Tresiba Basal Insulin

Treatment Insulin
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Hi Jacob - you are describing what I’m doing right now. I went cold turkey from pump to Tresiba. All I did was take about 85% of my basal for the first 2 days. I then upped my Tresiba dose. Right now I’m actually 3u more on Tresiba than my daily basal total on pump.

I decided to take my Tresiba in the morning. I did this because that’s the most consistent way for me to take it. I have way too much going on in the evening hours with my kids sports to worry about having to take my Tresiba then. I guess I could do before bed, but those times greatly vary sometimes as well so doing it in the a.m. when I get up made the most sense. It’s so nice to take the injection and be done and know my basal is covered without a pump attached. I take it anywhere from 6:30am to 8:30am and have seen no difference if I take it on the early side over the later side.

My advice would be to just be patient with the Tresiba. As you mentioned it will take a few days to even out, but once it does it’s extremely stable. I was taking solely Tresiba and Afrezza and I’ve actually taken a break from Afrezza because I have a pretty nasty cold right now, so I’m doing Tresiba and Apidra. I’m liking the Apidra, but still working my boluses because taking injected insulin vs. the Afrezza is so different (IMHO).

Good luck and let us know if you have further questions.

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Mike, great thanks for that. Are you seeing good control with Tresiba and for the first day or two did you experience dramatic highs or lows - or really nothing that you couldn’t correct with the pump still on? So, you kept your basal reduced to 85% for a few days? Would you say that worked for a day or two - would you have done anything different?

PS. - How about injection sites? Did you inject in stomach or somewhere else? its been so long and i don’t know how tresiba absorption is?

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Hi Jacob
My experience was somewhat different from @mikep’s as i unhooked the pump and went to MDI straight away. have to say though my first month MDI was on Levemir, but same with that. Levemir stops working after 12 hrs, and i just did my next basal shot with tresiba when transitioning. the first few days will be wonky, but i can’t imagine it being a benefit if you keep your pump on, as you can’t really predict the way tresiba is gonna work the first few days anyways.
I take my tresiba at night, any time between 8pm and 11pm. tresiba does allow such inconsistent times, and i prefer it in the evenings as i like to sleep long on weekends (maybe up till noon), and on weekdays that would fall into school time, so an inconvenient time to take it in my opinion.
good luck, keep us posted!

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Swiss - thanks do you inject in stomach? all of it?

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Also, - what do you guys use to keep track of IOB or memory. For example I am using the Luxura HD Pen in 1/2 units. And I have an app on my phone…

But then I just realized I also can input insulin dosage into my DEXCOM G5 - so that makes it easy to know when was my last injection for either a correction or whatever - to not stack my insulin.

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I always inject basal in my thighs or hip / butt andinject bolus in the stomach.

I’d recommend switching cold turkey and using the exact same amount as your total daily pump basal for starters, just for the sake of keeping it simple. That seems a good place to start… If you’re pumping basal and injecting it you’re not really doing either right, just making things unnecessarily complicated in my view… Plus like I mentioned to Terry, using both you’re kinda getting the headache of both without the full benefit of either…

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I did it cold turkey from pump to MDI (sorry if I wasn’t clear). I pulled off my Omnipod and did an injection of Tresiba right away (at 85% of my daily pump total). I did notice some spikes in the first few days but corrected with Afrezza at the time.

I inject in either upper thighs or upper arms. No issues whatsoever so far.

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Hi, @Jacob2877. I’m on my fourth day transitioning cold turkey from a pump to Tresiba and Apidra. Like Sam said, it’s less complicated that way. I take my Tresiba shot at night before I go to bed. The Tresiba literature says that the protocol is not extremely sensitive to an exact and consistent time of day. I think anything +/- a few hours is OK. I chose night-time for the Tresiba because I go to bed around the same time every night so that’s the best cue for me.

I started the Tresiba dose as an average of my last three days of total daily basal dose. For me it was 14 units. I went high the first overnight and my CGM recorded the trace. Contrary to the recommended practice, I upped the second night’s dose to 16 and the third night’s dose to 18. My third overnight was very good, so I stayed with 18 units last night. My BG went higher than I liked so I plan to increase tonight’s dose to 19 or 20.

I’ve been setting an alarm for 2:30 a.m. and taking corrections if needed. I haven’t gone low yet overnight.

I say, just keep good records and trust your gut to make the right call. You’ve been at this a long time. No one knows your metabolism as well as you.

I keep my dosing record with my CGM and I haven’t depended on an exact running insulin on board number for reference. I just look at the time since my last bolus to factor in a rough sense of what my IOB is. I’m not afraid to stack insulin, if needed. The medicos are too hyper about the dangers of stacking. It’s more important if you’re taking a multiple series of high BG corrections. It’s not a big deal to me.

This is my first week since 1987 that I’ve been off the pump. It’s nice for a change. Not sure if I’ll stick with MDI or go back to the pump. I’d like to give this trial at least 30 days. Good luck!

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I am nearly 4 weeks into tresiba. I started with the same dose as i was on with levemir, taken at night just before sleeping (whenever that is. Can range between 9 pm to midnight).

I have had to reduce the dose about 20% (from 25 units down to 20). When I first started it, I was getting lows, though not terribly low (in the low 60s). With reduced dose I can get fasting in the mid-70s to high 80s, which is about perfect. Have found it to result in very stable blood sugars. So much so, that I am now reducing my frequency of testing. No unexplained by food indulgences highs and nothing lower than about 70. I am the sort of person who doesn’t like to eat on schedule, so this suits me very well. I did have to adjust my bolus dosing compared to before, and am taking less insulin overall. This is helped, I guess by my mostly very low carb eating, and intermittent fasting approach.

