Pump vs Tresiba

[Michel]

@mentat

No, it’s not available here yet.

Where are you located?

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

[Eric]

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.

[Chris]

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…

[Chris]

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?

[Eric]

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

[DuckFiabetes]

YDMV (Your Diabetes May Vary)

[DuckFiabetes]

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

[Sam]

@Eric

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

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

[Eric]

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

What do you do if you need to change?

[Sam]

If I need to make a change it becomes apparent over days or weeks that my trends have become predominantly upward or downward and I adjust accordingly and leave it alone for a while

[DuckFiabetes]

The 8 hour window is a beautiful thing! I’ve fallen asleep, woke up in the middle of the night; injected my Tresiba and not skipped a beat.

[mentat]

@Sam

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

I have heard similar stories from others but I just can’t imagine getting similar results. Is Tresiba secretly a “smart” insulin that acts more the higher one’s sugar is? Occasionally I get crazy liver dumps that send my sugar to 15 (270) by morning if I’m on a flat basal. Other times I need a flat basal all night.

Things are crazy during the day as well. Here’s the latest: usually my basal needs plummet after I wake up or after breakfast, but over the last two weeks I have needed much more basal after breakfast than I do before breakfast! My breakfast hasn’t changed; I’ve tried increasing my breakfast dosage but this causes lows; and if I skip breakfast I still need heaps of basal.

At least during the day I can sugar surf, but I hate the constant interruptions in my life. If I regularly update my basal profiles on the pump, there are far fewer interruptions.

[Sam]

@mentat

Is Tresiba secretly a “smart” insulin that acts more the higher one’s sugar is?

No I don’t think that’s really the case… I think more accurately, previous basals were just secretly “dumb” insulins and caused us to have a lot of misperceptions of our bodies reactions to them… but that’s just my own personal observation not exactly based in science or anything

[Millz]

I just did something similar. Was out watching my husband’s Blues band (in Chicago). Drove home… woke up the next morning pretty and realized I didn’t take my Tresiba the night before So I took it about 14 hours late. Here is how my day went.

[Gus]

Same experience here as Sam and others on Tresiba. While on the pump and especially novolog, I thought my body basal needs changes drastically all the time. Once I removed IOB and got a flat line absorption basal like tresiba, I discovered that my body only has subtle changes. So I do what Sam stated. The approach here is, instead of trying to nail everything perfectly, I have a basal that works most of the time. I correct as needed with Afrezza as I sugar surf all day with my CGM. And at night, if 2 or 3 days in a row I go slightly up consistently, I might think of increasing the basal by 10%. Or if I do some odd training session that is new and particularly intense, I might skip my night dose just to be sure (slow mo highs don’t disturb my sleep as much as slow mo downs).

It used to be that “the tighter your BG control, the further away from a normal life you are” . Tresiba and Afrezza brake this paradigm. Which is what I love about it. It turns T1D management from a full time job to a 2ry hobbie. As Deadpool would say “Minimum effort, maximum impact”.

[Michel]

@Millz

So I took it about 14 hours late. Here is how my day went.

What a terrific track! You should post it in flatliners!

[mikep]

So I’ll comment on this as well. First and foremost YDMV and I’m only speaking from my own experience.

Was a pump enthusiast for many many years and recently (within the last year) went to Tresiba, Afrezza, Novolog combination. Going to Tresiba has actually helped me understand my body a bit more. Let me explain.

While on a pump I had a higher basal from around the 12pm to 5pm time frame, never could really explain why . . . i always just thought I needed more basal and it was easy to adjust on the pump. Then Tresiba came out and honestly the most appealing thing to me was that I only needed to take it once a day, so I asked my endo if I could give it a try.

At first, my numbers were high in the afternoon and I told myself “Self, you have to go back on the pump because you need a variable basal.” HOWEVER, I loved not having the OmniPod attached to me all the time. So I experimented. Once I felt comfortable that my basal does was dialed in on Tresiba, I fasted (did not eat for 24 hours) 3 separate times to test it. Not once, did my blood sugar rise in the 12pm - 5pm time frame, as a matter of fact my basal was rock solid all night and all day.

I fasted twice with my pump on after the Tresiba test and both times my blood sugar dropped in the afternoon.

Needless to say, clearly the increased basal was not required and I was 100% confident that my basal was spot on and comfortable ditching the pump in favor of Tresiba.

Well what was causing my blood sugar to rise in the afternoon? My I/C ratio in the afternoon is higher and I needed more bolus to cover my lunch. Piece of cake adjusting this using Afrezza.

We are all different, one way isn’t better than the other, BUT I do believe as others have said, that Tresiba and Afrezza break the rules/traditional way of thinking as it relates to basal and bolus.