Pump vs Tresiba

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.

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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

Where are you located?

[EDIT] Never mind, read your other post: Australia

On a hunch last night before going to bed, I cut my basal by 25%. I’m glad I did that, it worked out well for me.

I think managing that on Tresiba would be difficult, because that 25% reduction would affect the next two days instead of just one night.

If your basal needs are the same every day, I think Tresiba would be a great thing to use. But if you change from one day to the next, or night and day, it doesn’t fit that profile.

To Sam’s point, the key is to know exactly what your basal needs are. And to make sure it is basal needs that are actually changing, and not IC ratios or insulin sensitivity.

Once you know what your needs are, there are plenty of different insulins available to choose from that can fit what you need. It should never be a discussion about which is “better”. They are just “different”. Better for Sam and better for me are just two different things.

While I think the debate is interesting, it is clear there are at least two approaches (and probably more) that currently can give diabetics very good results.

I personally am not hung up on which way is the “right” way, but if you are, keep going…

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Out of interest, are there other approaches that are currently giving low A1c’s and near flat lines?

Currently it seems the two most popular here are:

Tresiba + fast insulin + Afrezza
Tresiba + Afrezza
Pump therapy

Any others?

I am mostly on MDI now.

95% of my insulin use is made up of:

  • Rapids - Apidra, NovoLog, Humalog with setups for micro-dosing
  • Basals - Lantus, Levemir, NPH

YDMV (Your Diabetes May Vary)

Low carb life style was the only way other way for me to get flat lines and lower A1C’s.

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I’ve gone to bed completely without taking tresiba in the evening like I normally do, taken it the next morning instead, and continued on as normal with my pm dose that evening… without a wrinkle

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But what was the change in nighttime basal when you did that?

What do you do if you need to change?