FUDiabetes

Basal insulin delivery: pump, Tresiba, Lantus?

I’m going to be asking my endo for a prescription for the 630G, just so I have something “on file” with my insurance company should I suddenly decide to get a pump now (changing jobs, etc.). However, my understanding of the 670G is that it can only handle minor adjustments before it kicks you into manual mode and lets you take care of it. So I don’t think it would be able to handle the 12-unit increase in basal that I just experienced over the past 48 hours…

Ha, I was actually second-guessing myself this morning, just because I experienced my usual 50% increase in basal over the past 24-48 hours and had to make tweaks to an overnight segment since my BG suddenly started rising significantly at 4:00 AM. I’m really nervous about how Tresiba will handle those types of things… I’m feeling a bit reluctant to do something that may put my BG control totally out of whack, and then have to readjust again if I go back to the pump. I’ll still ask for a sample and/or prescription, though. I think the holidays would be a good time to give it a try, so I’ll probably still go ahead with it.

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I’ve had T1 for 26 years and most definitely believe you!

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You experienced a big variation in basal absorption / insulin effectiveness which is affected by so many factors it’s impossible to account for them all. The only solution is to use something that’s impervious to many of them. You can not program a pump to read the future and account for the vagueries of how your body absorbs and proccessss rapid acting analog insulins. It is not possible. Please don’t second guess yourself. Give it a try, if it doesn’t work out you can go right back.

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In this case, though, it’s pretty clear that experiencing a 50% rise/fall in my basal (and other settings) twice a month is due to hormones. That’s what caused this latest change. It’s different from the unexpected variations that may be caused by absorption issues or insulin effectiveness.

I’ll still give Tresiba a try, don’t worry. Just not looking forward to the adjustment and having to figure these types of things out.

This is why I was second-guessing… I could just go back to my pump, yes, but it might cost me a month or six weeks of completely out-of-control blood sugars. I dread the idea of doing that, if that’s the outcome. Of course, it may not be.

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I have no doubt the menstrual cycle can introduce different insulin requirements… that may be something that even with tresiba you have to learn a strategy with.

I also have no doubt that other hormonal cycles don’t just go crazy at random moments of every day yo-yoing from one extreme to another in terms of how much basal insulin is appropriate assuming it’s actually absorbing and metabolizing effectively … those unexplained variables have a lot to do with how the body is responding to the insulin…

There is a profound difference in recognizing that your insulin needs are changing twice a month based on a predictable cycle and them changing completely randomly at every hour of the day and night based on nothing…

I am on Tresiba, and I definitely still see menstrual cycle effects on how well Tresiba works for me. It’s part of why I think Tresiba is fine for me to get to where I am (low to mid 6s, A1c-wise), but I doubt I could be in the 5s easily on it. For now I’m ok with that, mostly because I’m not sure any of the current pump iterations would be much better and they have other drawbacks. If an AP system comes out that is really good though (better than the reports of the 670 so far), I would absolutely try it.

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I wouldn’t say my basal needs change that frequently or randomly. I think when they do change there is almost always a cause, such as exercise, illness, allergies, weather, food, and so on, but the cuase is not always obvious or controllable. If I run high for more than a few hours without coming down I change my pump site and/or give an IM injection. Occassionally, I’ll have that one act resolve my entire problem…but often doing that doesn’t help much. I’d expect that if my issue were primarily with insulin absorption from the pump, doing an IM injection would completely bypass that system and would fix my problem, but if the issue were primarily some factor external or internal to my body cuasing insulin resistance, that IM injection wouldn’t have much effect, which is what I find more often than not. So, I do agree with you that insulin absorption/effectivness is one factor…but I disagree that it’s the main factor in my variable insulin needs. But, we’ll see what happens wtih Tresiba…

This is exactly what I was getting at with my “doubts”. My A1c has been in the low 6s for a while now, so my control is not terrible on a pump by any means. I would like to see if I can hit the 5s, because I’ve been so close to doing so several times. It feels like Tresiba would give me fewer tools to achieve that, rather than more. My main concern with it are reports I’ve heard that it takes days to ramp up or down into a new dose. When my insulin needs shoot up or down by 50% over a day or two, I just have no idea how I’d handle that with Tresiba. These are separate from concerns about variable basal rates throughout the day, which I’m willing to just go with Tresiba and see how it goes. But it’s reassuring to hear from someone who has hormonal fluctuations that it’s perhaps not as terrible as I’m imagining!

