Same boat here. Was absolutely a die hard pumper and now I’m pump free.
Wow, bold statements!? Let’s slow down a bit and put things into perspective. At best, Tresiba just delivers steady basal rate. Based on what people are reporting, Tresiba does so pretty well, so that’s great! But, any pump can do exactly the same - just dial in a good fixed basal rate and you have it (which can be good enough for many people) - that’s all fine. But to claim that Tresiba or any other long-term insulin can result in better bg control than a pump (assuming the user knows how to use the pump) is an overstatement. It just can’t do any better than a constant basal rate - it’s not some magic “smart” insulin, no?
Although my proclamation was intended to be somewhat humorous — please do consider that you’ve just heard from several people who’ve used every advanced feature available on their pumps for decades, including highly complex basal rates, (all the while believing that pumping insulin was the pinnacle of insulin technology) and so far everyone seems to believe that they are having tighter control with tresiba… I would say that the theory that complex basal rates as delivered by pumping are superior is being disproven before our eyes. Or perhaps varied basal rates were the best thing available for a long time, with previous generation insulins but no longer are with next generation basal. You can draw a different conclusion if you see the evidence differently than I do. Want to try it and tell us what you think?
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@Sam19, I am not disputing the evidence presented at all, and I think we have more we agree on than not. I agree that Tresiba experiences demonstrate that complex basal rates are not necessary or superior. Furthermore, I suspect that, unfortunately, many pump users (even experienced users) have such complex basal rates off, resulting in more harm then good, and are then surprised and delighted to see how great a simple flat rate such as the one provided by Tresiba can be. I have already tried “Tresiba” in the form of a flat basal rate on my pump. The results are not bad. I could find and post remarkable overnight flat lines such as the results posted here by @Terry4, you and others. On average, however, I would often have early morning highs and afternoon lows that I would need to correct. None of that is too bad, but why bother with such patterns when pump can just do it by itself? My pump basal rates are not complex at all: the rate is higher in early morning hours and lower in the afternoon - that’s it. On average, this works better for me than a good flat rate.
Again, please note I am not disputing at all the evidence presented here and excellent experiences people have with Tresiba. I am happy there is a KISS approach that PWD’s can take advantage of. MDI has always been a great alternative to pumping even with older types of long insulins. I have never and will never dispute that. However, I do disagree with just telling pump users to ditch their pumps because Tresiba is magically “better.” It is not. Based on the evidence presented, we may want to encourage pump users to try simple flat rates (which is what Ponder suggests). I would agree with that.
Great discussion by the way!
I don’t quite agree that these two are comparable. They are different insulins, with different absorption mechanisms. @mikep went from a flat pumped basal profile to tresiba— I would love to hear him compare his results with the two.
Also, Ponder has since evolved his views and now uses tresiba himself instead of pumping a flat basal profile…
I was surprised to read Ponder’s successful use of flat basals with a pump. I used a fairly complex basal profile that was essentially high from 3 a.m. til noon and then lower the rest for the day. I was skeptical of a flat basal profile working for me and never tried it on the pump but having been living with it on this sixth day of Tresiba, sans pump. I still think that no one’s actual basic basal need is flat but perhaps it’s a lot flatter than my former multi-segmented profile suggests.
The reason I think that Ponder and other sugar surfers are able to live with this flat basal rate is because they are adept at living in the moment and adding appropriately timed micro-boluses and carb nudges. In other words I believe as much as we might like to think that we can separate basal and bolus needs, it’s really not fully possible or even pragmatically necessary. As long as the basal rate keeps you within striking distance of stable in-range BGs using micro-adjustments, then that’s all that counts.
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You have a point - there could be some other unknown mechanisms by which Tresiba may perform better than a flat basal rate on a pump. Intriguing!
That’s a very good point @Terry4 - I agree. I think Ponder’s flat rate recommendation is exactly along the lines of your argument. In his practice I would image he must have seen countless pump users with completely messed up basal rates, so his first recommendation would be to reset the mess to something easier to work with - a simple flat rate is not a bad starting point at all. I could live fairly well with a flat rate and I am happy Tresiba would be a good option available if I had to part with my pump for whatever reason. Plus, as @Sam19 suggested, there could be other beneficial mechanisms involved with Tresiba - this is yet to be confirmed and hopefully explained.
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May not be something that can ever really confirmed or explained… Might just be the reality. Maybe the proof will only be found in the pudding so to speak. I’d encourage everyone to try it and see what they think instead of wait for an explanation that may never come… Can always go back to pumping if that’s a better fit, it’s not like you’re marrying it to try a free sample.
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I’ve never used a pump but I thought this was a great, succinct summary of how many of us manage it. I know for a lot of people there are advantages to customizing pumped basal rates to various diurnal or other physiological variations, but this is really at the core of it: whatever keeps you close so you can avoid the proverbial rollercoaster. The micromanagement is of course also important, both on the bolus and carb sides, whether for exercise or the million other variables we all encounter.
