Long time pumper switching to Tresiba

Type 1 and LADA
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Hello, new to the site but have had T1 for about 20 years now and had been using a minimed pump for about 16 of those. I feel like I have gotten complacent in my diabetes care even though my a1c usually had been between 7-7.5 while using the pump. Last doctor appointment my urinalysis showed an elevated microalbumin level and I decided I needed a change to hopefully wake me up from my complacency.

I am switching to Tresiba and will be using the novolog I have on hand for bolus. In the near future I would also like to use a dexcom cgm (used minimed but was never impressed with it) and adding afrezza. I have also gone back to an extremely low carb diet and completely cut out starchy foods. Just thought I’d introduce myself and if anyone has a similar experience I would value your opinion.

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Welcome! There’s a lot of us talking about tresiba here, and more and more of us using it. There’s a very active discussion here

Including a number of people who’ve switched from pumps to tresiba and a number of afrezza users as well. We’d love to hear all about your experience with the transition.

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Just an update.

So far I really love the stability of this insulin on my blood sugar. The only issue I’ve had is waking blood sugars tend to run high but sometimes it doesn’t at all…one night I had a few peanuts before bed and it spiked in the morning…the next night I had the same snack with no spike in the morning. Has me scratching my head…

I just put in an order for a dexcom…

Does anyone have any tips for dawn phenomenon on Tresiba? With my pump I could just adjust my basal…I’ve heard apple cider vinegar before bed can help?

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The only thing I’ve noticed is that late night snacks lead to morning spikes more with tresiba than they did with
Lantus… So I’ve just learned to avoid them more than I used to. I consider it a small price to pay for an overall better experience.

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Welcome and you’ve described exactly what I am doing. Went from 15 years of pumping to Tresiba/NovoLog combo. I love it. Have not experienced DP that others have reported with Tresiba. My morning numbers tend to look really good. I also use Dex G5.

Good luck!!!

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I accidentally forgot to take my atorvastatin the night before last and my morning numbers were perfect. I “forgot” again last night and they were perfect again.

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Hello I realize this is an older thread but I thought this would be a good place to ask. I’m desperate to come off my pump. It’s just not working for me after 14 years I just need a break. Just curious how much Tresiba do you take compared to your pump totals. I currently take 13 units daily on my pump and don’t need to blous I basically live off my basle. I’m so apprehensive about taking shots again! My doctor said start at 10 and see what happens.
Thank you!

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That seems like a reasonable but conservative place to start. I suspect you’ll end up taking more though. Only one way to find out–

The conventional wisdom is that people require less total basal when delivered by a pump than by a shot. I didn’t switch from pumping to tresiba but have had great results with it.

Pen needles are so tiny and sharp they’re no big deal-- you’ll be fine. I hope you like it, let us know how it goes

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@KidMelody

This thread came up as “new” and I was curious as to why someone would go from the pump to prefilled pens/needles. If you have time and if you want to, would you come back and let us know how you are doing?

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@Ali4

Congratulations to you! If you’d like a good laugh, I think most of my boluses are 13 units, but I happen to be a carb junkie.

I also wish you success on coming off of your pump. I hope you’ll come back and let us know how you are doing with the switch.

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If you don’t need to bolus then tresiba may work very well for you. Try it and see.

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Hello Tresiba crew! I just wanted to reach out and thank you for the little push I needed to try this. I’m still not stable an finding spikes to 200 without little one unit shots of humalog. But OMG the freedom. I never ever want to go back to that pump. I’m taking it at night 7-9 o’clock right now and notice around 12 in the afternoon is when the spike sets in.
I’m hoping I can figure out how to work with it and make it work. I think I don’t have enough on board. I’m at 12 units but think if I creep up to maybe 16 I can eliminate all the little shots of fast acting. Supplement when I need it of course just not all the time. I can’t thank you enough.

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Have you considered Afrezza for the spikes? There’s lot of Afrezza users on TU to find out more and some are using it with Tresiba. That combination would take you to 1 shot a day. Good luck.

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I bottom out on just 1 unit of fast acting. Last I heard you could only take 2 units at a time. Have they been able to change the dosages?

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I’m not a user and can’t speak from experience, but would suggest you talk to a few. I do know that Afrezza units do not equate with injectables. It’s very different and much more forgiving. Sam19, Mikep, Terry4, and several others are great resources here on TU with Afrezza experience.

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…would be enough to abandon complacency for many, but the psychological aspects — including depression — of dealing with T1D can be complicated. A lot can depend on supportive relationships and having stress-relievers like regular exercise.

Diet plays an important role in minimizing kidney damage, but you don’t mention reducing your protein intake; too much protein can stress kidneys like high glucose levels. Shifting a carb balance to emphasize complex carbs and increasing vegetables with roughage have yielded glucose control benefits for many, many years.

When we drive an automobile, we check the speedometer to keep our speed within posted legal limits. Using a glucose meter and performing checks every 2-3 hours is comparable to using the automobile speedometer when driving, Intuition and feelings are no more accurate for managing glucose levels than when keeping a car’s speed within legal limits.

Surviving T1D has so many challenges and motivation has always been one for me.

I remind myself frequently with this saying, “grant me the serenity to accept the things I cannot change, the courage to change the things I can, and wisdom to know the difference.”

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I don’t think this analogy holds well with diabetes. Depressing the gas pedal to increase speed in a car is a predictable and repeatable response for acceleration. For diabetes, eating the same meal with the same insulin dose size and timing may produce a range of BG results.

