Sam, I’ve read a lot of your posts about Tresiba being incredible. I got fed up with infusion site problems after pumping for 11 years and decided to give Tresiba a try when it first came to Canada. My first 2 weeks were pretty good but I think it was because I still had Levemir in my system (I tried MDI with Levemir for 2 weeks prior to trying Tresiba). After that, I started to get spikes in the late afternoon and it was like Tresiba would just shut off for me for hours. I tried adjusting the dose and the problem got worse. I finally gave up on it and went back to Levemir. On my pump I only had 2-3 basal rates just to account for needing a little more around 3am, so my basal needs should be flat. I’m wondering if it’s just like everything else in diabetes, it works well for some people but not for others. Even if it had worked well for me, there are things I could do with my pump that are just more annoying on MDI. Eating pizza was definitely easier as well as carb counting and dosing in public!
I don’t doubt it’s not the ideal solution for everyone, but it really seems to work phenomenally well for a lot of people… certainly a pump has some advantages too, but they also have some disadvantages that a lot of people are very willing and even eager to overlook
I agree and come to realize all of these treatment options have shortcomings and some work better for some people over others and some just depending on the day. I’m sticking with MDI and the Freestyle Libre for now, as I find both the least-worst options at this point in my life. I’m disappointed Tresiba didn’t work as I expected for me, but Levemir is still marvellous technology compared to whatever basals existed in the 1990s!
How do you use your Levemir? Do you use 2 shots a day? 1 shot?
If you do it with multiple shots, how do you split it up? For example, do you use 50-50% or do you weight it differently for morning and night, like 60-40% or something.
This is what I wanted to do, two different doses of levemir each day when my doc insisted I try the tresiba first… “ I understand you are telling me you need more and less insulin at different times of the day, so I’m going to give you a sample of levemir also… but I want you to try this first”. He said…
2 shots - between 9 and 11 units around 9 pm depending on if I ate something that will digest slowly, and 8-9 units between 7 and 8am depending on when I wake up and have to be at work. When I was first diagnosed I would take 1 shot of 10 units a day and it seemed to last 24 hours and keep me flat. I didn’t know this was the honeymoon phase at the time and for years thought Levemir was a flat 24-hour basal until going back to MDI recently and reading more about it before doing so.
There is a dose-dependency on the duration of Levemir. The more you take per kg of body weight, the longer it lasts For me it’s 12-14 hours.
The link below explains it and gives the numbers.
Duration of action for insulin detemir was dose dependent and varied from 5.7, to 12.1, to 19.9, to 22.7, to 23.2 h for 0.1, 0.2, 0.4, 0.8, and 1.6 units/kg, respectively.
Yep, I get about the same. It can be annoying if I eat a late dinner because it fades out quickly. What I like about it is I can take my morning dose before the evening dose has run out to help with DP/feet on the floor phenomenon.
Even Lantus isn’t a 24 hour insulin for people who are not honeymooning. For me it lasted 18-20 hours and I was getting huge spikes after dinner when taking it at night. I had to split it into two injections morning and night. When I give Tresiba a try I’ll start with one injection, but I’ve heard of some people who need to split that as well if they are on low doses. I’m not on a low dose, though. I’ll get a prescription and/or sample on Tuesday but won’t start for a week (I’ll wait till I have three weeks of holidays and don’t have to worry about crazy blood sugars at work).
I take relatively low doses for my size and can’t imagine any benefit that I’d see from splitting
As to taking numerous injections / day yeah sometimes that’s the reality with MDI… if you get it just exactly right and take one bolus injection with each of three meals plus one long acting you’re already at 4/ day… in all likelihood you’ll need a correction or two so I’d consider 5-6 the realistic baseline, and certainly there will be days with more… to me that’s a small price to pay for tight control without a pump.
It’s like Lantus. Some people find it lasts 24 hours, some find it wears off sooner and they get spikes. I’d say if you’re not getting spikes, not something to worry about.
