For those who have tried both Tresiba and pump therapy, is the control just as good with Tresiba as it is with a pump? The last time I did injections was with Lantus, back in 2000. I did not split the dose and I would get some pretty high numbers around 3pm. So I was just wondering if sugars stayed as low on Tresiba as they do with a pump. Thanks.
I have had 3 pumps and am now on Tresiba with MDI novolog and it works wonderful. The pumps only function is not just basal rates though, at least it wasnt for me, so being on Tresiba doesnt negate the benefits of a pump. You still have to take shots if you dont have the pump. I have looked at going back on the pump (omnipod) just for the conveinence of taking shots or corrections but Iām trying Afrezza now so might not need it. The best approach imo if you want to stay on the pump is to do the untethered approach which is to take 70% or so of your basal as Tresiba so you always have a guarantee against insertion set clogs, etc. and then give the rest of the basal with the pump.
2 Likes
A very, very subjective question to say the least. Iāve worn a pump for 15 years and decided to try Tresiba. I loved the Tresiba, however, I need more basal from 12pm-4pm and the ability to have multiple basal profiles with the pump is what made me go back. If you do not need multiple basal profiles then Iād say give Tresiba a try, it really is an excellent basal.
2 Likes
Iāve never pumped but why not give it a try? You can easily get a free sample from your doctor and go right back to pumping if itās not for youā¦ Thereās really nothing to lose
1 Like
We were on pump for approx ten years then switched to toujeo plus Afrezza. We loved that combination vs pump because of hugely decreased hypos (almost daily vs 4 in 7 months). We recently switched to tresiba and find at least with Afrezza that it makes mealtime insulin seem stronger. In addition morning numbers much better and no mid-morning gap, where toujeo seemed not to give full 24 hour coverage. Over-all for us we like tresiba much better, and though Afrezza plus toujeo dropped a1c by one point we are hoping better nighttime control will improve performance further. For us the one negative, though far outweighed by the positives is a very slight increase in mild hypo events. Hope this helps. Good luck!
1 Like
Sorry one caution which you may already know is you need to give any new basal a good 10-12 days to really settle in and start working. Good luck!
1 Like
A simple answer to this question:
YES and NO.
Some people will have better control with Tresiba as part of their MDI regimen, while other folks will have better control using a pump.
YDMV.
1 Like
Iām thinking about the untethered approach myselfāsteadiness from the basal injection, flexibilty for eating, and corrections. Meanwhile I have some Afrezza samples (!!!) to try.
1 Like
I am very unlikely to give up my pump because of the convenience of bolusing and the ability to micro-dose corrections throughout the day and night. I just canāt imagine having to take out a syringe and vial or pen every time I needed insulin. But thatās just me. I spent a lot of years taking injections in bathrooms throughout the US. I didnāt become comfortable with sharing my diabetes until I had a pump.
Also I am amazed on this website that so many people seem to be able to get access to these new insulins and Afrezza. None of these therapies are in the formulary of my insurer and my A1c is so good that I canāt imagine any scenario that I could argue that I need anything different. Unfortunately we canāt negotiate our insurance coverage with the notion that I will give up my pump if you fund Tresiba and Afrezza. That isnāt a bad idea, but currently not part of our reimbursement landscape.
1 Like
I was on a pump for 25 years, sometimes with good control and sometimes considered āuncontrolled.ā For me, absorption at the pump infusion site became an issue and I switched to Tresiba and Afrezza.
Tresiba gives me basal control overall, but I do have slight highs in the afternoon that I have to cover with Afrezza. Despite what some say, at my āidealā Tresiba dose for most of the day, I have lows (high 50ās/low 60ās) in the morning. If I adjust the Tresiba to not have those lows, I have significantly higher bg in the mid-afternoon.
So it all comes down to which works better for you. I prefer to give up the pump for the benefit of smaller injections, giving me better absorption.
Despite not being covered by my insurance, Tresiba costs me less than my co-pay for other insulins when I use the GoodRx discount, and the Nordisk manufacturers discount. I pay $15/mo for my Tresiba.
As to Afrezza, it was quite simple for me to get a PA for Afrezza, though it is not on my insurance companyās formulary. With the help of @Castagna2011 and MannKind Cares, it took less than a week. But yes, you have to show that injections/pump donāt work effectively, or you have a fear of injections.
Your mileage may vary with other insurance companies.
