Pump to Tresiba - So far very tough

Everyone I am new to the forum, great information, so I thought I would post my current activity, looking for feedback.

I have been type 1 for 42 yrs, currently 47, extremely active, have been on a pump the last 20 years. Time for a change, started Tresiba Weds of last week so I have taken 5 shots prior to me writing this. I have increased my dosage by 2 units thus far, doing the every 3 days prior to making the next change.

Yesterday was the best day so far, until approx. 6PM, seemed the basil had run its course. However yesterday was the first day that when I took a bolus of Humalog that it actually worked. However today I am right back to the 300’s with very little carbs. Wanted to find out if others had experienced this, I know I am in the adjustment phase, but wow, doesn’t seem that my bolus’s are even working, body is absorbing. I am assuming because I need a higher does of basil, which I am working on, but want to ensure I go through the break-in period, but this is really rough!!! All I do is bolus all day, bad thing is today the bolus’s don’t seem to work, yesterday they did. Tonight is my last night at this dose, then I will increase prob by 2 again tomorrow night.

Again looking for feedback if you had experienced something similar, again coming off a pump, not from another long lasting insulin. I am getting to the point that I might not continue to move forward if I don’t see a change, again high all day, dropping weight etc. Again looking for input.

Thanks everyone!!

It might take a while to get your requirements figured out. If you don’t mind sharing what your basal profile looked like on your pump, it might make it easier to translate from one to the other

If you are taking it once-per-day, it did not run out. It might be that your basal needs are varied at different times of the day. Certainly your activity level will cause your basal needs to be varied. Tresiba can be tough for people with varied needs and varied activity. As an example, on some days I cut my normal basal by 40% because activity (which is something I can’t do with Tresiba).

Was there a reason you went to Tresiba? Does your Endo know you are extremely active?

If you don’t mind, share your basal numbers with the pump. Were they always the same every day?

Welcome to the TuDiabetes forum, @Jd111. I made a switch from pump therapy to Tresiba + Apidra last year. I only did it for four months but I did get to reasonably good results. I have a few questions for you. How did you arrive at your starting dose of Tresiba? Did you consider how much basal insulin your pump delivered? Are you dosing once per day?

I think your discipline of only doing basal dose changes after three days have elapsed since the last change is a good. Are you keeping a log of your doses and fingerstick BG readings? Adding some food and exercise notes might help you draw good conclusions.

Where do you inject your Tresiba and Humalog doses? Are you using the same sites that you used for 20 years of pumping? You may be getting some inconsistent insulin absorption due to scarring.

When you take Humalog for meals, how much time do you allow to elapse between insulin injection and first bite? Pre-bolus time has a large influence on after meal BGs.

When was the last time you changed your insulin sensitivity factor (ISF, the amount your blood glucose number will drop for one unit of insulin)? This number may have changed. Many of us use different ISF ratios for different times of day. I am more insulin resistant in the morning and it takes more insulin to bring down a morning high than it does for the same high number later in the day.

Good luck with you MDI/Tresiba experiment!

I hope you can work this out, because I tried a pump vacation with Lantus and I gave up. Once a day was not going to be enough for me, and I was looking at having to inject Lantus in the morning and at bedtime because it did run out. I guess they say Tresiba is better than Lantus? I had the exact same issues you are having but I didn’t persevere through very many days. And they wouldn’t give me a 1/2 unit pen, and I use low doses of insulin. Again, I hope you work it out. I thought I would love being detached, but I got too frustrated and found out my new HMO would buy me a new pump 100 percent paid so I went that route.

I tried with Levemir once and realized how foolish I was being within a day. I would love to take a diabetes vacation, but short of a cure that isn’t going to happen. I still think the pump is the greatest tool for living as close to a normal life as possible until a cure or some kind of magic smart insulin comes along. Plus it’s nice to have the time always close by!


Have you thought what you may be forced to do, by circumstances beyond your control, if your pump were not an option?

Everyone - thanks for your input - additional information:
Basil rates on pump were 1.150 per/hrl, no variance - have never really had a dawn issue. Prior to me turning off the pump I used the Humalog pen for my bolus’s, which was awesome, always, I mean always absorbed what I took, which is a major factor into switching over.

Today prior to lunch I finally fell below a 200, but right back to 255 after lunch, just took another bolus. Re insulin sensitivity, the ratio I am using now I really can’t speak to, yesterday it dropped me perfectly, today not so much. Again I feel I need to tighten up the basil aspects first, circle back/close in on the bolus. I will know when it happens, I feel once I get a few good days of bolus response I will be in much better shape. Re dosage, I didn’t want to share, remember don’t go off me, each person needs to find their own pattern, but I am 178lbs and taking 18 units Tresiba at 9:45PM once daily, then Humalog for bolus’s.

