One time is an incident, two times is a coincidence, three or more is a pattern. I’ve come to be quite fond of that little saying when making decisions regarding dosage adjustments of all kinds.
2 Likes
Terry
yes, you are right. With levemir i actually used to take different doses different days depending on activity level, food, time of the month. I haven’t tried that with tresiba - and will be curious to see if it makes a difference given the long duration of action.
If this were like our hba1c test, the dose just given would have the biggest effect while the dose from the previous 2 - 5 days would have decreasingly less effect.
Next time i have a day like yesterday i may try what a reduced dose that night does.
Of course, eating is a simple alternative… but i want to eat when i feel like it - not because i have to for blood sugar! Obstinate me!
1 Like
Off target, but acceptable – will Tresiba produce consistency?
Last evening, at 9:00 p.m. I took my sixth dose of my daily Tresiba basal insulin. As you can see below, after midnight my BG ramped up to a peak of 151 mg/dl (8.4 mmol/L) fingerstick @ 3:17 a.m. I inhaled a 4-unit cartridge of Afrezza and took 1 unit of Apidra via the pen. That mid-sleep correction brought me down to a 105 mg/dl (5.8 mmol/L) wake-up @ 8:19 a.m.
yellow line = 140 mg/dl, red line = 65 mg/dl
I can’t point to anything obvious in my eating/exercise/insulin regime to account for this less than ideal overnight rise. I ate my usual meals and snacks yesterday and walked a little bit more than usual at 5.9 miles over three sessions. I’m just attributing it to the general chaos that is diabetes but I’m secretly hoping that the Tresiba routine is just not settled into a real groove yet and more consistency will soon appear.
Don’t get me wrong. This overnight trace falls within the acceptable to me but I’m always reaching for that 65 mg/dl - 99 mg/dl sweet spot. I still hope this is within my consistent reach with Tresiba.
Interesting… what would have happened without the afrezza do you think? Just continue to rise until corrected? I don’t often see unexplainable rises like this-- though realistically it’s not like it was spiraling out of control
The Afrezza correction in the middle of the night allowed me to turn the corner more quickly. I was surprised that the wake-up number was above 100. I thought it would have been closer to 70. I thought 4 units of Afrezza + 1 unit of Apidra was bold for a 151. But I felt that the rise indicated to me an underlying resistance. I needed to throw something at that resistance in addition to the real correction.
I think that aggressive overnight correction set the stage for a great in-range day. Tresiba does have a propensity for sideways moves. This is hopeful and interesting.
If this becomes a more prevalent pattern, a more fun way to deal with it might be a glass of nice wine before bed.
2 Likes
May as well as have some fun, too. I stopped buying bottles of wine to drink at home because then I’d snack too much. Wine goes well with cheese, nuts, dried fruit and chocolate, of course! I limit my wine drinking to meals out these days.
Maybe you still need a slightly higher dose? I adjusted to get my fastings consistently in the low 80s.
Thanks for the suggestion, @JustLookin. I was thinking about that myself. I haven’t been shy to bump up the dose; I’ve gone from 14 to 16 to 18 to 20 in six days. I think I’ll try 22 right now! I’ll keep you posted. 
Don’t get into a tail chase though. Remember it takes 3-5 days for a daily dose to stabilize… One night with a bit of elevation does not a pattern make… My .02c worth.
Terry,
I am like you in terms of changing things. I like to do things quickly. When was your last increase? My advice to others who ask (not that I follow my own advice) is that it is best to wait at least 3 days between any changes… this is probably more important as one gets closer to target. With this slow acting insulin, this is even more relevant. 
`` Hey guys
Wanted to give you an update on Tresiba. So, as explained; I started out with the first day at 50% basal on my pump during the transition and then the latter half of the evening I drop down to 25% and then in the night I drop down to 10%.
I did experience some mild blood sugar In the 125 to 130 range over the last two days. I have continued to reduce the pump and it is now off and gone. I will continue to take 26 units for the next day or two as I am using that as a loading dose. But I would expect that in the next 4 to 5 days that number might reduce down to 24 or 23 units per day. [quote=“Sam19, post:1, topic:50202, full:true”]
There has been a lot of buzzing lately about tresiba basal insulin. Even picking up the support of some big name doctors like Bernstein and Ponder. I’ve not seen much talk of it here yet. The manufacturers claim is that one shot can last several days— Bernstein has his patients using it more frequently…
Anyone here using it? Please tell us about it and how it’s comparing to other basal insulins you’ve tried.
[/quote]
indent preformatted text by 4 spacesBefore Tresiba I was taking 22 units daily basal.
@Sam19 and @JustLookin – The way I see it, I have my CGM as a safety net. If I overstep, it’ll be beep-beep-beeping through the night. That kind of nuisance has away of self correcting any over-confidence. My dog, Norm, backs me up, too. And Norm will be cleaning up his night-time bonus of peanut butter!
1 Like
I don’t think you’re at risk of causing yourself any physical danger by taking a couple additional units, @Terry4
I think that the risk is more of a psychological one of never having it just right by adjusting more frequently than it takes the dose to stabilize… Making it a less pleasant experience than it might otherwise be and ultimately leading you to consider it a failed experiment… Do recall just the night before last you were ecstatic about how perfectly flat it kept you. Not trying to sound bossy just hoping my thoughts might be helpful.
1 Like
Thanks for your concern, Sam. This insulin holds enough promise for me to not give up on it easily. I’ve been given an impressing glimpse of what it can do.
I remember talking to people when I was considering limiting carbs in my diet. They mentioned that most diet changes, if successful in the short run, would end up in regaining the weight in the long run. I reminded them that the immediate consequence of my blood sugar would give me, as a diabetic, more motivation to sustain my effort than the average weight-loss seeker.
I think I can make Tresiba perform better than my insulin pump. Time will tell.
1 Like
If even @Terry4, the most die-hard and experienced pumper I’ve ever known of can make this realization-- then I am ready to declare to the world that insulin pump technology has been surpassed. Soon they’ll be relics of history. Our great grand children will wonder what the hell that was for when they see one in a museum.
2 Likes
Glad to hear it’s working so well for you already @Jacob2877. I think an ocassional drift into 120-130 range is unavoidable even for people who don’t have diabetes at all— I certainly don’t lose any sleep over that, as long as I can keep the average nice and low without significant hypos.
What are you doing for bolus? I’m interested to hear more about what people who’ve used pumps for years think about the transition, how going pump free feels?
@acidrock23 you are invited to join the party.
1 Like
LOL,thanks @Sam19! For once, I’m speechless as I haven’t tried Tresiba. I considered having the doc swap my RX out for a trip to Antigua in a few weeks but I’m too lazy and haven’t gotten around to it. We are moving (about a mile…) and everything is nutso. It seems like the wave of the future. One of my buddies works for Novo Nordisk (sales…) and is very friendly with info, etc. but I’m just a slacker about it. Great thread from the people at TU though!!