Chemical name is ‘insulin aspart’; i think it’s the probably the same. i must be able to get a 0.5u pen.
I’ll have to speak to my endo about dilution and using syringes rather than flexpens… i’m open to it if it allows me to control things a little better, without the effort/faff exponentially spiralling.
2 Likes
I can inject 0.5 units with my pump in less time than it takes you to read this sentence.
Could be one avenue to explore, as it could give you the kind of tight control you seek and go a long way towards preventing the excursions you experience. You haven’t said why you’re not keen on the idea of pump therapy. Cost? Insurance? Having something “stuck” to you?
2 Likes
There is a lot of variability for each person. So 5-10% may not be exactly right, it might take some experimentation.
But certainly, with a different basal, you could make such changes easier.
Consider what you could do with Lantus (or maybe Levemir) twice-a-day compared to Tresiba. You could have different basal rates for daytime and nighttime. And you could have a lower basal amount for exercising days versus non-exercising days.
Those changes would be very easy.
2 Likes
Thanks Beacher. You’re right, it could well be an area to explore. The main reason is having something stuck to me. I’m forever banging my Libre on a door jam, which sends my upper arm into spasms…and often breaks the sensor. It feels like a further reduction in physical (if not metaphorical) freedom, particularly when i wear lycra when cycling, swim outdoors in a wetsuit and prance around the gym requiring me to lean on various parts of my body…tricky enough with the Libre and miaomiao sensor. I really don’t feel like i want any more tech attached to my body. Perhaps i should try harder to find a 0.5u flexpen, and/or find vials and syringes that let me dilute and inject <0.5u. But then that’s a lot of faff. Whichever way i look, i see faff… and i have to weight that up against the marginal benefit of running X% lower on average and Y% lower in std deviation. Particuarly when my endocrinologist says (aside the hypos) i’m doing okay.
2 Likes
You might well be right. Perhaps i misunderstood. But even to think of targets as precise as this, on the basis that you’d surely only set achievable targets, seems extremely difficult, if not impossible for me.
I think i could manage more frequent small injections, if they were possible… c.f. my earlier comments about procuring a flexpen with 0.5u increments, or diluting and injecting with syringes.
Interesting. I didn’t realise lipohypertrophy was related to the amount of the dose…i thought it was the trauma of the needle injection. But makes sense I guess.
Again, interesting. I’ll look into all of the above. Thank you.
2 Likes
Thanks Eric. It seems a little odd to go back to Lantus, which i started on back in 2003, but if it’s easier to adjust for a life that involves plenty of exercise (with occasional rest days), then it’s probably worth thinking about. There was a big noise about Tresiba being a game-changer 5yrs or so ago, but perhaps that’s just because of the convenience of a once-per-day, any-time-of-day injection.
My endo has suggested Levemir also, and i think that even predates Lantus? What is the group’s received wisdom on the pro’s and cons of Lantus vs Levemir? or does it just vary randomly from one person to another, and need a month or so test-driving?
2 Likes
In most people Levemir has a small peak while Lantus has a flatter curve. With that being said, it is hard to generalize because some people find that Lantus doesn’t last as long as expected, and many people do very well on Levemir. If it was me and you have experience I would start with Lantus, but no reason not to try Levemir if you are interested. Experimentation is the best teacher in my opinion.
2 Likes
Levemir’s duration is dose dependent.
Here are Levemir duration’s based on units per kilogram of body weight:
| Dosage amount (units / kilogram) | Average duration |
|---|---|
| 0.1 units/kg | 5.7 hours |
| 0.2 units/kg | 12.1 hours |
| 0.4 units/kg | 19.9 hours |
| 0.8 units/kg | 22.7 hours |
| 1.6 units/kg | 23.2 hours |
Make sure you convert body weight to kilograms.
This range lets you dial it in pretty well. It ends when it ends, there is not much unknown with Levemir.
The downside is if you have a random number of hours, like 19.9. That kind of sucks. But if you are in the 12 hour range, it’s a great basal to use, as long as you don’t forget to hit it twice-per-day.
