Tresiba Basal Insulin

Well I don’t want to give specific dosing instructions… but the general concept is that if your basal is holding you perfectly flat and you’re seeing elevations resultant from meals you have to correct them. If what you’ve been doing in that regard isn’t getting you to your goals, then you’ll have to be more aggressive with your corrections, or change your goals…

I appreciate your thoughts. Yes, I understand that information/advice is not intended to be medical advice. It is truly emotionally helpful for me to be able to bounce off ideas and suggestions. You and other members of the community have been SO supportive and helpful. Thank you VERY much! (about being more aggressive with corrections: If I see a BG =88, I feel anxious. I am concerned that…I may have a weird physical reaction like passing out?)

88 is not a low BG! If you experience “low” symptoms at 88, it likely means you’ve been running too high for far too long…

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I understand the fears and anxiety… blood sugars in the 80s that aren’t plummeting or skyrocketing is my target zone… it’s where I strive to be. I’ve never had a weird reaction or passed out or anything like that… never even close really. If my blood sugar gets a little low, I eat a little-- it’s only as big of a deal as my mind lets it be

It is about the fears and anxiety.I don’t experience any sweating or racing heart beat. In fact, when my BG was 62, I did not feel any different.

About pre meal and post meal BG’s: My BG’s are generally around 100/120 premeal to about 140/170 post meal. The basal is ok. If I wanted to bring down the pre meal and the post meal, am I supposed to be a bit more aggressive, in that do I increase my bolus quantity at the meal time so that I may be able to avoid post meal correction?

Yes, generally that’s what it means. Ps 62 is still pretty much a normal blood sugar only barely into the “better pay attention” range. I generally wouldn’t even treat that unless I had bolus on board

I do see noticeable action from Novolog for 3-4 hours out, so this is definitely a YDMV. Also remember that for women, carbs or one unit insulin can have more of an effect on us because of smaller bodies.

Presently, let’s say my baseline is about 115. I go to sleep at 115, wake up at 115.
If I dose correctly for breakfast, for example 2.5 units, my post breakfast BG may be 135. If I dose more aggressively, (let’s say I use 3 units or more instead of 2.5 units) and my post breakfast BG= 100 or less (let’s say BG= 85): did I “overdo” the I:C ratio? did I use “too much insulin” because my post meal is less than my pre meal? Or is it ok?

What’s the best way to bring down my “baseline”? Is it easiest to have a good bedtime BG between 90 to 100? What are your bedtime BG targets? What are your baseline BG targets ? (I may have been subconsciously aiming for a bedtime BG near 120 because of the fears and anxiety).

I weigh 90 pounds. This may be a factor in my anxiety about using too much insulin.

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Thanks. That makes sense- if zero bolus on board, one could expect to stay flat. What baseline do you aim for? Like a flatline, if you were not to eat? What do you try to aim for at 2, 3 or 4 hours? I can achieve about 130’s after 3 or 4 hours sometime. I guess that’s insufficient bolus insulin?
(I can’t even begin to imagine how people achieve a flatline eating.)

Yeah, that’s not enough bolus insulin, for sure.

Given the duration of fast-acting is 3-5 hours (3.5-4 works for most people), you should dose so that you get back close to your fasting target within 3-4 hours. If you’re not, you’re not taking enough bolus insulin.

As I said in an earlier post, the only way to do this is to learn to count carbs and dose bolus based on an IC ratio. Once you have this figured out, you can confidently “blindly” bolus based on these calculations, and be safe and on target most of the time.

Otherwise, unless you eat a regimented, pre-calculated food menu, you’ll just be guessing most off the time, in which case everyone’s tendency is to do exactly what you’re doing – underdose.

I’m not sure I really have a specific baseline number. I try to stay below 140 after meals and under 100 before meals I suppose. I’m more satisfied if I stay under 120 after meals but that just probably isn’t realistic. Ultimately I just try to have as close to normal levels as possible w/o significant hypos

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This may sound like a “stupid” question, I’ll ask anyway. How accurately do you measure carbs? Half an apple may vary between 10 -15 g carbs. For milk, 4 oz v 6 oz would be 6g carbs v 9 g carbs. My endo told me to try to estimate the amount of insulin for the meal (estimate/eyeball) ; that is, to not try to measure, count, add every item.

Well I started by learning to count carbs very precisely as best I could…I looked up and tallied up every thing I ate as best I could–which over time and experience has given way to more of an “experienced based” estimation of carbs… e.g. Instead of counting half an apple as 10-15 like you just said I’d count a small apple as requiring one unit and a large one as requiring two, and learn my own timing with different time of day… I suspect that sounds more crude when I try to explain it but I’ve gotten really good at it. I suspect most professional drivers can’t precisely explain very well how they know what gear to be in at any given time and circumstance either…

Then when Afrezza came along I pretty much stopped trying to carb count when I use it-- it’s unnecessary

I still use novolog a lot too though and carb counting is an individual science / art in my estimation. Eg if Dave and I went out to dinner and ate the same thing we may well estimate the carbs quite differently… who is closer to the actual carb content doesn’t really matter though-- who closer estimated the correct amount of insulin for their own individual needs matters much more— not that it’s a contest-- just saying that the individual ability to count carbs in a sense that’s meaningful to their own dosage decisions is all that really counts

So true! I can really relate to the driving and shifting gear!! My daughter asked me the other day when I was driving and shifting a manual transmission car- how do you know when to shift? Gear shifting is so “natural” that I don’t think about it! Back to carb counting: At one point, I weighed or counted everything I ate; reduced my carbs. My A1C was 6.2; there were not as many high BG’s(but I like and enjoy food too much to give up carbs, plus weighing was time consuming). My most recent A1C was 6.5 without the precise weighing. While 6.5 is not bad, I would like to improve by not having as many numbers in the 160’s or higher. The goal is to try to shift my overall “line” lower.

Since we may spend anywhere between 6 to 8 hours sleeping, I suspect having a decent “flat” and lower sleeping BG numbers can improve the A1C number. My first goal is to try to aim for a bedtime BG of 100 which will also mean fasting BG=100. Wish me good luck.

If your post meal is 120, what do you do to get it under 100 before the next meal? bolus injection to correct? Out of curiosity, if one unit insulin lowers BG by 60 points, do you aim for a BG= 60 and inject one unit, or do you inject half unit targeting a BG=90?

It all depends… sometimes it’ll drift back down to target on it’s own, sometimes not…

Good luck shooting for 100. It’s doable.

I am so grateful for you and all the other members of this community for your support, knowledge and patience.

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So much knowledge and experience on here. I love it. I am about a month in on Tresiba after 14 years on humalog on a pump. I;m so in love with it. I notice more hypertrophy (feels like dense tissue) lingering in the areas I’m using. I have been rotating around lower abdominal area. No so much when it is injected but after the fact. Any one notice this or have any remedies (message, essential oils…) AND what other location do people use that have good absorbency.

It’s my experience places like glutes doesn’t work well, at least on my pump it took forever to get the insulin absorbing.
Thank you for any ideas or thoughts!

I inject all around the love handle- a big wide areas around the waist, front back, side. For the novolog, I have tried the thighs.