After pumping for the long term I decided to take an MDI break and try the basal insulin Tresiba. It works well and can certainly produce good results. I found I need more Tresiba (about 19 units) than my pump basal of Apidra (14 units). I would get some nice overnight lines, sub-100 mg/dl and flat but I couldn’t do it most nights. My tendency was to go high (150-200 mg/dl) in the 2-6 a.m. time frame.
I tried cranking up the Tresiba dose but then I started to go hypo in the afternoon. And my pants started to get tight. During my recent move, the scale got left behind and I’m trusting my pants for now and I’ve gained weight. I was getting these slowly arching overnight highs two out of three days and I was scheduled to go on an Alaskan cruise with all the attendant food decadence.
So I pulled the plug on the Tresiba and gracefully transitioned back to the pump. I solved my overnight highs relatively quickly and felt better about traveling with my old setup. I had to bump up basal rates from 10 p.m. to 7 a.m. I was reminded how convenient it is to micro-dose with a pump.
Once I can regain my former metabolic footing, reduce my total daily dose to my former level, and lose a few pounds, I’ll try the Tresiba again. I’m thinking that I’ll try adding a 1 a.m. Apidra dose to set me up for the dawn phenomena. I don’t mind setting an alarm; I usually fall back to sleep easily. I like the feeling of being disconnected from the pump but I didn’t like the additional data entry logging my pen doses on my CGM.
In any case my original motivation was to gain some experience with an alternate delivery method. That’s done and I feel better about it. I would like to take a 6-month pump hiatus later this year.
I think my pronounced dawn phenomena basal needs make it tough for the Tresiba to match. Perhaps splitting the dose is another option to test.
Tresiba is amazing insulin and it’s surprisingly tolerant of time-of-day dosing variability. It only asks that doses be space apart by 8 hours. So if your schedule changes day to day, this may give you the flexibility you need.
Any way, live and learn. I’m happy I gave Tresiba a test run.
I totally understand your move. While I will stay on Tresiba, I don’t feel that it is less work/better than the pump, it just fits me at the moment and I am happy with the setup, but I am definitely not as elated about it as others have mentioned in the other thread.
I still think it is the best basal insulin out there, and am very pleased with my Dexcom/MDI plan right now, but i will definitely return to the pump once i will start working in the hospital (hopefully closed loop by then).
Have fun on your Alaskan cruise!
I need to drop 65 lbs to get back in shape. I told myself I’d do MDI once I got to 170 lbs. But I dunno. What you described sounds like a lot of work. Getting up in the middle of the night to take an injection? I’ve never done that. I did shots from 1994 - 2001. When I did MDI, I didn’t split my Lantus and I didn’t take a shot at lunch. Not sure if it was MDI or not.
I’ve been thinking of trying MDI for a bit because the last time I lost weight I was using MDI rather than the pump. But that may just be a coincidence… I did get a prescription for Lantus from my doctor, though, just in case I give it a try (I don’t think we have Tresiba in Canada). The dawn phenomenon is the primary reason I started on the pump. I set an alarm for 3:00 am every night for several months and just couldn’t do it indefinitely (I was a full-time university student at the time).
I’ve often read comments like this over the years. I once thought that injecting myself several times per day was an outrageous idea. But when faced with that proposition and its alternative, I quickly changed my mind. We all make value judgments about things we do. We do these things because, at least at one time, we felt that it produces more benefits than it costs. The benefits and costs are all subjective in nature so it’s understandable that we adopt a spectrum of preference related to things diabetes. There is no one right idea or strategy.
It’s important, however, that we reconsider “firmly held beliefs” from time to time. These beliefs can go unchallenged for long periods and may only be embraced by inertia alone. Our ability to reexamine our values can create flexibility that permits us to update our internal value gyroscopes in light of new experiences and facts.
I see the ability to flex as a character strength, not weakness. I see it like the structural strength a bridge displays as it flexes in response to heavy loads moving across it. If it didn’t give it would break.
Maybe an MDI trial would be worth it for you right now. I think mixing things up once in awhile can keep things fresh while often providing some new insight.
I think I could adopt a 2:00 a.m. alarm to give myself a dose of insulin without too much consequence. If it interfered with my ability to get a good night’s sleep, however, I’d quickly change my mind. Currently, waking up for a short period mid-sleep isn’t a problem for me.
There’s nothing wrong with using a pump or MDI to successfully treat diabetes. The availability of a new basal insulin, Tresiba, accompanied by positive comments of others here using it, persuaded me to give it a try.
At this moment, I prefer to use a pump for reasons stated upthread. I enjoyed the change of daily routines when I used MDI. I also enjoyed learning the traits of Tresiba firsthand. For me the ultimate measure is the BG data produced by any treatment method.
I want a high percentage of time in range, low percentage of time hypo, low variability, and a low average. I have specific targets in mind and I watch my numbers every day. The method that drives consistent success meeting these goals is what I will use. BG performance is everything to me since I know when my BG behaves, I feel more energy and just feel better.
Sometimes people are shallow. Those unkind comments need to go in one ear and out the other. If the comments persist and badger, I’d look to keep different company. But I’ve seen this all discussed at length in other threads.
