nice Sam. Good information.
So three days in and I’m allowed to adjust my dose now per my doctors instructions—some of my initial observations are a bit counterintuitive to what I’d expected so I thought I’d share them–
- I appears that I’ll actually need a little bit more tresiba than lantus, which is not what I was expecting to see, but isn’t necessarily bad, it’s just a surprise since I was initially concerned about stacking up doses… I say this because I’ve been waking up slightly over 100 over the past couple days, which is something I can avoid most of the time with the same dose of lantus particularly when I exercise as much as I have been-- possible coincidence though because both my kids have colds right now and higher fasting bg is almost always the earliest sign of a cold virus for me…
2). This basal is very, very stable. More-so than lantus, which I never really had any complaints about either. Counter to any logic I can figure out, with lantus around hour 20 (when it should be wearing off) is when I have tended to drift a bit low— I always just assumed because around the early evening hours I don’t need much basal and it was just going to be a fact of life with a 1x daily basal. My assumption was that this would be even worse with a basal that’s not wearing off at this point-- but it’s not happening with tresiba, not even when I exercise without eating around this timeframe so far.
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The pen I hated at first has grown on me. It has some sort of spring mechanism so basically just a tap on the button after the dose is dialed up dumps the whole load quite quickly, this was a little bit alarming at first but I think I’m going to like it.
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novofine plus pen needles that came with are way better than any I’ve ever used before— they’re only 4 mm but they have a solid perpendicular face below the needle so you can just stab it right in without pinching, etc —I know you can with any needle that’s short enough too, but it just feels like a better idea with these with their face below he needle instead of the needle transitioning to a just slightly larger plastic cylinder. I can’t even feel them.
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Hey Sam, thanks for keeping us updated!
I started the Tresiba/Novolog combo about 4 days ago. I had a couple lows (50-60) on the first day… maybe due to some lantus/tresiba overlapping or me eating a little healthier than usual. I concur with Sam’s statement… Tresiba seems to be a lot more stable than Lantus was for me. I have been waking up a bit higher than normal at about 150 in the mornings, but this is to be expected as I adjust to the new insulin, and figure out how to dose myself the night before. I tend to go conservative and shoot for a higher blood sugar than normal at night when trying new insulins. I dont have a CGM, but every time I have checked myself the last 2 days it has been between 130-160.
One caveat though, I do feel a bit different than what I used to feel with Lantus. I would say I had a better feeling with Lantus, with the Tresiba I seem to feel a little more dehydrated, almost like my glucose levels are high. This could be withdrawal symptoms from the Lantus (10+ years on lantus i am sure my body is expecting it still!).
I too like the pen and the novofine needles! They work great. I have a ton of BD pen needles I will need to go through though…
I plan to introduce the Afrezza Sunday or Monday afternoon. I tried a sample of it a couple months back, so I kind of know what to expect, but I’ll give you all an update a week or two from now.
Cheers!
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Sam and Rozale - great posts. Thanks for the updates, please keep them coming. I’m still waiting on my Tresiba. Look forward to giving it a go!!!
Keep us posted— it’s hard to think of much else to write, it just seems to work really well…
One thing I’ve noticed is that if I have any late night LC snacks without bolusing (which have been doing all along with lantus) like cheese, peanuts, etc I’ll wake up with modest elevations say 110 maybe, that wouldn’t have happened with lantus—
At first I was a bit irritated by this but the more I’ve thought about it it is actually kinda indicative that it’s even more stable than lantus… Eating without insulin is supposed to raise ones blood sugar-- that’s how its supposed to work— wheras In the past I’ve been snacking in order to ensure stability with lantus — so ill have to adjust my behaviors there a little bit if I want to wake up under 100 on a regular basis—
Hard to keep thinking of new things to write about it, it works well— a new basal that works very well just isn’t as exciting as a new bolus
Haha, i guess i feel about the same as @Sam19 does… it really works well and is so much easier to handle than levemir. Probably going to say farewell to my pump (which is still on my shelf) pretty soon…
it is really nice that you dont have to give the tresiba at the exact same time every day, and it really is sooo stable!
the only downside is that if you need to increase your insulin quickly, there really is no way of doing so except for raising your bolus insulin (compared to the pump). i was sick on last friday and ran slightly high (around 200, nothing horrible).
i am still waiting for some kind of bomb to drop and make everything difficult again 
hope you get a hand on that tresiba soon, @mikep!
