FUDiabetes

Pump vs Tresiba

I talk to a lot of T1’s and T2’s for my job as Mannkind Patient Advocate. While most of the time I’m talking about Afrezza I certainly get my time in with Tresiba. Now full disclosure, I have never been on an insulin pump in my 34 years as a T1. I honestly couldn’t stand the thought of being attached to something 24hrs a day (ironic since I wear a Dex and love it). My question is, wouldn’t you (pump users) rather take one injection of an amazing basal insulin and do away with a pump? Now hear me out. Most pump users I talk to love that they can adjust their basal rate. When technically aren’t you just adjusting your “fast” acting insulin? Your “fast” acting insulin works much differently than a basal insulin. Newer basal insulins like Toujeo and Tresiba don’t have a peak, unlike “fast” acting insulins. So with Tresiba I don’t ever adjust my basal rate. I take the same amount of Tresiba if I were to spend 8 hours in an office or on my bike riding 100 miles. No adjustment needed. No pump needed. Add into the equation Afrezza. The beauty of Afrezza is that its so rapid in and rapid out. I can eat my pre ride meal in the AM and have no fear that my “fast” acting insulin is still working in my system for 3, 4, 5 hours after injecting. Same concept works for when I go to bed. I can comfortably go to bed with a bs of 70 and wake up with a bs of 70 because my Afrezza is already out of my system and the only thing that is working is my basal insulin.

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I couldn’t agree more… I’ve tried to express the idea countless times that people are actually adjusting for an insulin than absorbs irregularly, but people who pump swear up and down that it’s a function of their own bodies psychological mechanisms. I disagree somewhat… I don’t imagine I will ever use a pump. I believe pumps are an outdated concept for most applications. I have great results with tresiba, and couldn’t imagine having a pump attached to my body…

Look how many reports we’ve seen of pumpers ditching the pump for tresiba and being thrilled vs tresiba users switching to a pump…

At one point in history, when pumps arrived on scene, and NPH was the most consistent basal out there, maybe it was a godsend to be able to trickle in R 24 hours a day instead… ever since then their benefit has been reduced more and more by more effective insulins… with the advent of tresiba, i honestly think it’s just the big pharma ‘pumping’ more profit out of them that’s keeping them relevant… though that could change with more advanced AP technology than we currently have, but I don’t think we’re there yet… of course those are just my thoughts

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When we used MDI, we had difficulty sleeping in and skipping meals. Perhaps we had our basal set to high, but I don’t think so.

With the pump, my son regularly pushes meals out with no ill effects, and sleeps in until noon on some days with a flat line if we did our part to knock the growth hormone high out in the middle of the night.

For us, the change to the pump was quite helpful. Our basal rates currently vary considerably for different times of the day, and allow us to handle variable schedules and activity levels easily. Finally, when going low we often turn the basal down and with just a few carbs are able to land very comfortably without eating very many calories.

Now I know you guys using affrezza have soft landings, but that wasn’t our experience with MDI.

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Pumps give you a very small amount of insulin every few minutes. There is no “peak” because it is almost a continuous infusion of insulin, and only in a small amount.

Think about it like this - if you write enough small dots close enough together on a piece of paper, they can form a line:
Pump basal looks like this ==>…

Put enough 0.05 unit injections into your body a few minutes apart, and you will have a straight line, no peak.

That’s exactly the way the non-diabetic pancreas works. For basal, it spits insulin out every 3-6 minutes.


The omnipod is essentially the same size as the dexcom sensor.


The problem with Tresiba is the lack of ability to adjust. If you don’t need adjustment, it can work well for you. But for people that need to adjust their basal amounts, it is not very practical. I adjust basal all the time, that’s why I don’t use it.

