Sadly Tresiba is still not approved for sale in Canada (though of course Toujeo got approved last summer). I am a die hard Levemir user when I go off the pump (taking a holiday from Ziggy my Animas Ping for abit). Will see how my CGM works with MDI - never had it last time I took a pump break).So I will live through the ones here that have the luck of being able to try it out. Being a T1D for 50 years - I love to be a human guinea pig … okay - maybe “love” is to the extreme, but anything that keeps me out of diabetes complication area … I’ll give it a go and make money for stock holders of these pharmaceutical giants until a CURE comes along 
Who knows I suspect it will be approved there before long, I really don’t understand any potential advantages of toujeo over lantus, as far as I understand it’s the exact same thing except u300— I really don’t even know why they gave it a new name and marketed it as a new formula, it’s still just plain old insulin glargine
1 Like
I’m starting tresiba trial tonight - just did last shot of levemir. . … expecting the same as you all.
I tend to Have variable basal requirements affected by hormones / activity level / calories consumed. . So will be interesting to see how this works.
2 Likes
Keep us posted… Do try to be patient for the first few days because I think there is an adjustment period with anything
Side note— I just had some mixups with my new mail order pharmacy that made it look like my long term supply of tresiba might not arrive in time to prevent me from having to use lantus again in the interim… It was surprising to me how worked up I got over this— because I used lantus for years and never complained— thankfully I think I got that straightened out-- but that mixup definitely reinforced in my mind which one I prefer
@Terry4 you’re gonna be late to the party!
Hi, I’m a physician in Mexico, FACP , internist, (with diabetes for more than 33 years)
Tresiba has been in Mexico for several years , I frequently use it on my patients with great results, mainly with the ones that have a very changing time of works, that change from day to night frequently,
Several days after you start using it you reach an equilibrium in the amount of insulin on your blood.
Have seen very rare hypoglycemic episodes. .
I feel very comfortable using Tresiba.
3 Likes
Thank you for weighing in, Doctor. I also work extremely variable hours, shifts etc and that has not made insulin management any easier (to say the least).
I hope you’ll continue to share your observations and expertise with us here.
@Sam19 - Even if I smoothed out this basal profile with longer time segments and fewer changes, do you think Tresiba would work? I take about 15-16 units of pump basal insulin daily. I wonder if basal insulins are sometimes supplemented with bolus insulin. In other words, some of the bolus is actually doing the work of the basal.
Right now I’m busy with other projects but I would like to at least experiment with MDI this year so that I have enough chops to do it well if I were forced to do it. It’s been 29 years since I used MDI.
It’s hard to say @Terry4, I know that I felt that my varying needs throughout the day (similar it appears to yours) actually required more adjustability than was possible with lantus— which is why I requested levemir; thinking I could try some More advanced methods, split and varied doses, single doses and tweaking the timing very carefully, etc… (A lot like you’re doing with a pump, but with MDI)
My doctor told me to try this instead, which I was certain would effectively be even less adjustable and wouldn’t work as well for me— but my assumptions were proven wrong. I actually argued with him about it and insisted I needed the more adjustable levemir that would allow me to use all these complex techniques. Finally he agreed to give me samples of both but said “hey, I can see you’re not going to take no for an answer-- but do me a favor and use the tresiba first-- I think you’re going to like it”
I’d say the only way to see if it’s a good fit is to try it for a couple weeks at least— what’s there to lose? If you don’t like it it’s not like there’s no turning back… I know you’ve been on a pump for a long time and have pretty much perfected those methods, but (for me) this has actually made my day easier instead of having been a “project”
I agree entirely that sometimes basal doses are hard to pinpoint because boluses are doing part of their job a large portion of the waking hours of the day…
hi guys!
so i am still reducing my dose. i started with 22 units and am now down to 16, and still on the lower edge. i eat so much without bolus, and it is still difficult to get through the night. this is really weird, do i need so much less of this tresiba than levemir?
we’ll see how low i will have to go…
Keep us posted. Thanks!
