Tresiba may or may not be a good fit for you, I hope it is, and am hopeful that it might well be. Even within people who have varied pumped basal profiles I suspect that people who get their settings dialed in as best they can and leave them alone for the most part, maybe just adjusting seasonally or when clear and consistent trends develop, infrequently, are having better success than those constantly adjusting them multiple times every day
I switched from Lantus MDI basal to Tresiba last year and find that changes to basal are not needed (for me) very often with Tresiba whereas with Lantus I was always searching for the optimal dose. My activity level varies a lot from day to day and I keep my basal tuned to the high activity days. This means that on inactive days it might be a little low so I am like a manual insulin pump with multiple Humalog corrections to stay in or close to range on those days.
I also want to point out that adjusting basal is a slower process with Tresiba due to the 2 day action time. I am maybe ultra careful but I usually adjust up or down in 1 unit increments with 3+ days between increments. This is a seasonal thing for me, increase in late fall and decrease in spring. It takes a few days for the adjustments to kick in.
I tweak a basal (usually the same one, covering late afternoon) up or down by 0.05U about once a month. Other than that I leave them alone. It took me nearly a year to get them mostly correct and I ain’t meddling unless I really need to.
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i might adjust my basals 2 or possibly 3 times a year unless i see a clear pattern. otherwise i leave things alone. this year was the first year that i learned how to adjust my I:C ratios and that has made all the difference in my post meal control.
I don’t know anyone who adjusts basal rates multiple times every day… Unless you’re talking about temp basals, but those are only used for specific purposes over very short time periods and don’t really have anything to do with BG patterns. I’ve found a thirty minute temp basal a great tool to help prevent lows during “routine” exercise like walking somewhere and a longer temp basal works well for swimming at keeping me in range rather than dropping really low halfway through my swim. I wouldn’t really consider these “basal adjustments” though, since they are done in the moment and don’t change any part of the basal profile(s) programmed into the pump.
I would love to be someone who only adjusted basals a couple times a year. It’s not like adjusting basal is fun…it’s super annoying, and I only do it when my blood sugar is consistently out of range day after day. When blood sugars go from mostly flatlining to ping-ponging wildly all over the place or running extremely high or low non-stop, I’d argue that it indicates that the person needs a basal adjustment or adjustment of basal and ratios. Certainly my experience as recently as last week has been my blood sugar goes from literally chaotic and never being in range for two weeks to flatlining most of the day, and I’m not sure anything would have changed had I just left my settings alone…
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I know a guy who does temp basals almost all day and night every day, different all the time, to the point that his underlying basal rates programs are almost meaningless. How, in practical terms, is this different from adjusting basal rates up and down all day every day? 
I don’t change my basal rates very often. Perhaps a couple of times per year when my CDE and I agree that something needs to be changed.
Veering a little off topic … How far ahead do you set your temp basals for something like walking somewhere? I have mixed results with these, since much of my activity is of varying intensity and varying duration. For some things it works fairly well, such as Saturday morning grocery shopping, when I know I’ll be walking for an hour or two – like your swimming – and I can do a temp basal a few hours in advance (even though Walsh, I think it is, says to set a basal for up to 6 hours before you want to see the effect). For short-duration activity – walking to the bus stop or to the store and back – I find a temp basal totally ineffective. The activity and the temp basal just never match up right. Taking some carb right before the short walk usually saves me from going low.
Usually I try for 30-60 minutes before the start of the walking, if I can. But, like you, my activity is quite varied, and so sometimes I don’t have that type of warning. For more structured activiteis like swimming, I’d aim for one hour in advance. I’m using Fiasp, which I find very fast acting and makes temp basal rates much more effective. When I was on Apidra, it acted too slowly to make temp basals worth doing for anything other than extended exercise (in which case I set a temp basal two hours in advance).
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personally i have negative opinions about Walsh, so i wont even go there. BUT, every PWD on a pump and every CDE and ENDO has told me the exact same thing: set your TB 2 hours before exercise. no need to set it 6 hours before. that sounds crazy. check with eric, our guru, but i have never ever heard of that before.
also, the duration that you set it for will depend upon how long your activity will be. if you are going to be walking to the market, and it will only be an hour on your feet, you might want to set it for 2 hours, this way, by the time that you are ready to leave your house, that TB is already doing its job. remember that when you set the TB, it will still be in your system after you turn it off. this concept might help you make your decisions about the duration of your setting.
my husband and i frequently walk over the Manhattan Bridge from Brooklyn into Chinatown. its a 45 minute walk there, then we eat, then we walk around for another hour, then we walk back over the Bridge into Brooklyn, then we walk some more. all said, i set my TB for 80% (down from 100% on my Medtronic Pump ) and set it (typically) for 4 hours. if we are cutting our walk short, i can always turn the TB off.
hope this is helpful in some way.
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Keep in mind that not too long ago, Regular was the FAST acting insulin used in pumps. John Walsh is author of the earlier books on Pumping that explained alot about pumps that medical team did not teach me in 1990s. I’m not sure what is recommended time in recent editions.
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We go with 1-1/2 hrs advance. When possible and convenient. If not there is always the carb-up option.
I would second the opinion of @daisymae but would consider the possibility that perhaps Walsh had more things in mind and this point was not supposed to be taken in isolation?
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I’m definitely flat basal now I’ve removed all the carbs from my diet - before when I ate them I wasn’t it was up and down all the time - but i didn’t adjust the basal but messed around with homolog doses when I wasn’t eating anything to control it. I just think there was too much sugar swirling around in my liver and now there isn’t any so there/s nothing to upset it and its all calmed down - he may be getting on a little stuck in his ways, but Bernstein is spot on for the 30g a day carb and 80g a day protein regime.
I was 28 basal tresiba for 10 yrs (equivalent lantus before that)
Now I’ve dropped carbs and weight ( I just got under 200lb for the first time in 20 yrs - I’m down to 19 tresiba - but I’ve seen its dropping slightly at night so I’ll probably take it down to 18 when I get to 195lb
The episode the other week when my bolus went shooting up seems to have passed now - I just have to keep to the diet strictly and not stray - particularly on the protein - I was eating too much over what the body needs for maintenance and my liver was just pumping it out as sugar. Back to 15 Humlaog now for bolus and all seems calm
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Has Tresiba really been around for 10 years?! Wow. We just got it in Canada a couple of months ago.
No my grammar was bad - I meant I’ve been on tresiba / lantus at effectively the same dosage for 10yrs - I think I went on tresiba about 2 yrs ago when it first came out
@Jen, I will be really curious to know what you find out. Please do report!
I have the 6th edition of Pumping Insulin (2017). For adjusting basal rates (he doesn’t specify for temp basals), he says:
Change basal rates 2 or 3 hours before your glucose begins to rise or fall, and 5 to 8 hours before the high or low readings you are trying to avoid typically occurs.
I aim for 2 hours before planned, quantifiable activity. For me, though, unplanned, unknown activity is more often the case, so the temp basal is rarely an option.
I may be trying at the same time. I’m intrigued by this notion that we may actually not have variable basal requirements. I always struggled with DP and the afternoon slump on long-acting insulins, so I suspect I do have changing requirements, but I’m open to being surprised.
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Yep, my situation as well. On all the other long-acting insulins I’ve tried I’ve always gone high in the morning and evening and low in the middle of the day and overnight. On the pump it’s the same, but I have my basal rates adjusted so that it usually doesn’t cause a major high or low. I’ll document my success or failure here since some are interested. And if nothing else, this will be an interesting experiment.
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