3 Likes
As I understand it, Levemir may be interesting because it doesn’t last as long as Lantus. That property facilitates having two different basal rates during each 24-hour period, which can be helpful for addressing routine overnight lows or highs, or for addressing exercise days vs slack days. See Eric’s table to find out roughly how long a shot of Levemir would last in your body. If I couldn’t pump I’d definitely try Levemir, because my overnight basal requirement is more than double my daytime rate.
5 Likes
Here is the reference link.
They don’t word it very clearly, which is why I posted the chart.
Results: 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.
3 Likes
Hi @john_coburg! It’s nice to meet you.
I’m similar to you in that I’m not a big fan of pumps. I was diagnosed about 25 years ago. Started on NPH and Regular- hated how regimented that made my life. I switched to Humalog and Lantus when those came out then eventually to a pump. I switched off the pump back to Lantus for a couple of years and then tried Tresiba for a year or two before switching back to Lantus.
Tresiba was a really bad fit for me for multiple reasons, but one of those was that I couldn’t easily adjust my basal. I like to go on long hikes, and if I’m going to do sustained activity like that, I need to be able to decrease my basal. I’m also a woman in my 30s and my monthly hormone cycle really impacts my basal needs- I learned to track this pattern from @T1Allison.
Anyway, all that to say that I do think Lantus or Levemir might help you a lot- especially with a cgm. CGMs are just so valuable. I look back now and wonder how I had any level of control before getting a cgm.
I do two Lantus shots a day- one at 9 am and one at 4 pm. I need less insulin in the early morning and more in the evenings. This timing addresses that well. Lantus tends to peak a bit around 6-8 hours after my dose and seems to start wearing off around 18-20 hours. If I have carbs at breakfast, I have to dose aggressively or I’ll go high. I usually keep that meal low carb, and I guess that is my compromise in using Lantus rather than a pump.
I use Afrezza and Humalog as my boius insulins. Afrezza is an inhalable insulin that works really fast. It’s improved my quality of life a lot because it’s easy to get back in range without the same worries about lows. A lot of insurance plans don’t cover it, and I’m not sure if I’ll be able to keep using it next year or not. I got lucky this year.
I target an average bg of 110 and usually have a standard deviation of 25-30. With the pandemic, that has increased to 35. I’m not able to swim like I used to and my overall activity levels are lower. I’m working on that. I do watch my cgm quite a bit during the day and make adjustments as needed. Bg excursions make me exhausted, so I’d rather stay on top of it and feel good. Im sure I’d benefit from a pump loop system, but I hate the thought of having a pump attached to me all the time. I also had a lot of problems with sites, but I probably should’ve tried different infusion sets
With Afrezza, it’s really easy to head off bg excursions before they spiral out of control. If I do go over 160, it’s generally just for a brief amount of time. My understanding is that brief excursions aren’t as bad as sustained excursions. Some studies show that people without diabetes can briefly spike up to 160 after meals before quickly heading back into range. If I remember correctly, Afrezza shaved a good 10 mg/dL off both my average and standard deviation- maybe even more. Not to be a walking advertisement for Afrezza- I often end up doing this 
I don’t even know if that’s an option where you live.
It sounds like a good first step for you would be to try out Lantus or Levemir with a cgm. The combination could allow for much better control than you experienced with Lantus before. That’s my opinion anyway. Hope some of this rather long post might help.
7 Likes
There are likely multiple factors, but the key is to rotate (as you know). Anywhere you have adipose tissue is potentially an injection site, beyond the conventional sites we’re taught. For instance, after I realized I could use my pecs for a pump infusion site, I started occasionally injecting there as well. Nearly 50 years a diabetic and it had never occurred to me! (OK, maybe I’m just unimaginative.)
4 Likes
I meant A1C!
1 Like
Yes, it is related to my age. It is supposed to be bad between 15 and 25.
Yeah, it can be freaky. I had to inject 30U a few times, stacked. When I make a mistake and overinject it lasts for hours, and I have to stay up until I am stable.
It is a DIY method where you use closed loop algorithms in your phone that take your BG input from your CGM and send corrections to your pump. There is Loop and there is OpenAPS (“we are not waiting”). I am interested in a version of Loop for Omnipod that is nicknamed Omniloop.