Again I am hoping as I build up the Tresiba, was reading it could take up to 8 days, that I will begin to flatten out more. This thread was started to hopefully hear I might be right about that, if you had a similar experience.

Hope this additional info is helpful, again like the comments!!

So your 1.15 units per hour for your pump basal comes out to 27.6 units for a total daily basal dose. I realize that considering the pump total daily basal insulin is just a starting approximation but your early BG experience since starting Tresiba indicates insufficient insulin. I suspect you will start to see better control when your Tresiba dose approaches 27-28 units/day.

Do you know what the rationale was behind starting out with such a low Tresiba dose?

I believe for safety actually - we all know that everyone is impacted differently, I feel a bump of 2 units might be in order. But yesterday/today are now throwing me off, very inconsistent. Again I agree feel that it is because I started so low. Will keep you posted.

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Yes–sounds a bit like the inverse of what I went through when changing from MDI to a pump 4 years ago, but basically for the same reason. They hate for you to go low, so they start out very conservatively and bump you up in cautious increments. With the MDI->pump transition you end up taking considerably less per day for basal than whatever your basal-insulin (in my case Lantus) dose was but it still took me a lot longer than I anticipated to get back to a level of control I was happy with. I did finally take it upon myself to start re-jiggering my settings myself, at which point I did finally start getting it dialed in to where my BG’s looked like they had pre-pumping.

Nope, you’re right I’m very fortunate that cost has never been a barrier, and if anything that’s why I find it surprising to see people wanting to go off the pump for reasons other than cost.

Costs hasn’t been a barrier for me either, but having been on it for 20 years, I need a little more real-estate at this point. In fact just received a new pump 3 weeks ago!! At any rate glad to hear your pumping is going well.

Fair enough, maybe I’ll be saying the same thing when I get to 20 years if a cure hasn’t come along by then!

I’m glad I did a little trial. Stashed some stuff and have prescriptions if I need them, and if I had to lose my pump I think I would be ok…maybe.

Thought I would share a quick update, hopefully this information will be helpful for someone else.

I am on my second day at this unit of basil, finally got my numbers to come down during the night, and skipped breakfast this morning. Side note: something I have noticed coming off the pump is that Novolog brings me down fast, Dexcom falling alerts etc, but then all of a sudden evens out. Also, since I have switched to Tresiba/Novolog, I notice just a little food goes a long way. So with that said, my sugars came down this morning after a nice bolus, I let it ride out and came to a 125. So again I skipped breakfast and at 10:30AM EST went back to a 175. Have taken a bolus of 2 units and so far I am coming down, slowly, exactly what I want.

So with all of that said, few takeaways:

  1. Find a point that you are in a normal range and being your fasting like I am doing, only until lunch. If you get into range at lunch then try to ride it out to dinner, no food etc.
  2. If needed take a bolus, as I said my bs has begun rising on its own, this allows me to see that I will need to up my basil one unit this evening, I have already been on my current dose 2 days, should be 3 but I know I at least can do 1 unit without damage.
  3. In my case I have updated my correction bolus, I honestly should have taken 3 units for the 175, but I only took 2, again being conservative, will allow me to make additional adjustments in the coming days.
  4. I have always said, do not go to extremes when treating diabetes, and I didn’t follow that rule over the last several days. What I mean by that is this morning I had double arrows pointing down on my Dexcom, yesterday I would have eaten something, which would have then put me back the other way. Today I rode it out, and it evened out, this has allowed me to take my next step in keeping a rather controlled, normal reading. Plus I was able to see my correction bolus seemed to be spot on. Now I can focus on additional details around that bolus. I know I will be increasing my basil by at least 1 unit, that will impact how I bolus, but I at least now have a baseline that worked.
  5. I saw someone else talk about taking a bolus and it not reacting, again switching from a pump. Again the key is to get into a normal range, and then begin taking minor adjustments which include basil/bolus and food intake. Throughout this process I have seen: I need more of a bolus to correct food and when I do eat it hits me hard. I know this will even out as I slowly bring my underlying basil up, again going back to this morning, I saw it rise from a 123 to a 175, very slowly, but it did rise.

Again thought I would share, more to come, hopefully I will continue to even out, will keep you posted. Thanks again for the feedback!!

