Pump Vacation/Tresiba

Hi everyone! I’ve been pumping for 15 years, was on Medtronic for most of them and recently switched about 2 years ago to the TSlim. The tslim is great in terms of aesthetics and I love it’s ability to communicate with my beloved Dexcom. HOWEVER, lately I’ve been having MANY pump related issues- whether it’s a bad site or something else (I SWEAR sometimes despite removing the air from the cartridge some is still slipping in leaving me with high BGs) ANYWAY, I’ve decided to take a small vacation from the pump for the first time in literally 15 years. Needless to say, I am scared. A few questions for my friends out there using Tresiba/those who have switching from pumping back to MDI:

  1. What time are you taking your Tresiba? My endo said to take it at night time, but I see lots of variations. She also dosed me based off of my daily basal dose which I suppose is a good place to start.

  2. Um, so I just inject at bedtime (or whichever time I choose) and take my pump off? How does this transition work?

  3. Has anyone experienced weight gain with Tresiba? I’ve read that some posters have and this girl CANNOT afford to gain any more weight. The struggle is pretty real as it is.

  4. Lastly, I noticed in the side effect pamphlet not to drink alcohol with Tresiba? I’m not a heavy drinker by any means but do enjoy a glass of wine every now and then, and didn’t think that was a thing at all until I (diligently) took the time to read the pamphlet LOL.

Any advice would be much appreciated! Kinda (very) nervous to make the switch


Just for the record (and you can google this) some of us have had issues with Tandem pumps and needed to get a refund. Documented cases have often resulted in some of us being given our money back. The issue was increasing BG around day two to day three. Endless site changes resulted in no difference. My BG would climb to 500 on day three of a site or sooner. Think it has to do with the bladder system built into the pump and it may happen to people who are on small basal daily doses. So just in case this applies to you… and you can find bloggers and writers out there who had this happen. My refund came after the 30 day trial period but that was because I had so much documentation in my file. Scar tissue is of course another possibility but that could be investigated by changing site locations to new areas.

I’ve seen some people say this as well. Unfortunately I’m two years in and don’t think they’d refund me at this point. Up until recently I thought I was doing something wrong! I love pumping and the freedom it gives me but I think I just need a break. Just nervous because it’s been so long.

I tried it with Lantus but it was a failure. I heard Tresiba is very good, but it was not on my plan. Also if you can secure a meter with bolus advice it really helps (unless you like calculating). I wanted it to work, and I hope it works out for you!

Switching from a pump to Tresiba requires a totally different perception of basal insulin. Tresiba’s doses last for a very long time, so essentially you’re layering multiple day’s insulin doses. Below is a cool, conceptual chart I saw on another forum that illustrates this layering methodology well.


It will take a few days before you’re at the full dose, so I would plan on bolusing regularly the first few days so you don’t run high. Also, when you’re refining your dose, don’t change it often. I usually make a change and then see how it looks 5-6 days later. That’s when the new dose will be clearly visible. You may have to increase or decrease at the beginning if your dose is far off, but once you’re down to +/- 1 or 2 units, you really want to take your time to refine the dose.

Also, the first month on Tresiba I could do just 1 AM shot per day. After a couple months though, I started seeing the dawn phenomenon, and I split my dose into two injections (AM & PM). This helped a lot. I would choose the injection time based on what’s most convenient for you; however, it might be worth asking your doctor why she recommended an evening dose.

When my endo switched me to Tresiba, she gave me all sorts of terrible advice. I’d ask lots of questions and do your own research. Sometimes endos are awesome, and sometimes they’re only good for prescriptions.

I drink wine and other forms of alcohol with Tresiba. I think most insulin comes with some precautions regarding alcohol- for good reason. It can be easier to drink on a pump because you can lower your basal rate. That’s not going to work with Tresiba, so you may need to eat more when you drink to make sure you don’t drop low. I don’t think 1-2 glasses of wine should have much of an impact though.

I have gained a small amount of weight over the winter, but I wouldn’t attribute that to Tresiba. I haven’t been working out as often. No significant weight gain though.

Happy to answer any questions you have :slight_smile: Your experiences may be different though!


This is all great information! Thank you so much! I really appreciate you sharing your experience. Because I work long hours (I’m a nurse, I work 7a-7pm) I think evening dosing is best for me (for now). This way I know I’ll be able to take it at relatively the same time everyday. When you started your Tresiba and came off the pump, did you leave on a small basal rate on the pump for a short time? Or did you completely disconnect once you gave the first Tresiba injection?

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Thank you! And same! I’ve downloaded a few different apps and am hoping one of them assists me with the calculations. Haven’t had to manually calculate in forever!

I think you’ll really like tresiba. I’d love it if you’d keep updating this thread as you go along. I wouldn’t be surprised at all if your pump never sees daylight again…

A lot of people out there are very uncertain about the benefits of latest generation long acting insulins, and feel very attached and dependent on their pumps—- in my opinion people in your position, switching from one to the other, whether temporarily or permanently, have a tremendous value to add to the diabetes discussion. Good luck! I think you’ll like it!


I switched to Tresiba + Apidra pen doses after using a pump exclusively for 29 years. I spent five months on the protocol before switching back to a pump to use an automated insulin dosing system, Loop.