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Again, as I have written to you before, your experience is not ours, and your denying our reality because it is not yours is demeaning to others.

Honestly, I think it’s a combination of not being too horrible and my not being overly concerned about having perfect basal all the time. I know there are days where I’m compensating more with more corrections and where I’m also just less in range. I can live with that, but there are definitely plenty of folks on this forum who would be super not ok with that level of control (which great for them, I might not be either if I’d ever had consistently tighter control). I’ve gotten to the point where I don’t think I could go sub-6 without shifting considerably more effort to my diabetes care from other aspects of my life, which I’m unwilling to do, especially since I never used to imagine I could even get sub-7. I do suspect I’d be in a similar situation with a pump though—my research makes me suspect a pump would likely be a different (and for me, significantly less pleasant in important respects) way to get similar results at the present. I could be wrong, but that’s a super expensive and time consuming experiment (vs going from pump to MDI) that I’m also currently unwilling to do.

My experience is not the same because I’m on a better basal… I’m encouraging you to explore that option too. You already experienced better control with even a previous generation long acting…

I’m going to say that your basal is better for you personally but we didn’t find it to be a silver bullet.

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It is not possible to use basal insulin and adjust your basal when you do sports. I don’t want to go back to the times when my son dropped 70 mg/dl every quarter of an hour and could fall unconscious in the water after a 30 minute swim. If I can avoid it. So my first priority is to make the pod work for us.

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I understand the reservation particularly with sports… Lantus dropped by bg every time I exercised. Every time I’d run I’d end up in the 40s . Tresiba doesn’t do that to me at all. I don’t understand why, my best attempt to connect the dots is that it’s absorbtion just isn’t increased with exercise. That’s the main reason it’s such a big improvement for me. With Lantus I also had quite a few unexplainable mild lows and really struggled to keep by morning numbers as dialed in as I’d like them

@Sam, your experience is your experience, but it’s really NOT everyone’s. I absolutely still have major effects of exercise on my blood sugar on Tresiba, and if I was a major athlete, especially one whose exercise regimen varied dramatically day to day, I am quite certain it would not work for me. I think it’s because for me, it has nothing to do with the absorption (which I agree is better); it’s that my underlying insulin needs change.

Has he tried any other type of pump? My Omnipod experience was not the greatest and found absorption was much more consistent on a Medtronic pump. I know the Omnipod works very well for many people, but I think the one-size-fits-all cannula can be a problem for some.

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I understand… which is why I’m not trying to convince you or anyone else that it’s the best option, all I’m saying is that it’s one that everyone should evaluate with a trial, as you did, because for some people it is phenomenal and they can’t figure out if they’d be one of them by the logic they’ve applied to and the experiences they’ve had with other insulins

He has not, it is his first pump. But, with any other pump, it is an on/off switch when you swim, and for many contact sports. So we worked very hard to be able to use the pod. For us, the ability to adjust basal (not only to zero) during sports is truly a wonderful thing.

We are open to other choices though. Swimming, for my son, is the only sport with truly extreme effects. If he stopped swimming, many other options could work with less impact.

I would love for him to be on Tresiba, because it would be a no-fuss option. I am hoping to try it in the next swim practice break.

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I think there are only a few people on this site that have tried using both Tresiba AND a pump, and probably even fewer that tried both Tresiba and a pump when running every day. @TravelingOn Kim’s man EH is one of them. I am one of them. Who else?

I’ve tried Tresiba. Have you ever tried a pump?

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No. I have no reason to. I am no longer seeking any improvement in basal performance and flexibility so I have no interest in trying a pump.