My daughter is T1D for 13 years now, has been pumping for 10 years and wears a Dexcom-she is 16 years old. We went to the Endo yesterday A1C of 7.5-typical range for her. We had been discussing a pump break. Her sites have been failing leading to highs and she wants to be unattached for a little while. I had researched Tresiba and heard a lot of great stories. Our Dr. agreed and put us on 12 units-her daily Novolog on the pump is 15. We did the shot at 10am yesterday and took off the pump (big mistake!) She ran high 300s with constant Novolog corrections-lots of IOB stacking. Finally at 11pm I put her pump on her with normal settings because she was so tired and it didn’t seem like she had any insulin working. Finally at about 6 am she bottomed out at 60. She had a juice and went to 115 and slowly started to rise. We did 13 units of Tresiba at 8:30am and she’s run 300s WITH her normal pump on. What is going on? I am just so confuse it’s like neither the pump, the boluses or the Tresiba is working now. How is this even possible? No ketones so she has insulin in her system-its not her cycle week that completed last week and she feels crappy from highs and lows though. But I’m on the verge of sitting on the floor and just crying. Thoughts?

My understanding is injectable basal insulins typically require a much larger dose than the equivalent of daily basal on a pump. They also take a while to kick in, so it’s possible her blood sugar started rising before any Tresiba started working and stayed high since the dosage wasn’t enough. Her liver probably started dumping its glycogen stores due to not enough basal, making corrections very difficult and she probably went insulin resistant running such high blood sugars making the whole situation even more complicated. Consult her doctor before making changes - obviously don’t do something based on what I or others say on the internet - but I’ve heard injectable basals can require 2x or more the total amount the pump would give a person for basal over a day. I’ve also read people on here saying Tresiba takes time to properly kick in (days or weeks) and work consistently, and there are people who need to take basal insulins 2x/day even though they only tell you to take them once per day. Talk to her doctor right away and don’t despair! Hope it works out for you/her!

I am starting to think she should be on a higher amount off of pump too versus the 20% less. I did increase to the full amount 15 units novolog basal so 15 units tresiba this morning. Pump is running at 33% capacity and she is under 250-170s today with pump corrections for highs and meals. Guess we will see how this night goes! I am feeling much more positive today…Thank you- Our doctor just lets us muddle through these decisions and dosages. I asked if she wanted to hear from us or come in sooner and she didn’t. I like the control UNTIL I feel like we are out of control and it seems like I am at a loss as what I should do! I REALLY appreciate these type of boards to compare others experiences!

Are you using any kind of app or program to keep track of your doses, insulin on board etc.?

Jess51 - saw your post this morning, current update on switch is below, hopefully one point might be helpful.

  1. I am now 12 days in, since my switch/first dosage of Tresiba, I have noticed that a build up is necessary, in fact Tresiba mentions it takes approx. 8 days before the insulin becomes stable.
  2. In talking with my doctor I should make changes every 3 days so, last Thursday I took 20 units, also on Fri and Sat as well, still noticed I need more so last night I went to 21. I probably should have taken 22, but I was doing much better over the weekend so I didn’t want to go too far the other way, so again conservative.
  3. I have now noticed my bolus’s kicking in, which started after approx. 5 days on Tresiba, after a little buildup. During this time I had also increased my dosage, so now when I do go high, I am able to get my BS back to normal.
  4. A small amount of food hits me hard, in other words as an example 40 carbs when I was on my pump does not impact me as much as it does now when I eat 40 carbs without my pump, I need to really watch the impact. I have also noticed workouts don’t drop me as hard, but again I feel this goes back to I need more basil, just haven’t gotten to my needed amount at this point.
  5. I was taking my Tresiba shot at 9:45PM, however I was having highs starting at 6, noticed yesterday at 4, so I now take my shot at 7, this has helped me become more stable heading into bed. I know what you are thinking, Tresiba is 42 hrs long, I get that as well, but I have noticed, things seem to kick in approx. 2 hrs after I take the shot. Honestly I think this goes back to me needing more basil, time will tell but just an observation.

My next steps are to continue to increase my basil to get to a steady state when not eating, I have done this during the morning hours and afternoon, but noticed I still need adjustments. I have also noticed on my Dexcom, at any range, 240 or 112, my BS stays steady and slowly, I mean slowly rises. So I feel I now need to also focus on my bolus units, again an adjustment on both sides, both long and short acting. I am noticing I need more of a bolus, but again hard to tell since my basil isn’t in place.

With starting with such a low basil, it has been tough, but it’s better to be able to be in control (taking bolus) instead of taking one shot and being too low, just my opinion. My overall basil for a 24 hr period was 27, I have not reached that yet with Tresiba, but again, I feel that might be too much, only time will tell as I continually adjust.

Again keep experimenting, but don’t make a huge change at one time, pick a dose, keep it in place for a few days then make the next adjustment, this will NOT be an overnight/week long journey, might take a couple/few weeks or more.

I will keep you posted/include some hints I find along the way as I continue to move forward. Again hope at least one of my comments is helpful!!


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