G6 says that my glucose is 180 and rising quickly, I can take out my controller, put in my G6 reading (or do a blood test with a meter if I REALLY want to be sure), and click a button to tell it to give me a prescribed calculated dose of insulin. Like you, I am sensitive to insulin, so perhaps that only will be .4 of a unit. No one in that church or library or shopping mall or restaurant sees anything but me interacting with what appears to be a phone. No one knows I just took an insulin “injection.” Also, if you want to take multiple injections a day, you do not throw out any needles or alcohol wipes because no needle (other than the cannula already in your skin) goes through the tissue.

I, too, have experienced wild inaccuracies between a blood test and my G6 reading. Perhaps that is because we both have been diabetic over 50 years. Perhaps that is just our genetic make-up. At any rate, with the OmniPod DASH system, no insulin is delivered based on a G6 reading unless I CHOOSE to use that number. The DASH can connect with a Contour Next 1 meter to get glucose levels, or I can manually enter in a meter or a G6 reading. From there, the pump will calculate the IOB (if there is any), and what my dose should be, based on the pump’s set-up. I STILL have the power to change that dosage based on my own experience, but you are always in control. I will tell you that with the newest Insulet product, the OmniPod 5, that system will be a closed-loop system based on what the G6 readings give it, so if you want to try a pump, I strongly suggest the OmniPod DASH.

Another advantage is with the infusion. We both have read horror stories about infusion sets, but the OmniPod eliminated that problem. You just put on a new Pod (which sticks to the skin like the G6 pod), press a button on the controller, and the cannula automatically inserts. I have very sensitive skin, but I have never had problems (like some people) with the Pod adhering to my skin, and I do not blister from the Pod adhesive. The Pod is waterproof, so you do not have to disconnect anything to shower or to swim.

The Pod is not large and not connected by any wires, so I have NO trouble sleeping with it. I usually wear it on my abdomen, but others use arms, upper thighs, or upper part of the buttocks. You should be able to find areas on your body that you do not lie on while sleeping, so you will find that like the G6, you put it on and forget it, even while sleeping.

Set up of the Pod is one training session with a endo, nurse, Insulet rep, or diabetic educator. Believe me, I am not a great technician either, but everything you need to know about diabetes and control, you already know, Marilyn.

(Added benefit: recent hand surgery left me less than dexterous for a while. While my husband reluctantly could have given me injections, he was not hesitant at all in helping me fill a Pod with insulin, peeling off the backing, and placing it on my body so I could just push buttons to take care of my diabetic needs while giving my hand three more days to heal.)

Pump or no pump is your choice. You have excellent control with your current MDI, but you may find a pump makes life even easier. Good luck with your decision.

26

What is ciq?

Being off 10 wouldn’t bother me, but I don’t like to be off anymore than that.

27

SherryAnn, you have given me a lot to think about and I appreciate it very much. Thank you for sharing your reasons for preferring a pump. I need to check out my health insurance and find out which pumps they cover.

I hope that your hand heals quickly. I have had several hand surgeries over the years.

28

It’s the looping software that is built into the tandem pump.
When it is on, it will alter your basal rates based on your dexcom readings. It will also bolus for you if you are headed out of range or if you are out of range.

When it is off, it works like any other pump. It just delivers the programmed rate.

29

I found out that my insurance will cover the Omnipod Dash, Animas, Medtronic. Tandem T- Slim, and the Accu-Check. I didn’t realize that there was an Accu-Check pump.

The only one I am a little familiar with is The Omnipod Dash. I just read mostly bad things here about Medtronic.

The Omnipod Dash sounds like the easiest to wear, but again I don’t know what I am talking about.

I don’t know what looping software is.

I am a bit wary about pumps, because so many of our members seem to have problems with them from time to time.

This kind of reminds me of when I was a kid trying to talk my dad into buying a color TV. He was convinced that they were a fad. LOL

30

I was thinking Omnipod might be best in your case, and you can certainly do pump some days and pens on other days, maybe based on your plans for those days. I think Omnipod runs up to 3 days per pod.

Not sure you would benefit from looping, if you have been using long acting basal Tresiba and it matches your basal needs well. Pump can provide more choices to adapt to irregular basal patterns, due to exercise, hormones, stress, etc.

If on medicare, I think I saw it mentioned that plans may cover Podds as Pharmacy with lower costs/copays.

https://www.omnipod.com/medicare?utm_campaign=wh_us_brand_65&utm_source=google&utm_medium=cpc&ctoken=7012J000001NYeIQAW&gclid=EAIaIQobChMIvu6xq4j39wIV1uDICh1thw8HEAAYASAAEgJu6_D_BwE

31

My basal rates are quite steady. I take 11 units most of the month, although I do have to drop down to 10 units for a few consecutive days. I take 9 to 12 units of Novolog depending on what I eat. Pretty close to 50/50 which I guess is old fashioned, but it sure works well for me. If I exercise more than I usually do then I just cut a unit of Novolog.

My life is pretty routine especially since I am leery of getting covid. We spend a few months at the beach, but life doesn’t change very much. I guess that is why pens are so easy. If we were traveling I can see why a pump could be a real advantage.

Thanks for your opinion MM1. I appreciate your thoughts.

I think my private insurance would pay for a pump, since they pay for my CGM. I wouldn’t have a co-pay just those expensive monthly premiums.

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32

My pump average shows me at 55/45 (basal/bolus) for last 30 days, average 25 units per day. So not too much different.

When I first started pump (1992 ish), I switched from syringes, so made a big difference. I was using NPH + Reg injections, with am NPH peak covering lunch, and lower dose NPH overnight.
Switching to pump gave me a lot more flexibility. Some day I may try pens, and newer long acting like tresiba!!!