Have you ever corrected a high blood glucose level with an insulin dose that’s previously been successful and this time the BG doesn’t budge, or falls only a small portion compared to prior experience? I’ve found the diabetes “gas pedal” and "brake’ inputs have variable results. They usually work fairly consistently but not always. This is where gut instinct and intuition play a role for me.

There are a lot more factors that influence BG outcome in a diabetes system than the simple “step on gas pedal and accelerate” model of a car.

This is a wise and useful way to guide your life.

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Thanks for the opportunity to clarify –

Actually, not always the case: Is it raining and the pavement wet or covered with snow and ice? Strong headwind or rough road surface? Is there contamination in the gasoline? Does the engine need a tune-up?

These questions all describe conditions that could affect the efficiency of how far a car can travel on a gallon of gasoline, comparable to the efficiency of a unit of insulin per gram of carbohydrate. Just like road service, weather, or engine tuning represent resistance to the metric we think of a miles-per-gallon (MPG), for a T1D conditions like illness, stress, glycemic index, exercise, and site absorption all affect how our bodies respond to insulin.

In science, we can think of road conditions as resistance that impedes efficiency and resistance is everywhere; but, while it can be measured, we don’t always know the many variables to fully understand the effects of resistance and predict the consequences. Likewise, we know that stress and illness create insulin resistance, but we each have enough genetic and biological differences to make predictability difficult and more generalized than specific.

Have you ever corrected a high blood glucose level with an insulin dose that’s previously been successful and this time the BG doesn’t budge, or falls only a small portion compared to prior experience? I’ve found the diabetes “gas pedal” and "brake’ inputs have variable results. They usually work fairly consistently but not always. This is where gut instinct and intuition play a role for me.

To answer your question, yes – but that doesn’t mean the analogy isn’t useful. For example, how did I know the glucose level? I used a glucose meter, analogous to a speedometer. The meter, like the speedometer, is an tool/instrument for measuring that is far more accurate and consistent than how I feel, even though how I feel will often prompt me to check my glucose levels. Over the 50.5 years since my diagnosis, experience has taught me that hyperglycemia and hypoglycemia can “feel” the same.

In language, few analogies are 100% consistent, but the speedometer analogy has worked well for me to help explain why quantity limits on glucose test strips can undermine glucose control and to help friends with newly diagnosed T1D and T2D understand the need to check glucose levels. The analogy is not meant to diminish the value of experience.

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If anyone has done a cost comparison of Tresiba/Novolog compared to various insulin pumps that would be really, really helpful.

For example, at simple retail costs, using Walmart Relion test strips Walmart Relion/Novolin R insulin, and Animas reservoirs and infusion sets, the annual cost is about $3,600 to $4,000 per year.

Tresiba retails for about $509 per 300 units compared to a low cost of $25 for 1,000 units of U-100 Relion/Novolin or $280 for 1,000 units of U-100 Novolog. Since Novo Nordisk suggests “adults with type 1 and type 2 diabetes already on insulin therapy, start Tresiba® at the same unit dose as the total daily long- or intermediate-acting insulin unit dose” simple math yields a cost for Tresiba of $1.70/unit, Relion/Novolin of $.03/unit, and Novolog of $.28/unit.

Using myself as an example, my average daily insulin use with a pump (including waste from infusion tubing and priming) is about 65 units/day or 23,725 units/year; my average daily total for meal boluses is about 70% of that total or about 46 units/day, 16,790 units/year. Hence, using a pump the approximate retail cost of Novolog would be $6,643 compared to about $712 for Relion/Novolin. Tresiba would avoid infusion set and priming waste that averages out to 10 units/day or 3,650 units per year; Tresiba would, however, still require use of Novolog or Relion/Novolin before meals and to treat hyperglycemia. Switching to Tresiba would require about 6,935 units at a cost of $11,790 per year PLUS 13,140 units of Novolog at $3,680 per year or Relion/Novolin at $394 per year – assuming traditional syringes, not insulin pens.

In other words, based on estimated retail costs, using Tresiba could cost me between $12,184 and $15,470 compared to pump costs of $3,600 to $4,000 per year.

This kind of cost analysis may yield yawns and responses of “so what!” because insurance coverage may reduce these costs for the T1D by 50% to 80% – but insurance actuaries look at these costs to make coverage determinations, including quantity limits.

If Tresiba is so wonderful, how is Novo Nordisk helping patients answer these cost versus benefits questions? What additional benefits and cost savings need to be considered?

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Out of pocket costs with my prescription plan, if I use mail order are capped at $75 / 90 day supply. Even if I precisely used my quantity in exactly 90 days, the max expense would be $75 + 75 for tresiba and novolog + about $25 copay for needles = 175. X 4 for the year = $700 out of pocket / year for tresiba, novolog and pen needles. Of course in reality my prescribed 90 day supplies could probably easily last 120+ days, so we’d really be talking $525 / year out of pocket, or less. Granted, that’s very good coverage which not everybody has.

I have no idea what secret prices my insurance benefits manager has actually negotiated with manufacturers and distributors (nobody else seems to either really) but I’m confident that they aren’t paying anywhere near retail costs for my insulins and supplies.

I buy my own strips outside of insurance coverage. $45/300. My usage varies, but even at 10 / day that’s $45 / month or 540/ year

Are you citing 3,000-4,000 as your actual out of pocket expenses for your pump supplies and novolog?