2 Likes
Medical providers deal with prior authorizations all day long for patientsā¦ It isnāt uncharted territoryā¦ And you make an excellent point about the great cash discounts for tresibaā sometimes insurance isnāt the solution.
You pay $15/month for tresiba. People whoād be happily paying way way more than that in copay if their insurance covered it are convinced they ācanāt get itā
Iām always amazed by people thinking they just ācanāt getā something because itās not ācovered by their insuranceā. Where thereās a will thereās always a way.
1 Like
Like you say, @Sam19, my co-pay for Lantus was $30/mo, and a 90-day supply of Novolog (when I was on the pump) cost me $90. All discounts included, Afrezza costs me no more than $15, and with the PA from insurance my copay is $0 right now. I am way better off after doing a little legwork.
My wife recently had a patient with diabetes who refused a free iHealth bg meter from her because he would have to pay the $7 for his test strips out of pocket, preferring to get his test strips through insurance - at a copay of $50.
I just canāt figure that mentality out.
Your financial benefits from this regimen wouldnāt work for me. Right now I do not have co-pays and once I reach my deductible, everything is paid for 100%.
6 months from now I will go on Medicare where beneficiaries are not allowed to participate in patient discount programs. Depending on what plan I choose, I will have co-pays, percentages, and deductibles for drugs. But what is weird about Medicare is that pump users buy their insulin under part B and it ends up being free if you are in a supplemental plan that covers your Medicare deductibles. If you donāt pump, you buy insulin under Part D which quickly puts you into the donut hole which is a very expensive proposition. For me this is a big motivation to continue to pump. And I like my pump:-) I have no idea whether anyone on Medicare is getting Afrezza covered.
As another poster mentioned, I would love to have Afrezza available for stubborn highs and for occasional high-carb treats (think chocolate covered donuts!).
1 Like
I quit using the untethered regimen a couple of weeks ago. I had been doing it with a once-a-day injection of Lantus which peaked in the early morning hours to help cover morning hormones. I do think that it really helped smooth out my basals, make my mornings easier, and cover erratic insulin absorption after I changed pump sites. It also provides a safety cushion from DKA from pump failures.
I quit for a couple of reasons. 1) After doing this for 6 months, I rarely remembered the Lantus injection without my 8:00PM alarm. Since I am beeped at 24/7 by my Dexcom, I was definitely suffering from alarm fatigue. 2) Looking at going on Medicare soon, the Lantus part of the equation would get very expensive. I didnāt think the benefits mattered that much. 3) My basal rates are quite low and it was difficult to get meaningful results from temporary basals on my pump. 4) At most, I have one bad pump site a year and have never had a pump failure. I trust my Dexcom to alert me before anything too bad happens from a deficit of insulin.
Although I am currently not using the untethered regimen, I am still a big fan of it and think that it can provide a lot of benefits for many people.
Iām on Medicare but my mail order pharmacy supplemental benefit as part of my retiree benefit covers the Afrezza. Itās an 80/20 split.
1 Like
I donāt understandā why would you not be able to pay cash for any drug not covered by your prescription plan and use any manufacturers discount program regardless of whether youāre on Medicare? I understand that you canāt combine discount programs with the prescription coverage, but thatās not primarily what we are talking about hereā¦
1 Like
I think the root of this Medicare policy lies with vendors giving the patients special favors/rewards for getting their Medicare business. Medicare did a large audit and found corruption and fraud. I think the āmedicare scooterā explosion was mixed up in this decision. You could pay cash for any drug your doctor prescribed but just canāt take advantage of any special offers or discounts.
So for example you couldnāt use the tresiba or afrezza savings cards offered by the manufacturer? That sounds ridiculous.
Just a thought, but how would a new pharmacy even know you were on a medicare plan if you just showed up with an rx, money, and a discount card?
I canāt use any of those discounts. It is discriminatory but I understand the need to control the bad actors that provoked this.[quote=āSam19, post:18, topic:55925ā]
Just a thought, but how would a new pharmacy even know you were on a medicare plan if you just showed up with an rx, money, and a discount card?
[/quote]
Good question. They always want to know who you are with a picture ID and then they want to know which insurance you have. Iāve never tried to deceive a pharmacist by withholding info so Iām not sure what may reveal your lack of disclosure.
Isnāt it a US requirement to abandon your private or public health care policy
FOR Medicare at age 65?
Supplemental Plans not withstanding.
Just looking at the patientās DOB would say it all?