My total daily basal rate on the pump was about 14 units. Today I took 20 units of Tresiba. I don’t place a lot of value in this comparison. I learned with taking the inhalable insulin, Afrezza, that insulin with a fundamental different action is not exactly comparable. I will watch my weight, however, as an additional data point to judge my basal insulin dose.
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Agree 100%. I’d go even a step further and say I think often times our tendency to try to directly compare two completely different mechanisms can be counterproductive when it comes to insulin.
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Comparisons are interesting intellectually. However, at the end of the day, what matters is good control. Whatever achieves that, is what you do. Eyes on the prize.
I just don’t want to make my already 10 extra pounds become 20, so I’m thinking of all ways to prevent that (one being IMHO taking the least amount of insulin I can, while maintaining good control). All sorts of things factor into my decision to find the right treatment for me.
Thanks everyone for sharing!!
I just posted a reply with this sentiment in another thread. Please excuse the repetition.
I’m a big fan of the philosophy expressed in Dr. Ponder’s Sugar Surfing. He writes that it is not the mechanism that we deliver insulin that matters in our success. It could be the latest and greatest insulin pump, or a 15 year old pump without any modern bells or whistles, or even an MDI regimen delivered with syringe and insulin vial.
What matters most is the knowledge, experience, and attitude of the person making the insulin judgment calls. Bottom line, I think, is that we need to invest in ourselves to learn all we can, be willing to do the n=1 experiments, and look upon failure as a natural path toward finding what works for each of us. BG numbers are signposts, not judgments as to our worth as human beings! They simply suggest what to do next.
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How’s everyone doing? Has anyone gone back to the pump? Is anyone missing it?
I wanted to share my last 4 days morning readings just to brag a little---- 87, 86, 85, 84 (just editors to add day 4) hard to beat that.
Finally ended up slightly reducing my dose from 12 to 10u daily after starting to see some lower fasting numbers during a couple weeks of significantly increased activity levels (aka work… Trying to ease my way out of that racket)
Anyway hope it’s working as well for you all as it is for me.
My daughter pumps Apidra. I had “back-up” pens of Lantus (which she HATED because it burned like heck) and Novolog, which we never had to use because the OmniPod rep tossed us a free back-up PDM when my daughter started pumping about two years ago (which we ended up needing to use when her “main” PDM went ferklempt in the middle of the night a few weeks ago). These back-up pens recently expired and my daughter’s new endo, who we both absolutely lurve (shout out to Kathryn Woods, MD, at the Harold Schnitzer Diabetes Center) gave us rxs for Tresiba and Apidra pens when I asked for them at my daughter’s most recent appointment. (What a refreshing change from my daughter’s previous endo, who embodied everything I try hard not to be as a physician on a daily basis: she never listened, was never in our corner when personnel at my daughter’s school turned me in to CSD for allegedly being negligent about my daughter’s D-care because she had a few minor lows and then for endangering my daughter’s life when I instructed her to go old school with a syringe when she had a site failure, was turd-useless as an advocate when this was needed, never respected my knowledge as a mother and physician who manages [along with my daughter] her Type 1 24/7 with A1c’s that have always been in the low 6’s/mid-to-high 5’s, the list goes on …) I know there’s no exact formula for converting pumped basal units of fast-acting insulin __________ (fill in the blank with Humalog, Novolog, or Apidra) to units of Tresiba and I realize that the YDMV rule applies, but does anyone have any suggestions as to how much Tresiba I should start with in the event of a Zombie Apocalypse (it’s only a matter of time) after my daughter’s PDM and back-up PDM fail? I’d ask my daughter’s endo, but she admitted to not knowing because this was the first rx for Tresiba she’d written (I believe it’s still considered “off-label” for children?).
I started with my last weeks’s pump average of my total daily basal dose rounded to the nearest whole unit. For me that was 14 units. I stepped that up to 19 units over time. Tresiba takes many days for its effect to accumulate so wait a few days before changing your dose. Some people use less Tresiba than their pump basal but I think the pump basal average is a safe place to start. Stay vigilant and do the fingersticks even though you have a CGM. I ran a whole night with my CGM reading the mid 70s but found out it probably was the mid 60s, on the edge for me.
I am currently taking 16 units of Levimire at 8pm and 7 units at 8am. When I start Tresiba, how do I change to a once daily shot in the morning only? I will be asking my Endo for samples on my next visit in April. Thanks for any suggestions.
I’d probably just dive right in and stop taking the levemir and go to tresiba 1x daily. Since you take your larger dose in the evening it might be an easier transition if you just replaced your pm dose with the total daily levemir dose (23) you were taking before— I wouldn’t worry too much about getting tricky with a transition plan if it were me.
agree with Terry here. My Tresiba dose is only 1 or 2 units higher than my total daily dose of Humalog when I was on a pump.
@rgcainmd - as Terry mentioned it is absolutely necessary to wait for the Tresiba to equalize (3-5 days).
@Sam19 - I love the Tresiba. No plans to go back to the pump.
Just got done with my doc appointment – he’s giving me a sample of u200 tresiba to try because it’ll be cheaper and pens will last longer… He said just to keep them in the fridge because they’ll last so long
@sam19 I understand what you are saying however I do not like taking my insulin in the evening (for me, it is too easy to forget ) I am most comfortable taking it in the morning ( it is a habit for me, since I’ve done it for 53 Years😊) I really, really what to switch from evening to morning. Hopefully, there is a way.