I’ll be really interested to see what my control is like on Tresiba. Every time I’ve tried to go back to Lantus I haven’t lasted a week before going back to the pump because I just couldn’t take the constant rollercoaster. Since I have three weeks off, I’ll try to stick this trial out as long as possible. Though I’d probably go back to my pump after, say, a month if it’s anything like Lantus, where virtually none of my readings end up in range.
It lasts far far longer than 24 hours, night and day different from Lantus… imo that’s a lot of the problem with Lantus is its always in some state of wearing off or recharging, taking it twice daily helps that in many cases , but doesn’t change its fundamental shortcoming
It is a truly steady state basal. Imo no other formulation, including pumped steady basal truly allow for the benefits of this.
I don’t agree with this, at least from my experience with pumping. However, I do agree that variations in absorption and site issues can interfere with steady basal delivery, problems that don’t exist with injectable basals.
This is what I mean… with insulin absorption is damn near everything… in hospitals ICUs they manage with regular insulin in an IV drip… that’s why afrezza works so amazingly well too… it’s just regular insulin… it’s all in the absorption. It’s a huge huge factor in the overall equation. A huge part of “variable basals” are actually about “variable absorption” imo… which are of course essentially impossible to pin down because it’s “variable” and only partially predictable
Definitely see that variable absorption is a huge factor for my son. When one site requires 40% less insulin and he’s not sick… really makes you think about the issue being crummy absorption and why oh why are insulin pumps still relying on a 1980s technology for their primary delivery vehicle?
It’s a huge deal I’m really surprised it’s not more recognized and discussed… it’s the insulin! In addition to just bizarre irregularities from one site to the next add in that it absorbs completely differently with different levels of physical activity and blood flow, etc…
I don’t think it’s the insulin, but I do think infusion sets haven’t progressed since the 1990s and that AP technology will never work well if the pump companies can’t design a better way to infuse insulin. When I pump I run an almost completely flat basal profile, except for a little bit more overnight to help with the dawn phenomenon. This small variability isn’t caused by pumping rapid-acting insulin - I still need more Levemir overnight to cope with this, and have to time its peak to when my insulin needs are higher. I had no memorable site issues for my first few years of pumping and my basal needs stayed relatively constant. It was only after years of overuse (mostly my fault since I left sets on way too long in the early days) that I began to have problems. When I would get a good site, the insulin acted exactly how I expected.
Absorption issues don’t solely just pertain to bad sites…
if you’re sitting on your couch watching tv does the same pump basal dose have the same effect as when you’re outside doing yard work or hiking? If so you’re really lucky and the pump might be a really good fit for you. A lot of people though experience much more efficient absorption of rapid acting analog insulins when they’re physically active… there are of course other factors in how much insulin one needs between active and sedentary states but insulin absorption is a major factor as well IMO…
If rapid acting insulin behaved consistently wouldn’t it seem that virtually any reasonably intelligent person could dial their pump in to keep their fasting bg perfectly flat 24 hours per day? There’s an awful lot of very smart people here, PHDs, MDs, scientists and engineers of all stripes, accountants, you name it, who just can’t seem to do that with pumped basal? Why would we speculate that is? I have my theories.
I understand what you’re saying. I was thinking of variable basals in terms of needing different rates at different times during the day and whether this was caused by pumping rapid insulin, not how activity affects basal.
But this is just T1 diabetes. It’s not like pumpers, as a community, have worse control than those on MDI. Both groups have examples of people with spectacular control and those with really poor control. I don’t know many people with T1 diabetes who can keep their BG perfectly flat around the clock…because, unless your pancreas still produces a bit of insulin to help out, at best all we can do is make crude guesses at how much insulin our body needs at any given time, regardless of how it’s delivered…
I know that, for me, the pump + CGM combo allows me FAR better control than I ever had on MDI (and even better with low-carb eating). I complain about my control issues here because I’m comparing myself to the top 0.1% of patients on these types of sites and I’m only in the 96th percentile instead of the 99th…
Next week I will hopefully try Tresiba and see whether that changes things up.