This is interesting in light of the fact that Stephen Ponder of Sugar Surfing fame, runs his pump on a flat basal for the entire day. Maybe backfilling basal needs with regular meal dosing is another tactic that we shouldn’t reflexively frown upon.
I’ve gone through periods using my pump when I was eating less and exercising more. So I was consciously trying to correspondingly reduce my basal. It appeared to me that the mere act of pulling back on the basal made my basal needs paradoxically decrease even more! This didn’t go on long and in the end I would have to increase some rates from their low point but still at a net reduction from the starting point.
Sometimes with basal rates less is more. Conversely, It fits in with my theory that adding more and more insulin eventually drives insulin resistance. A paradox, again.
1 Like
Sometimes we find good results through complexity, and therefore become convinced that more complexity = better results. Sometimes this is accurate, sometimes not.
Stephen Ponder states in the book that he believes that for most people (and, clearly for himself), a stable basal rate is what they need. I’m not sure that even he would recommend backfilling with bolus instead of a correct basal rate (or, if needed, rates).
2 weeks ago I would have absolutely not agreed with this for myself. I’ve since become convinced that it was correct for me. I am thankful that it turned out my doc actually was smarter than me after all;)
I’ve actually been running a flat basal for a couple years now which is why I’m excited to ditch my pump and roll with Tresiba/Afrezza combo.
2 Likes
Haven’t tried Tersiba (not sure I can) – but for me, I got almost exactly the same results from Lantus and Levemir when I tried them. Three days after any change, my BG patterns of highs or lows fell into almost precisely the same pattern. My Endo and I tried all sorts of adjustments without success, which is why I went to a pump. Could be the characteristics of Tresiba could produce more stable results even for me, but I am uncertain. I suppose I could experiment with a single basal rate on the pump and see the results…
I suppose, though it’d be hard to know how precisely those results correlate to tresiba, which absorbs through different mechanisms etc etc…
I thought I read that Dr. Ponder himself was now using tresiba himself – I see some references regarding that on his Facebook page, but don’t see a great deal of explanation. One of his posts is “tresiba update— nighttime lows a thing of the past”
Another is :
"DEGLUDEC UPDATE
After almost a week I can truly say Tresiba (insulin degludec) is a fantastic basal insulin. It takes 3-5 days to reach a “steady state”, but once it does it’s a steady background insulin. Less hypo than my Glargine, especially at night.
Will try Toujeo later. Then compare the two. But now I’m gathering more experience with my new Surfboard."
---- Dr Ponder is one guy I’d love to see do a live interview? Has he ever or been asked to? I only have mobile internet right now so can’t really dig into the sight well.
Dr. Ponder has mentioned in comments on his FB page that he’s on MDI now. I think he returned to MDI some time back to test his sugar surfing theories while on it and then decided to just stick with it because he was still able to keep the wave pretty smooth.
Update on Treseba use: I believe there may be a spike ten to twelve hours after injection but it lasts four hours, not protracted. I believe it is flat. The highs from 6pm to 1am are due to her basal pattern where she needs 20 percent more insulin at this time. And the drop from 2am to 6am also is a basal pattern where she needs less insulin. I do see a drop from 6am to 11am which is definitely not a time when she would ever normally drop but would stay steady or rise. Therefore, I attribute the drop from 6am to 11am to a peak caused by Tresiba. If on a pump for years, you will know your individual basal patterns. My DD never had one flat basal; few do. So I am seeing a four or five hour peak (probably four) twelve hours after injection where Tresiba is stronger. The highs and lows from 6pm to 1am and 2am to 6am occur despite the time of injection. For us, giving the injection at 6am would be best. She gives it first thing in the morning, which for her is around 9am though. Also she has varied up to five hours post and pre earlier day’s injection and no problem. So if you count back twelve hours from your time of greatest basal need, that may be an ideal time to give the injection.
1 Like