Overall, I give that regimen very high marks. I believe due to the long duration of a single dose at up to 42 hours, I couldn’t discern that the time of day for dosing made much difference to me. I remember a few nights forgetting to take my dose and I just did it the next morning and I saw no effect in my CGM line.

I started a Tresiba daily dose size at just under what the pump’s average basal was for 7 days. I did need to increment slowly so I could get good waking numbers without driving me low in the late afternoon. I only dosed once per day but I tried it before bedtime, upon rising and mid-day. I didn’t see much change overall across varied dosing times.

I would definitely go back to that Tresiba-based MDI system if I needed to. I like @katers87’s analysis and suggestions. Good luck!


Happy to help :smile: I hope you like Tresiba! It’s worked very well for me.

I originally switched off the pump to Lantus, so I didn’t have quite the same problem. I switched from Lantus to Tresiba a few months ago. I like Tresiba a lot more than Lantus.

When I switched from Lantus to Tresiba, I did have a little Lantus on board the first day because I was using the split dose method on Lantus too (so I basically had 1/2 my Lantus dose for the first 10 hours). I could see how a small, reduced basal rate for the first day would be helpful. I personally wouldn’t keep it for the second day because you may end up dropping low, and it seems like a lot of variables to track.

When I made the switch from pump to Tresiba, I cut my basal 30% on the first day I took Tresiba, then 60% on day 2, then took the pump off completely on day 3. That was 2 years ago and I wouldn’t go back to a pump at this point. (I use Tresiba with Afrezza)

I would make the switch on a day you work, with day 2 and 3 on your of days so you can monitor your bg closer.

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Well until there is an insulin that can replicate the bolus advantages of pumping which MDI still cannot, many are still going to be attached and dependent on pumps.

Afrezza. It actually works faster than a pump bolus, on the principal of MDI, without the pricks.

I think there are advantages and disadvantages to both, and it’s a very personal decision.

I actually think the biggest advantage of the pump is that you can have can have varying basal rates. This will likely be more important for some people than for others. Also, the recent looping technology that enables the pump to suspend when you drop low is pretty cool. I’m not that interested in most of the other closed loop functions though.

As far as bolusing goes, there are some bolusing disadvantages to a pump. I’ve found injections absorb much faster than my pump insertion sites did. I can see why a dual wave bolus or other similar function could be helpful, but I think Afrezza is way more helpful than those. I suppose you could use a pump and Afrezza if you wanted though.

For me, the requirement of being attached to something all the time outweighs any benefits a pump might have, but that may be because my basal needs don’t vary significantly.

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It’s not available outside the United States so not something I considered. Either way, it’s not a complete solution as it’s not discrete and doesn’t replicate extended boluses. What I hated most about MDI was that I couldn’t eat a high fat/slow digesting meal late at night since it would require multiple injections hours later. Also couldn’t bolus around other people without them seeing, like I can do on my pump without even pulling it out of my pocket.

I did that with an Omnipod for a few months to get basal adjustability. But I threw a lot on insulin away and I still had site infections and absorption issues.

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I don’t think it’s as good though because it still requires a lot of intervention after eating. You can’t just eat, set an extended bolus and go to sleep or do something else for example. Late night pizza or pasta is impossible!

Well, to be fair, pizza is difficult to deal with most of the time (pump or MDI). I don’t eat a lot of pasta either, but I’d probably consider that a high glycemic index food (fast digesting) unless you’re piling on a bunch of meat and cheese.

I could see how late night high fat/protein meals are more challenging on MDI though. I suppose that comes back to why using a pump or MDI is a personal choice. Depends a lot on your lifestyle. I wonder if R would actually work well for this circumstance though… I can’t believe I’m saying that! haha

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Pasta is worse than pizza for me, I find it keeps digesting for ~12 hours!! You’re right it’s definitely personal choice though. I wasn’t trying to say a pump is superior, my point really was that people who wax evangelical about Tresiba and think of it as a pump replacement have to remember that there are bolus benefits to pumping too, which to be honest are more important to me personally (and I’m sure others) than the basal benefits.

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Yes I definitely see the advantages of pumping I mean, I’m only on day one of being back on MDI and it’s not that I MIND it at all, it’s just that the pump allows for more freedom, changing of basal rates when needed, adding a little extra insulin as you go or cutting back, etc. I like the freedom of the pump but truly just needed a break between the sites not working and unexplainable highs. I also feel like absorption is much faster when I inject. However, if I’m going to stick to this for a while I’m definitely going to need a pen that can dose in half increments!

I took the Tresiba last night and found myself trending down early this morning. I wasn’t LOW, but I was heading there (albeit slowly) if I didn’t wake up and eat. I took the injection around 9pm, and that slow drop started around 3am. However, it should be stated that I’ve been trending down at that time, even on the pump, and had been trying to adjust my basal rates accordingly. I’m running a little higher right now but I’ll give it some time and see where it goes. I’d prefer not to decrease my dose just yet as I’m running higher at this time of day, but at the same time I’d kinda like to avoid that waking up at 5:30am drop on my day off. I know it will take a little patience and time to adjust. It would be awesome for SOMETHING to just work out for once with this diabetes!

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