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That’s great! It works so well for you that you’re gonna put the pump in a memory box! Congrats I imagine that’ll feel pretty good to do.
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Swiss - great post. So you went from pump to Tresiba? I’m on a pump now (using Humalog for basal) and I’m wondering how much Tresiba I will need. Obviously, it’s going to be trial and error for a bit, but any thoughts you may have would be welcome. Thanks!!!
Yup still working well with me. Only difference I see is me being a dehydrated at night… Goes away mostly when I wake up. My kids have been battling colds, So that might be the issue… I’ll let you know if it goes away.
The Tresiba / afrezza combo is working pretty well. I take a 8 or 12 unit of afrezza right before I eat a burger or wrap, and my levels 30 minutes later are just about the same as before I ate. Last night I ate burger took a 8 unit puff of afrezza , pre-burger I was at 84 post I was 100. Previously on the lantus/novolog combo I would have jumped up to 200 or so before coming back down.
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Just watch for delayed spikes if you’re just learning with afrezza… That’s the only tricky part-- im sure it’s different for everyone, for something like a burger with a lot of fat I wait quite a while after I eat, like a half hour or so before I use it to help mitigate the delayed spike— high amounts of fat really slow down my digestion a lot—
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+1 to Sam. I normally do a puff when I start eating and then another about 45 minutes later to cover the delayed glucose spike.
@mikep, i went from pump to levemir and from levemir to tresiba. but i was on levemir for only a month before switching insulins.
on pump i had a basal rate of around 24 units/24h, evenly spread over the day (my basal rate was flat as a pancake). then i went to levemir, because i switched to MDI pretty quick without talking to my doctor first (read the whole story here ) and ended up taking 12 units of levemir both at 10am and 10pm. I wasnt too happy though with it, sometimes those 12 units worked great, sometimes not, and especially in the morning i had trouble for the levemir to last me until my 10am shot. at night i had the dinner bolus insulin to help me over the last few hours, but in the morning somehow nothing worked. so when i had my next endo appt he suggested trying tresiba, and i tried it. i started with 22 units at bedtime, reduced after a few days to 20 units and am now probably going to reduce even further down to 18.
and while i know you have awesome results on afrezza, i also have noticed less pp spikes on MDI, because i usually inject my bolus in my forearm and the insulin seems to work there like a rocket, whereas with the pump i would have much slower absorption as i was restricted to a few pump sites.
so far so good 
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very interesting and thank you for sharing.
When’s your launch date with tresiba mike? Have you done pump vacations or anything like that in the past that might give you a baseline for what to expect with dose adjustments, etc? Have you been on a pump your whole “career” ?
I’m still waiting for my supply order. I checked with my Endo to see what is going on today. I was on MDI for a while and switched to pump right around 2000. Haven’t done extended pump vacations so this should be interesting.
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Ah it’ll be simple, it’s not like a pump with a near infinite possible number of different settings that could require indefinite tinkering … You’ll just need maybe a little more, maybe a little less, and you’ll have it dialed in in no time I imagine
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I hope so and if not I’ll be hitting you up for tips/advice
we got your back 
good luck! 
Thanks Swiss!!!
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Requested a long term rx for tresiba now. I am a believer— I officially prefer this to lantus. I find comfort knowing that if I fall asleep without taking my dose I’m not going to wake up in a bad situation because it lasts 42 hours. Also, reading the specs, another thing I’ve come to appreciate is that it says it can be stored at up to 86F for up to 56 days after opened— it still says to store refrigerated before opening, but this does make me think that it must be considerably more shelf-stable at a broader range of temperatures than other insulins (that I’m aware of) whether opened or not… Which feeds into my other ongoing discussion about emergency preparedness— I will feel more prepared with tresiba due to what I believe to be its stability.
I have had perfectly controlled fasting levels with it… I did not adjust my dose from my previous lantus dose— so the transition was completely seemless
Having diabetes just keeps getting easier.
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