3 Likes
IMHO, this would be your choice and not your Endo’s as it is your life and not his. Quality of life which includes time and tasks to make the quality better or worse can only be judged by you. What I am willing to do may not be something that appeals to you, and what someone else is doing may not appeal to me. My Endo is a coach at best, but ultimately it’s my body, my life and my decision.
Blogs such as FUD are great sounding boards when evaluating what you are willing to endure, accomplish, and attempt to gain quality of life.
4 Likes
I don’t think it is that hard to do. For me, I inject if I go above 120 unless I have a reason to believe that it is going to come down on its own. It is a reflex.
+1. I don’t get a lot of good advice from endos unless they are T1Ds. They don’t seem to understand the everyday life I have. Sometimes they can be so naive or impractical. I get a lot better advice here.
In the end, it’s my life. I am just a note on my endo’s computer.
5 Likes
@john_coburg I had all the same problems when I was first diagnosed fifty years ago. In those days I used insulin injections, tried to balance my diet, and tested by peeing on a little strip that turned green if you had been spilling sugar since your last urination. We were almost totally in the dark. Nobody knew what their A1c was. I had begun developing neuropathy in my feet and when I got out of bed it felt like I landed on a bed of nails.
Then came new tech: home blood sugar meters. My control improved a lot and my neuropathy went away. At that point my control was a lot like yours.
You are in that stage of technology where we all were back in the 20th century. You are probably doing at least as well as I was at that point. And that’s your problem. You are comparing your results with people who have continuous glucose monitors and insulin pumps, some of them semi-automatic and even automatic if you are willing to work on it. They vary the basal rate perhaps hundreds of times per day, and deliver insulin doses in increments of .01 unit or less. My control is the best it has ever been in 50 years, and it’s not because I suddenly got good at managing my diabetes.
You probably have reasons for using injections, but if I were in your shoes I would ask myself what I can do. You are doing all the right things with diet and exercise, but if you are like me there are limits to what you can achieve with daily injections. You are not a hopeless case. You are not “light years” away from better control. It’s here now, but in my aging opinion it will help a lot if you can find a way to upgrade your medical equipment.
7 Likes
Thank you for this (@bkh and @Eric) - i’m hearing multiple shouts for Levemir, based on my lifestyle. I think it’s available for me too, so shouldn’t be too difficult to switch. So that i’m not completely ‘shooting in the dark’, i might come back to you once i have some in-hand for your thoughts on an initial suggested dosing strategy, and how i might adjust for a day off or a heavy day of exercise. I weigh 62kg and typically exercise at c. 7pm each night, eat at 8-9 and go to bed 11:30 or so. My current Tresiba dose is 16u each night, although i undertstand it isn’t like comparing apples with apples.
1 Like
Interesting, i haven’t heard of it. How fast, vs Novorapid? I tend to find it is the latency of both insulin and carb intake that makes managing this disease so difficult.
Truly baffling to me. Very well done. I have managed a s.d. of 45 since i got my CGM a week ago, down from 65. But 25-30 seems other-worldly to me. That’s really impressive.
That sounds good. Once i’m moving up, which i often am, i struggle to keep it below 180, and if my eye is off the ball it’ll be far higher.
Thank you very much - yes, feels like Levemir + CGM is worth a go.
4 Likes
Yep, could totally get that dialed in if you want.
Based on your weight and dosing, you would be in the 12 hour ballpark. If you did a 6:30am-7:00am Levemir dose, it would end around the time of your evening exercise.
And then if you take your 2nd Levemir at night with dinner and mealtime bolus, and it would end right near the time you are waking up. So your day would be covered, with a small gap of zero near exercise time, which would work well.
Another nice thing about this - your basal ends when you are waking up. So if you have a nighttime low that you are not waking up from, your basal would eventually end! This is a very nice safety measure, it prevents you from the hypo-sleep, where your basal keeps going and you stay low in your sleep. I like the idea of basal being over when you are supposed to be waking up!
5 Likes