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Well, the thing is, if you have never tried Afrezza and injected basal instead of a pump, its hard to describe it. In other words, how do you know that your need of custom basals is because of a “biological predisposition” but not instead to compensate for the inevitable iob/stacking that comes with using rapid injected for everything? And I don’t say this in a challenging way, YDMV, just from an experimentation perspective. Before Afrezza, there was no way of testing this other than a paleo diet, but now you can give it a try!
So for me, I had 100% the same experience as Sam and other Afrezza users. I couldn’t have possibly imagined or realized before Afrezza that custom basals where really to compensate for IOB of rapid injected. Which is why many “pure” Afrezza users ditch the pump.
I get how pumps work, I used it. The problem is, when I used rapid as basal, I developed IOB, there was no way around it. Example: 9-5 in the office, because I am sedentary and mostly sitting down, I needed a higher basal during the day. And this was with a VERY low carb diet. But, at 4pm I wanted to go training, so I needed a custom basal to compensate for all the basal while being sedentary. So that need for a custom basal came from IOB, not because my body had a special need.
With Afrezza, there is no IOBs, so injected slow basal works like a charm, after some tuning. But the key, at least for me, is to use Afrezza for everything other than basal. And the simplicity of this model is just wonderful.
Don’t assume that there are people that need adjustments in basal and others that don’t. I dont think is a biological need. Hey, I am the living example of that as I was there (I know, n=1) I think is more of trying Afrezza+ injected basal and see if the model fits your life. That’s all. But if it does, it will give you a level of simplicity and freedom that is just impossible to get with a pump, as those are complex by definition.

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@Eric, If you want to experiment, I know how you could get a hold of some (legally of course). PM if you want to try.

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Well, kind of, but not really. Because you are using injected insulin that has a different pk/pd than human insulin. Especially for degradation. And of course on non-diabetics they can block insulin when its not needed, which unfortunately doesn’t work in T1Ds using rapid injected, because its different (the whole exhamer thing, versus human (and Afrezza) being monomeric, etc.). Fascinating topic indeed.

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The reason I know is because I have used injected basal for 45 years. The last time I used it was Thursday. And stacking is not inevitable. It depends on the dose and timing of injections.

Not sure what you are saying. You believe everyone’s basal needs are flat all day and all night, regardless of what they are doing?

I have both Tresiba and Afrezza in my fridge. I have used them both. When I say they are not a good fit for me, it is because I have tried them. I’ve tried it all.

I think Afrezza can be a good tool to use for many people. But if I am at 130 and I have 5 miles left, there is no way I would want to inhale Afrezza for that. The smallest dose would knock me flat.

For me, its use would be limited to meals. I could not use it for small corrections.

I think the premise of this discussion is flawed. The idea that it’s one or the other is wrong. You can use the best tool for the job, whatever fits. Sometimes you inject, sometimes you puff…

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That’s very valid… my entire hope with afrezza was that it would completely replace injected bolus for me… but still I end up using novolog frequently… although worthwhile to note that the better physical shape I’m in (and I’m not a triathlete or marathon runner like you or Gus) the more I tend toward afrezza…

I’ve often wondered which I would chose if I had to decide on one of the other for the rest of my life. I certainly hope I never have to make that choice… I don’t want to play 18 rounds of golf with only a driver and a putter… or fish for every fish in the sea with only a trout rod or a marlin rig…

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Interesting, it never crosses my mind to correct a 130 when I am exercising. Just curious, why do you do that? Of course, having Afrezza during exercise will make you drop as its very fast insulin. The formula for me during exercise is:
If I am fasting (morning before breakfast), I take my 10U of Tresiba (I split 10-6 AM / PM), and then e.g. ride my bike. Usually at the hour mark Tresiba has killed the morning blues and I see the CGM slowly going down. I eat half a banana or similar and sugar surf during the rest of the exercise (2 hours total)
For the afternoon, I usually need a little priming of carbs before starting: Usually 25-50 depending on when was my last dose of Afrezza (usually 1-3 hours depending on whatever I did during the day). Then I mostly follow my cgm: If it stay flat between 100-140 I have 25gch every 30 minutes. If it starts going up I skip carbs until its flat in the 100-140 range again. If it goes below 100 I have 50gch. Carbs are gu gels.
For swimming its usually 25gch before the 1 hour intense session. I cant remember the last time I went low in the water.
I never ever have insulin during exercise as its not necessary. Tresiba will eventually bring things down from whatever I have. And clearly from my A1Cs and time in range that’s more than good enough control. Hence why I don’t need to microdose with rapid injected.
This is the lowest effort / tightest control way I could achieve. And all thanks to Afrezza. And Tresiba, I found its the most stable basal I ever used.