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Considering that mdi is far cheaper than pumping, and most people in the world cannot afford a pump (many cannot even afford insulin), i think that this insulin seems like a very good bet for those who can only afford insulin.
Seems like a good deal to me regardless of budget.
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Of course @Terry4 , this year I can’t afford to go to the Diabetes Unconference (went last year - it was AWESOME) - if only the darn Canadian dollar would get stronger - but know it’s too late now to attend. If things improve, hopefully I’ll be attending the Atlantic City #duncon in September - and who knows - Dr. Ponder will be in attendance. I’m still doing my Levemir shots … though CDE I met during Cuba holiday recently (she was at same resort) - said over a a few drinks (hope she remembers what she told me) - that she has Tresiba stashed in her office. I’d love to give it a go – though until a few days ago - my basal coverage was going fine … but I’m in hormonal phase with various things (just finished up a #dblog and will post it this weekend).
Sorry to read that You can’t attend the Diabetes Unconference in Las Vegas. Hope you can go to the Atlantic City meeting, however.
I’ve never used Levemir, in fact my last “long-acting” insulin was NPH back in '87 and that wasn’t even long acting. Good luck to you. I’ll look for your blog later.
How’s the tresiba working out for you Terry?
@Sam19 – thanks for the question. Three nights ago I had an extended hyperglycemia overnight. Oddly enough it was the night of my last Tresiba increase – to 22 units. That was the only significant anomaly recently. I attribute that to an off exercise day combined with eating more snack nuts than usual.
Overall, my numbers have been great. Since I started on Tresiba over eight days ago, my time in range (TIR) has been 82% with only 2.5% time low. My glucose variability as measured by standard deviation is 30 mg/dl with an average of 108 mg/dl.
These numbers are acceptable but I prefer a lower average, < 105 mg/dl. I know I can hit 90% TIR without too much effort. My variability is usually lower, too, in the low 20’s mg/dl standard deviation.
This trial is going well and I intend to use up the two Tresiba pens before I make a final decision. I still think Tresiba will be a better protocol than the pump but time will tell. I like the idea of giving another method a chance and not locking into my well worn path.
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Right on Terry… Glad to hear it’s still working well. How do you find the burden as far as time, convenience, time spent managing etc to compare to your pump? I realize it’s not a fair comparison BC you did one for decades and were used to it and the new protocol is a big change to you… But after the dust settled so to speak… Which one do you think would more conducive to not living a life ruled by diabetes?
I would give the edge to MDI with Tresiba but it’s not dramatic for me. I was so used to the pump protocol that it didn’t seem burdensome. My attention to my CGM number and making tactical decisions regarding corrective doses and walking sessions seems about equal to me.
It’s nice being relieved of the pump on my belt and the attendant responsibility to keep the pump out of the toilet! (That’s only happened once but it taxes my attention the few times each day I deal with it.) I will enjoy stocking and managing two less supplies, infusion sets and cartridges, if I stay on MDI. That’s a small but not insignificant thing.
So much of my diabetes burden has been off-loaded to habit that I feel like the plough-horse that knows the way back to the barn without any effort or guidance. And crazy as it may seem, I take a certain amount of pleasure in playing this diabetes game well.
Even if I don’t proceed with Tresiba, this is a boon to me, knowing I have a viable alternate if life throws me a curve.
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@Terry4 My memory is that you are on Medicare and I assume that you are getting your pump insulin free through Part B. Seems to me that if you quit your pump, you will then have to pay for insulin through your prescription coverage which is very expensive, especially because of the donut hole.
Obviously it is quite stupid that pump insulin is free under Medicare and injected insulin isn’t. But it’s one of the few Medicare things that will be in my favor, so I am not complaining.
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Hi, @Laddie. Last year I tried to get Apridra insulin for my pump under Medcare Part B through Walgreens. It was a frustrating and bureaucratic maze. After repeated attempts and showing up to pick up my insulin, they wanted several hundred dollars for my 90-day supply. I gave up and just ordered through my mail order plan that I earned as part of my company retiree benefit. I spent several conversations with the pharmacy tech, the pharmacists, and talking to the Walgreens national Medicare office. We went round and round about Medicare Part B when they wanted to say no, it’s Part D. Anyhow, they wore me out and I just used my other coverage. Now that you raise this point again, I’m tempted to restart my effort to get my insulin under Part B.
I’m enjoying trying out Tresiba. I’ll see how the rest of this trial goes and make up my mind about Medicare and insulin pump insulin later. I think that the huge price increases by the insulin manufacturers has put Part B suppliers in a situation where they are losing money. I notice that Walgreens has plenty of details on a website about securing testing supplies through them under part B with nary a word about insulin.
When do you start on Medicare?