I’d avoid making any minor adjustments to your dose until the 4th or 5th day.
If you clearly need an adjustment because you’re very noticeably trending down, then that’s something different altogether. I wouldn’t bump up the dose without having at least a couple of days insulin though.
When I switched from Lantus to Tresiba, I upped my dose too early and dealt with bad lows the next day. I ended up actually needing to decrease my dose by 2 units. It truly takes at least 3 days for the insulin to be at it’s full effect. For me, it’s actually closer to 5 days.
Are you using your pump to subsidize your Tresiba dose?
It can be if you have access to the distributor well, but it’s out of pocket.
Agreed. Unless you have a flat basal requirement, a pump is better.
But people need to quit applying pump principals to Afrezza. Two different monsters. My control with Tresiba and Afrezza is more than 2 percentage points over when I wore a pump - and I’m Italian!
And many people have worse results, but that’s not my point. Tresiba is a basal insulin, even if it works 100% perfectly it doesn’t solve the bolus problem. It doesn’t allow you to microdose, extend boluses, bolus without anyone seeing, or have a computer that keeps track of boluses and active insulin. I’m not saying there aren’t ways to mimic this on MDI (though not as well in my experience) or that these options are important to everyone, but they make life easier for many people and are the reason myself and others prefer a pump no matter how good Tresiba or any other injectible basal insulin is. Even when I was trying MDI I was tempted to reconnect my pump for bolusing due to how much more difficult I found bolusing with a pen was in many situations.
I haven’t used the pump to subsidize as I was afraid I’d drop too low. Hoping that I’m a little more level in the morning instead of going down. I had to take a correction bolus though early this afternoon as I was running a little on the higher side and seem to still be. I am hoping that by day three the Tresiba will be in full effect. Mid morning was very nice and steady and afternoon until night has been kinda high.
I agree. But in my experience, I don’t have to worry about insulin on board with Afrezza, I find I can enter my bolus quickly enough since I log what I eat anyway.
No extended bolus needed (for me)., Though not “in my pocket” discrete, I was never comfortable with bolusing without looking, and the complaints I hear about the newer pumps is that blind bolus is now very difficult to do.
It just depends on what you like and are comfortable with. (So I think we agree)
Okay day 2 UPDATE: Woke up trending down again this morning around 5:30 am. And when I say trending “down,” I set my dexcom to 90 for now to keep a close eye on things. So obviously “90” in and of itself is awesome, but 90 with a down arrow when it’s my day off and I’m not immediately getting up to eat is becoming annoying. I popped two glucose tabs and went back to sleep until around 8am where I woke up with 87 and a trending down arrow. (This was fine because I woke up and ate breakfast, but sometimes I don’t eat breakfast right away, etc and I thought having a “peakless” insulin should allow me to do the same?)
Side note- as I think I mentioned earlier a similar trend has been going on with my pump before the switch. I’ve been needed a LOT of extra insulin after dinner up until around 12am, and then I begin my slow descent down to low 80’s even when I don’t want to wake up yet. I had been making minor adjustment to my basal rates and dinner I:C ratio as it was when I decided I needed a break. Last night I ate dinner, two hours post dinner was high at 196, took a correction, two hours later was NOT budging at 224, took another correction around 11 (but not a full correction because was worried about the low) and woke up from my Dexcom alarming at 5:30.
So basically I obviously need to play with my I:C ratio for dinner and correction factor, but any suggestions on how to avoid a morning drop with Tresiba while simultaneously avoiding being high the rest of the day???
Fix one thing at a time or you will be chasing it forever.
I would do some basal testing and get your ball at properly. Since even seems to start the issues, I would test basal there first by fasting over the evening.
Oh - don’t supplement basal with the pump anymore. At this point, it will only interfere.
The highs in the evening may be resolved once you’ve layered multiple day’s doses. It is not surprising that you’re seeing highs on just the first(?) day of Tresiba. In fact, it would indicate that your dose was way too high if you didn’t have any highs on the first day.
I posted a chart above that shows how the first few days on Tresiba are not at all representative of what you’ll experience once you’re at the full dose.
The lows in the morning (after 2 doses) may indicate that you’re actually taking too much Tresiba. I can tell you what I would do, but please recognize that I can’t really see the full picture in the way you can.
If it were me, I would decrease tonight’s dose by 1 or 2 units. I wouldn’t make changes to my Tresiba dose for any high blood sugars until after 3 days. I’d just correct as needed until at least 3 full days have passed.
Thanks @katers87! I’ll try to decrease tonight’s dose and see how that goes. I know some people split theres or take it in the morning so I suppose that is something I can eventually consider as well, it’s just that the evening really does work best for me. I really appreciate everyone’s input and help!
@Scott_Eric - Do I recall that you are on the Medtronic 630G? And in Canada?
So just as FYI, the Tandem should be expected in Canada soon and does have a very nice “stealth” bolus feature. It is designed to be executed entirely without needing to pull the pump out of pocket or visually look at it. Entirely by touch and feel.