Hope you end up as pleased with this as the rest of us seem to be.

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Terry4. Thanks. Yeah I agree on the stacking. It’s just been a while since I’ve been pumping for so long I get used to seeing iob or really, the last bolus. But you’re right. On the cgm dexcom I can just input the insulin amounts. Pretty simple.

I also take metformin twice a day to help reduce insulin needs and it’s been great. Not sure if anyone here uses it.

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@JustLookin – What are you using for meal insulin and corrections? Are you using a pen or syringe and vial? Has your bolus dosing gone down? Nice to read a variety of perspectives. Good luck with your continued success!

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Terry4. I have been using the pump. Now I will be using the luxura hd with humalog as that is what I had in my pump.

The luxura allows for half dose.

I use metformin in the morning and at dinner to curb protein spikes. Limited bolus. Maybe 1 UNt in the morning. And 1 at lunch and 1/2 at dinner.

I follow dr b on a low carb diet and this has helped my control tremendously.

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@Jacob2877 – Wow, those meal insulin doses are tiny. You really need the 1/2 unit dosing increments. How much Tresiba do you use? Have you been diagnosed for very long? T1D or T2D? I tried Metformin but had gastric upset, so I stopped. It’s great you have the Dex CGM to monitor things.

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Yeah. I follow a low carb meal plan of dr Bernstein. Essentially 6-12-12. Totally no more than about 30 carbs a day. although I do try to eat more veggies now!

The metformin helps the post meal spikes. I was diagnosed in 1988. But the low carb diet doesn’t require a lot of rapid acting.

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Quick question. For those of you that use pens. Do you carry a bunch of little needles with all day?!? That would completely suck. Please advise. They claim I have to remove the needle every time due to air.

So I’m going to have to put 3-4 little needles in my pocket. Ugh.

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Yeah I carry a few around in my pocket and don’t even realize they’re there… It’s not a big burden really. Often I’ll put used ones in the little coin pocket in my jeans. Of all the things that are in a pain about diabetes, this doesn’t make it onto my list.

I really only need to remember to carry any when I’m planning on eating out, otherwise I just keep them in the kitchen at home or in my office at work… I stash a few in my wife’s purse also.

More often than not when I’m on the go I’m using afrezza anyway so I don’t even need to carry pens or needles away from home/work… I have had a few that I’ve carried around for so long that the paper seal on them pretty much disintegrated before I used them.

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Hi,

I use novorapid for meal time insulin. I have always needed to use very little bolus (except when pregnant). I tend to eat very low carb. I am probably LADA or some strange genetic-linked variety.

For low carb, high fat meals I don’t bolus at all. If I am eating low fat, high carb, probably I would dose 1 unit of insulin for about 20 g of carbs. If I am eating high fat and high carb, would use maybe 1 unit for 30 g. Don’t really have the science down as I tend to swag it based on instinct and usually hit it pretty close.

Yes, my bolus doses / corrections have definitely gone down. Now that my basal blood sugar is so stable and ‘low’, I don’t need to make corrections, and seem to have a much more stable place from which to cover meal time requirements.

For example, breakfast today was 2 eggs cooked with coconut oil, a few slices of bitey cheese melted on top of the eggs, with sautéed Chinese cabbage and onion (with some sesame oil for flavor, and pink salt).
Brewed coffee with cream. I did not bolus for that.

I am not having lunch today.

Dinner will be non-starchy veges and meats and probably a glass or 2 of wine, which I will also not bolus for, though i will check about an hour after eating and dose a correction if my blood sugar is higher than about 100 (unlikely to be though). I have less insulin resistance later in the day too.

I did bolus 2 units last night to cover a few pieces of liqueur chocolates, which I thoroughly enjoyed.

For the novorapid; I use a pen, but I dose insulin with a syringe. I don’t like the pen needles, as I find I bruise more from these (and I don’t like having to prime). I reuse my syringes for week or so, until they get blunt (depends how many doses I need to use in that time frame). When I have used pen needles in the past, I also reused them for a week or so. I carry the novorapid and the syringe in use, plus a spare one in a hard glasses case.

I am going to go get a Hba1c in the next week or so. Although it is a 3-month average, about 50% comes from the past month, so I am really wanting to see where I am now. My previous Hba1c was 5.0 (on levemir and novorapid with lots of effort). I am sure it is going to be well below 5.0 with what I’m currently seeing with blood sugars, and with less effort and monitoring.

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My tresiba usually goes in the thigh/butt area. I keep stomach and arms for the novorapid, as they are easier to access during the day, especially in winter right now.

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I have a case with me where i have some needles in it. I keep meter, pens and the needles all in the same stylish case. But if thats too much of a pain for you, you can keep your needle for the day. I do that too, and dont bother too much about the air. I think even CDEs here in Switzerland ltell you to change the needle once a day. I just change my needles when the injection becomes somewhat painful, which is usually after 5-8 injections.

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You spent almost 30 years getting this comfortable and proficient with a pump, perhaps after 30 years of improvement in technology MDI warrants more than a 30 day trial to truly compare on a level playing field? Just a thought… Up to you of course I just get happy to see people feeling liberated while still managing well.

Pls keep the updates coming, I am very interested in how well it works for you bc you’ve been using the pump for so long.