I feel, why be 130 when you can be 90?

So it sounds like you are just feeding your basal. That’s the advantage a pump gives you. You do not have to feed basal, you can turn it off. And take insulin for specific fuel amounts exactly when you want them.

It is helpful if you want to be able to fuel specific amounts at certain times. Otherwise you are just hoping your basal allows it.

Also, if you want to do a glycogen depletion run and not fuel, how would you do that?

Actual y, i tuned my basal so i can fuel like that.
And remember, my goal is good bg control but being as normal as possible. Having a pump stuck to my butt isnt something I want to do if I can avoid it.

@Gus, how do you deal with not being able to adjust your basal fast with Tresiba? Are you able to maintain a very steady regimen all the time?

My son’s training regimen changes all the time (particularly swimming) and we often have to adjust his basal (Lantus today). We have considered Tresiba (we actually have some in the fridge) but, every time we start thinking seriously about it, facing the constant adjustments seems too difficult.

The problem, for us, is that one week we may have 25 hours of practice with daily exercise, and the next week we might be off for 3 days, only have 10 hours of practice, and 3 days of meets (where you spend 20 minutes in the water all day). My son’s TDD can easily change by 30% week-to-week.

I agree… constant adjustment is a nightmare, a never ending rat race that can’t ever be won… a basal insulin that, at least to a large extent, frees one from that headache is a godsend.

I don’t dispute that some people have more variable profiles than others… but even within those I believe there is a baseline that can be met with a consistent basal, and excursions outside of that basal can be treated as needed, whether preemptively if they’re predictable, or reactively if they’re not, with bolus… chasing around basal profiles throughout life is in my opinion very detrimental to quality of life. Some people manage to do it very well, but they are a tiny minority…

I believe that, in my experience, tresiba is vastly more conducive to quality of life as a T1 diabetic than other basal options…

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The counter argument is that being able to adjust the amount of basal you have in your body on any given day isn’t chasing anything. When you do your shot in the morning or night, you simply take more or less depending on your needs. All you have to do is adjust the dose. That is very easy.

NOT being able to adjust is more like chasing, because you always have to either feed your basal with food, or supplement your basal with bolus.

As an Afrezza + NovoRapid user, I have tried to get good control without a pump, but I simply can’t. There are many reasons but these are the main ones:

  • Pre-dawn liver dump
  • The need for a major basal reduction during the first 3 hours of sleep on days when I have done any real exercise
  • Frequently changing basal needs

Have you tried tresiba?

No, it’s not available here yet. I have recently tried Lantus and Levemir though. Lantus is a pain but Levemir seems to have a pretty flat profile. But a flat profile doesn’t work for me, so I’m skeptical about Tresiba.

I understand the skepticism… as I’ve told others here it was my need for a more adjustable basal (in my thinking) that led me to ask my doctor to switch me from Lantus to levemir. I’d never heard of tresiba at that point. He insisted I try tresiba instead… which more or less pissed me off… I complained so much that he even gave me a sample of levemir too with the condition that I try tresiba first and only use the levemir if I didn’t love the tresiba… that sample of levemir is still sitting in my fridge— contrary to my logic tresiba was a godsend… I hope it’s available there soon-- but the lesson it taught me is that own perception of flat basal not working well for me wasn’t accurate in my case