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33

Animas went under they no longer make insulin pumps.
Accucheck pumps were actually desitronic pumps that were rebranded and then also went out of business.

You basically have 3 choices right now. Medtronic,Tandem and Omni pod.

If the new Omni pod would be released with looping software, I would reconsider it.

But I really can’t wait for the tandem mobi that sticks to your skin and you don’t need to deal with tubing. It’s also half the size of a standard pump, but bigger than a pod.

If they let you try a couple of pods, that would be awesome but I’m not sure they would let you do that.

But then you could decide if it was a good fit for you.
I know that Tandem offered me a free return policy if I didn’t like my pump if I returned it before 90 days.

It took 2 months to get it working smoothly so I really needed the 90 days to make the assessment.
I decided to keep it. It isn’t perfect, but I like it more than dislike it.

I think the Tandem Mobi will eliminate a lot of the issues for me.
Like the tubing getting caught on things, and it opens up a lot more sites. Being able to control it on my phone is also something I prefer so I don’t have to pull out my pump all the time.
My insulin needs change dramatically day to day. I don’t know why, even when I eat the exact same food.
So a pump really evens that out.
Today I used 47 units, yesterday 44 units and Sunday I used 53.
And no I don’t eat differently on weekends, I exercise the same.
The only difference is I’m more relaxed and even with that it’s not consistent to the weekends or I could more easily manage that.

So I really like CIQ because it alters my basal needs and keeps me in range no matter what my insulin requirements are.

34

I won’t deal with tubing, I just don’t want to. I have decided that the only reason I will consider a pump is for days like I am experiencing right now.
Every once in awhile, for some unknown reason, I just need less insulin and I will quickly drop into the 50 and 40’s. These drops don’t scare me at all, but they exhaust me when it happens a couple times in the same day.

Most of the time my diabetes, is pretty darn predictable until it suddenly isn’t. I don’t produce any of my own insulin, so I don’t know what is going on. My insulin needs just drop for no apparent reason.

I wonder why you Timothy need different amounts of insulin when your days are quite similar? Ahhh, the mystery of diabetes.

I was wondering about the Mobi. Isn’t that the device that Robin is waiting for? When is it supposed to be available?

Knowing myself, as soon as my diabetes starts behaving itself again, I will be happy with pens.

I will pay much more attention to you guys when you talk about pumps, and I will
do more research, so that I can try a pump when the time is right.

Thanks for all of your input.

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35

Actually, they’re doing exactly that right now. They’re doing a month long free trial. 3 pods and a PDM, with supposedly no commitment. I don’t know what the fine print is, though, other than the deal is only good for private insurance. No Medicaid/Medicare.

https://www.omnipod.com/is-omnipod-right-for-me/free-experience-kit

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36

Yes! And not for way too long. It was supposed to be out in 2020, and now it’s not expected until 2023. They say they intend to file for approval thus summer, which should mean we are the Mobi in the first half of 2023. There’s a “lure in fresh investors” talk scheduled for tomorrow, so I’m sure there will be an updated time frame.

I’m already a year out of warranty, and not sure my pump will last another year without any problems. I think I really want the Mobi, but may opt for Omnipod instead if I have to. I just can’t bring myself to commit to another 4 years with the same exact pump.

My control isn’t nearly as good as yours when left to my own devices. The automatic insulin adjustments have been life-changing for me. It’s like it erases my bad habits. In your particular case, the biggest advantages for you would be more precise insulin dosing, not having to poke yourself nearly as often, and the possibility of new insulin-dosing locations since you can apply the pod anywhere you (or your husband) can reach with at least one hand.

I would request the inactive pod sample from the above link. You can’t deliver insulin with it, but you wear it for thee days and see if i8 comfortable and whether or not it affects your sleep

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37

Yes they keep pushing back the mobi. My pump is only 18 months old, but they told me I can upgrade to the mobi for $1500 if I trade in my tslim. That was back when the mobi was going to launch in 2021.
That would mean $300 for me after insurance.
But who knows what they will offer when it finally comes out.

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38

I was 1,000% in agreement. But life changes. I wanted better control and more convenience. So I decided to give it a try.

I keep my (Tandem X2) pump in my pants pocket and in 9 months I’ve caught the tubing on a four knob and ripped it out exactly once.

At night I wear a slim “fanny pack”- like belt that I stuff the pump and associated tubing into. And almost no matter what I do, I wake up to a flat line on my monitor (not cardiac monitor, LOL) and a glucose of ~6. I do make adjustments to basal rate, correction factor, and insulin to carb ratios. And I have three different personal profiles: “Normal”, “Active” and “Lazy” that I engage depending on what my day is like. I have to rescue with additional snacks far less often than when on MDI. I awaken with low — or high — alarms very rarely.

Last A1C was 6.0% !!! (Before CGM and pump it was 8.5%.

But I will admit that most of the improvement was not due to the pump but rather the Dexcom).

So from being constitutionally opposed to a pump and tubes, I’m a convert.
I remove the pump if I’m in the hot tub or swimming or playing hockey. I just wish I could easily stop it alarming when I do that for an hour!

39

I think I will see about trying the pods to see if I think I can deal with them. Also I will try to find out more info about the Mobi device. I hope that you will continue to update us on any progress that the company is making getting them to market. You always do an excellent job getting the info and passing it on.

Thanks Robyn for contributing to this conversation.

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40

I am so glad that you are happy with your pump even with the tubing MBW. It sounds like it is making your life easier.

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