We do not use this feature but it seems quite nifty. For many situations, I imagine it could be extremely useful. It is designed to be configured in advance to bolus in a method that best suits your needs.
Anyway - just as an FYI if you are considering evaluating all your choices for your next pump selection.
I’m using the Paradigm Veo (equivalent to the 530G in the USA I think) which is why I can bolus without looking. I will definitely consider Tandem, not rushing into anything right now and I use Dexcom which is a reason not to get sucked into the Medtronic ecosystem!
Oh, absolutely. I think most people can achieve excellent control on either MDI or a pump and both systems have their issues. I wasn’t trying to get into a pump vs MDI debate, was just pointing out that Tresiba is a basal insulin only. It can’t render pumps obsolete on its own, because pumps have both basal and bolus features.
I wouldn’t wait 3 days if you’re trending down. My DD (16) switched from Levemir and she is taking a bit more than half of her Lev dose in tresiba. She takes it at night and we see a bit of a peak about 9 hours after injection. She also splits her dose into three injection spots 10/10/10 at the same time and we find it absorbs far more evenly. Overall we love tresiba. We pay for it out of pocket here in Canada, but we’ll worth it to us.
This is the number one reason I went back to the pump after trying Tresiba for a month. I just couldn’t find a basal dose that was even close to consistent at keeping my BG level. Since switching back to the pump, I’ve REALLY appreciated the ability to modify my basal rates by 0.2 u/hr or 0.4 u/hr (5-10 units total) essentially instantaneously. I have much, much better control this way. (I also have female hormones, which I think is what drives most of this craziness.)
I also very much appreciate the ability to bolus discreetly, since I tend to bolus 8-10x a day to keep my BG in a tight range, which was much harder to do with MDI. I use the touch/audio bolus feature for 90% or more of my boluses and love it (I passed up trying the OmniPod because it didn’t have this feature, and that’s a deal-breaker for me).
This was also a problem for me on Tresiba, one that I never quite solved (though that doesn’t mean you won’t!). I could not find a dose that kept me from dropping overnight that didn’t result in massive highs throughout the day. I found splitting my shot into a morning and evening dose helped, but ultimately after about 30 days I gave up and returned to the pump.
I hope you keep updating this thread. I’d be very interested in your progress.
What does this mean, exactly? I think trying to get Afrezza from the US would be extremely expensive (paying for both a doctor’s appointment and the medication out of pocket) and somewhat risky (no travel insurance and bringing a non-Health Canada approved medication across the boarder). I mean, maybe it could be done, but it’s not exactly affordable or practical.
Just wanted to throw my $0.02 out there…I’ve been using Tresiba for over a year. I recently switched my MDI bolus insulin from Humalog to Fiasp and really like the combo of Fiasp with Tresiba basal so far. I like the basal response form Tresiba which becomes very predictable (for me) once the basal dose is dialed in properly.
One of the things that is possible with Fiasp (because of the fast action time) is multiple bolusses throughout the day with no pre-bolus time and less worry about bolus stacking. I imagine this is similar to the dosing achieved with a pump. I’ve never pumped so have no basis for comparison, though.
Pump and MDI boluses are about the same, with the exception that pump boluses can be “extended” so that the insulin is delivered over a long period of time (though I’ve never used this feature much). The big “difference” being discussed in this thread is that those of us on pumps who use the touch/audio bolus option (which allows you to deliver boluses without looking at the screen by using a series of beeps or vibrations to confirm dose and delivery) can program a bolus by just sticking our hand in our pocket and pressing a button. It takes all of 10 seconds and is very discreet.
Fiasp, in my opinion, is great whether in a pump or with MDI. I’ve been using Fiasp for almost a year now and wouldn’t go back to any other insulin. But, for me, it didn’t solve the issues I was having trying to hone in on a correct basal dose nor adjust rapidly for monthly hormones.
I agree with you @Jen. My basal is not flat with Tresiba. I do run at a higher dose to eliminate the 3am and 2pm rise I get, but I do have to correct any drops with carbs. I just time my meals to fall into those drop ranges.
If I lower my dose 2u, I end up with highs at night and in the afternoon. And the difference isn’t the 60mg/dl I get in a drop at the higher dose. It will climb, and climb, and climb.
Unfortunately, I can’t return to the pump due to infections and lack of real estate for the infusion sets.
It means, it can be had. I know people in Canada and the UK are getting it and paying out of pocket. One guy in the UK that I know has it prescribed by his normal doctor so no cost to him.
I don’t know the specifics of how it is done, nor do I care to. Plausible deniability
Yes, it is expensive, depending on how much you need (roughly $300-500 USD per box). But I paid for it out of my pocket before my insurance started covering it. There are ways to reduce the price somewhat. It was worth it to me. Many do.
Pump boluses absorbed much slower for me and were often inconsistent. I have a lot more consistency in how quickly I can expect the insulin to work with MDI boluses.