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For sure, it’s really not going to be difficult… Just switch gears whenever you’re ready… Tresiba is so easy you’ll wonder why you put so much thought into it:)
I’d recommend taking your pm levemir dose, then maybe taking the full 23u dose maybe at noon the next day instead, then taking it in the morning every day thereafter… It’s really easy stuff with tresiba, very forgiving. I’m pretty sure you could even just start taking the whole dose tomorrow morning if you wanted… But if you feel better about a a multi step transition plan id recommend the one above. I think you’ll like it and find the transition seemless. As others have said, it takes a few days to stabilize in your body unlike lantus— it’s more like you’re taking a long term basal supplement than taking a dose of insulin that wears off in a certain number of hours…
So give it a good few days before you make any adjustments…
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Thanks @sam19, this sounds like it would work😀
Hey guys, I have started Tresiba as you all know a few weeks ago. During the initial start up time I seem to do quite well at averaging about 24 units of T per day.
Lately I have more seen spikes and difficulty with my normal rapid acting insulin ratios working. I am wondering if any of you have had to increase your Tresiba dose quite a bit.
My pump basal was 22.5 units a day on humalog for the last 5-10 years. I started Tresiba about 3 weeks ago, at 26 units but then scaled back to 24-25.
But!!! The last week or so or longer I have not been able to get great results. Even 1 unit of humalog normally would bring me down 30 points does practically nothing! It’s strange. And it happens mostly after dinner. I take Tresiba in the morning. I am also running higher than I like 110-115 fasting unless I take rapid acting. I feel like my rapid acting injections have been like 15-20 a day just to keep my bg from going over 160/200. So it’s got to be my Tresiba.
I am thinking of bumping it up to 26 for 3-5 days.
I would like to know of anyone experienced a need to increase Tresiba as the first month or so went on? Please advise! Thanks.
@Jacob2877 – As I wrote above, I started my Tresiba 1x/day dose at 14 units. In the first month I ramped it up to 16, 18, 20, and 22. I found that 22 units/day was too much and then stepped down to 20, then 18, and now I’m at 19 units/day. I have been taking about 3 or 4 corrections per day. While I prefer not to have to take any corrections, my sugar surfing philosophy supports doing whatever is needed to keep my BG in range. Fifteen to 20 corrections seems a bit much, however.
I also experimented with time of day dosing. The Tresiba package insert says that it doesn’t matter what time of day it is taken but I thought it might have some effect for me, so I started at 9 p.m. and am now dosing it around 9 a.m. Now I’m having slowly climbing BGs starting at 3 a.m. They climb from a 100 mg/dl level up towards 160-180 mg/dl. I’ve been waking up and giving a correction dose. The correction doesn’t drop my BG to a lower level and seems only to blunt the climb. So I’m going to gradually move my dosing time toward mid-day and see if that has any effect. I don’t want to change my 19 unit dose until I’ve taken it for about a week.
I think, like any diabetes insulin dosing tactic, you’ll need to experiment and find what works for you. I’m 90% happy with Tresiba’s performance so far and I really think I can get the last 10% dialed in. You really only have two parameters that you can vary: dose size and time of day dosing. I’m skeptical about the time of day factor as Novo Nordisk claims that Tresiba can be dosed any time of day and that time of day dosing can vary will little/no ill effects. It only says that you have to space out doses by at least 8 hours.
In keeping with my sugar surfing philosophy, I may end up regularly moving my dose around as needed. Based on the experience of others here, however, I’m hoping to arrive at the dose that will perform well for the entire 24-hour period. I guess you could also split the dose and take it twice per day, something Dr. Bernstein recommends. Good luck. Keep up the n=1 testing. You’ll get there.
Best day in last two weeks, still need overnight corrections
I can’t complain about a day like yesterday. I spent 96% time in range, only 4% low, enjoyed low variability at a standard deviation of 21 mg/dl (1.2 mmol/L), and the average clocked in at 97 mg/dl (5.4 mmol/L).
Since I started Tresiba, I had in my mind that ideally I could take a single dose once per day and dependably keep it between the lines without additional corrections. I’m starting to conclude that maybe I’ve arrived at my ideal Tresiba zone and I shouldn’t look a gift horse in the mouth!
I’ve been doing 3 a.m. corrections as my CGM wakes me up at 120 mg/dl (6.7 mmol/L) to a slowly rising line. The corrections do not drop me back into my desired sub 100 mg/dl (5.6 mmol/L) zone but they appear to be limiting the pre-dawn rise to about 140 mg/dl (7.8 mmol/L).
My BG management philosophy has me always looking for improvements on the margin. Perhaps I need to make an exception to this idea when I arrive at a pretty acceptable BG neighborhood. Sometimes any move you make has a much higher chance of making things worse than better.
Maybe, “steady as she goes” should be my stance in situations like this. I don’t mind the mid-sleep interruptions and quick correction dose. Should I be happy and simply stand pat? What do you think?
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It looks to me like your basal is essentially perfectly set, and if the goal is to avoid corrections you might have to look to other variables at this point… I know you like to walk for exercise-- does tweaking the timing of that exercise offer any potential benefit for the pre-dawn rises? Like a brisk walk in the late evening maybe instead of mid day?
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I don’t think avoiding corrections is a reasonable goal. Making insulin and carb nudges just goes with the territory. I’m slowly (2 hours per day) switching my Tresiba dose time form 9 a.m. to 5 p.m. While Tresiba promises flat delivery, I’m hoping that the first 12 hours is a bit more aggressive than the last 12 hours.
I often walk between 9 p.m. and midnight. That doesn’t seem to effect my overnight line one way or the other. I’m in a very acceptable spot right now and will just sit tight and watch. Maybe things will move in my direction without any additional effort.
I keep coming back to the notion of sugar surfing. We live in a dynamic environment. Expecting static solutions to a dynamic problem is not rational. What we do is both science and art.
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