Pumping Untethered with Tresiba

I believe the “untethered regimen” as it was originally proposed was exactly as you did: cutting back the basal by, say, 50% of 75% and making it up with a long-acting insulin.

I’ve been thinking for a while of trying the untethered regimen with Lantus, but haven’t tried it yet. I have an endocrinology appointment in the next few weeks, so am thinking of trying it after that. I think if I did it, I’d do 75% of my “lower” basal rate periods as Lantus, and that would diminish to about 40% during my “higher” basal rate periods (my basal rates vary by about 35% due to hormones, not counting any effect of activity on top of that, which I do as temporary rates).

Good luck trying the untethered regimen with your daughter, @rgcainmd! I’d be interested in hearing how it goes for both of you!

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I have found that tresiba stabilizes everything so much that it also changes how much bolus is needed, ie. less is needed.
Onwards with the Great Experiment!

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After pumping for years I was experiencing lots of site issues. So two weeks ago I decided to go old school and took off my pump and went with Lantus and Novolog MDI. Wow. So much less stressful when I’m not playing the “when will this site go to hell?” game. Now, my question… My fasting and pre-meal glucose numbers are golden on two doses of Lantus, equal and split 12 hours apart. Other than cutting out one injection a day I’m thinking Tresiba wouldn’t buy me much. Or is there more to it?

Neither I nor my daughter personally use Tresiba (but that may be about to change in the very near future). However, I am hearing quite a little bit about people like you who have good control experiencing fewer lows that do not come at the expense of more highs.

I used Tresiba for about 4 months this year, three months as the basal part of a multiple daily injection program, and about a month combined with my pump as an “untethered regimen.” While I am a firm believer in the “if it ain’t broke, don’t fix it” philosophy, I think Tresiba could maintain your already good control with added flexibility. Tresiba, unlike Lantus, does not require dosing the same amount at the same time everyday.

I actually missed my evening dose of Tresiba one day and just took it when I woke up. My blood sugar didn’t seem to care. I then took my usual evening dose of Tresiba that night without any disruption to my blood glucose line. (I use a CGM to monitor my blood sugar.) The package insert states that the only requirement for Tresiba dosing is that doses be given at least 8 hours apart. I found the time flexibility of dosing Tresiba a nice quality of life issue.

The worst that could happen if you tried Tresiba is that you don’t like how it works for you and you revert back to your Lantus treatment. The best that could happen is that you really like it and that you then have two great alternatives to choose between.

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Good info and advice, Terry. Thanks. I have about four weeks until my next endo appointment where I’ll show her what I’ve done with MDI and Lantus. In the past she’s been easy as long as I can prove I’m on top of my numbers.

Rose, have you started the Tresiba experiment yet?

No. My daughter is being especially difficult (read a living nightmare) lately. In her eyes, everything I say or do clearly serves to prove that I am dumber than a bag full of cat poop. Adolescence: you gotta love it! :wink::skull_and_crossbones:

My college freshman son systematically opposes everything I say on principle. And his 12-yr-old T1D brother is now starting to channel him.

Although I will say that, when I damaged my leg felling a tree the other day, my older son was strangely solicitous. I am not sure if it is filial love coming back, or, more likely, interest for the cold cash I may or may not leave him. Of course, after I am done paying up for his 4 years of college education nothing will be left:-)

Well, good luck to the both of us then! I just may serve myself a very small shot glass of 10-yr-old Graham’s Tawny in your honor.

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Hang in there. I was a “good” adolescent by societal standards (i.e. I didn’t get knocked up or wind up in jail), but my mom will still dish to anyone who will listen about how awful the teen years are, and how awful I was. I think it’s just a really rough period for most parents – and adolescents themselves. Thankfully most of us grow out of it by the time we’re 50, or so I hear :slight_smile:


I have to say that I am 100% with your daughter on this. TBH, I also cannot see any advantage whatsoever of using an untethered regime in terms of control. Being able to dial up or dial down your basal on-the-fly HAS to give you better control than being stuck on the Lantus/Tresiba express with no possibility of getting off before the station 10 hours down the line!. Plus it’s more unnecessary injections. (About the only reason I could think of for going untethered would be in special situations, e.g. scuba diving, or for someone who NEVER tests and might be at risk of DKA if basal delivery is compromised - neither of which would seem to apply to your daughter).

I terms of the W or M traces on the CGM, maybe you have to accept “good enough” rather than “perfect” control. She’s a teenager, so if her A1c’s are anywhere near “range” that’s probably the best you can aim for. The risks of long-term complications aren’t that much higher and in any event in 10 years time she will be using some sort of plug-it-in-and-forget-t AP system.

Personally I would rather amputate my own leg without anaesthetic using a rusty saw than go back to injected long acting basal insulin.



Joel have you tried tresiba? If you have your experiences with it must have been very different than mine. I agree with you though I see no sense whatsoever in subjecting
oneself to the worst of both worlds and I really don’t grasp the perceived benefit of “untethered”

What’d you find out about tresiba @David_dns?

If you go swimming, or for kids that participate in sports, being able to detach and not lose all their basal is the point.

OR if you have a kid like mine who dislodges his pump site at least once every few weeks, but is at daycare with 40 other kids, it’s a little bit of insurance that they won’t spiral towards DKA in 3 hours. Also, our kid hates injections, but I could imagine a scenario where, for instance, I give him a basal shot at night when he’s asleep (usually he doesn’t wake up from this), but leave him connected to the pump for meals/corrections throughout the day so he doesn’t have to be pricked a gazillion times.

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I can’t imagine wearing an infusion set 24/7 caused less discomfort than a 4mm 32g needle a few times a day… but sometimes fears aren’t rational especially to little kids. I persobally have no interest at all in ever pumping, since I discovered tresiba

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@Sam19, yeah I know. It seems irrational to me too, but then he’s a toddler – irrational is basically the working definition of toddler :slight_smile:. He also wears a tiger costume almost 24-7 and freaks out if he’s sleeves get even slightly wet or there’s a crumb on the table, but doesn’t mind eating pudding from the floor.

I’m not sure if he has discomfort from the infusion sets. He never seems to flinch when they’re inserted, and only complains if the site gets bent or dislodged. I hate having things attached to me, but he’s so used to it I suspect he actually feels a bit naked without his pump nowadays.

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No word yet

To me, untethered is taking advantage of the best of both worlds, not the worst. You’re still pumping 50% of your basal, so have the possibility of flexible basal rates (as long as you don’t want to go below a temp basal of 50%), and you’ve got 50% of your basal as long-acting insulin, so you’re protected from DKA and can disconnect from the pump without worrying about going high.

Though if Tresiba was available here (or Afrezza) I would give them a try.

I’ve been following this discussion with interest as I’m considering taking a lengthy pump break. Both here and elsewhere there seems to be anecdotal evidence that Tresiba is better than Lantus but, carefully reading of Novo-Nordic’s own information doesn’t really support Tresiba being adventageous over Lantus. Is it possible that offering a patient something new and expensive is enough to bring about better blood glucose control? I must be missing something here. It gets interesting around page #22.