I haven’t been swimming the past two days, but I definitely plan to try some swimming to see how I’d handle lows. On a pump I’d do a combination of disconnecting/bolusing and then a temporary basal rate. It did a pretty good job of preventing extreme lows (and highs), though often I’d still drift a bit out of range.
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That’s hilarious. I saw my endo today and discussed using Tresiba, and swear to God he said I’d probably need about 20% less basal.
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Are you going to try Tresiba? What are you using now?
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Are things smoothing out this afternoon?
Nope! Sitting at 19.3 mmol/L and rising (after eating, though). It seems that I bolus a big correction, it brings me down to maybe 10 mmol/L, but then a few hours later as soon as it wears off I go shooting off into the teens again.
I’ll definitely be upping my dose by four units when I take it in a couple hours.
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Yeah 4u is a very conservative increase… that’s only about 10%. Keep your head up it gets better when you get to the right dose
Another way to think of it, if we consider the duration to be 40 hours, is that an extra 4u is only 0.1u / hour… can crunch some numbers with that and your rising trends in comparison with your isf
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Right now I’m using Humalog with the Omnipod. I asked about several things. I asked about switching to Novolog, because some people find there’s less of a “third day problem” (although limiting my initial bolus seems to have dealt with that). But he nickered like a horse and shook his head. Then I said I was looking forward to trying Afrezza for stubborn highs, and he said he didn’t think it was coming to Canada because there wasn’t enough demand. Then I asked about using Tresiba and he said if I wanted a pump vacation that would work fine, just ask. I was disappointed with my A1c, which went up from 6.8 to 7.1 (though for decades it’s been anywhere from 9 to 12, so we’re maybe nitpicking), and I said I’d like to see it lower and of course got the orthodoxy about too much risk of hypoglycemia and I said people I know online are getting into the low 6’s and even the 5’s without frequent hypoglycemia and he brushed that off and I wondered if maybe I should look for a new endo because this is the chief of endocrinology at a major big-city hospital and I kinda hoped he’d be a little more on the cutting edge but anyway thanks for listening.
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Yeah, but since Tresiba is so long-acting, if I overshoot and end up low (which is not hard to do for me), then I’ll be dealing with non-stop lows for 24 hours or more. An endo once told me that I was sensitive to insulin not in the fact that small doses affected me, but in the fact that there’s a very precise dose that keeps my blood sugar in range and anything outside that perfect dose sends my blood sugar way out of whack. I find that to be true. It’s one reason why I feel like my blood sugar is so sensitive to everything. The tiniest thing sends it shooting off way out of range, when someone else may just experience a minor high or low. So it’s conceivable that three more units is not enough, four units is perfect, and five units is too much and will send me constantly low. With the pump I was more comfortable being aggressive because if I overshoot it was a matter of an hour or two before I could correct things, rather than a day or two…
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Yeah, I had an old endo who said he thought my A1c of 7.3% was “perfect” for me and that he’d be happy if we could get 50% of my readings to stay in range. I wouldn’t say he was horrible, but he certainly didn’t really seem interested in helping me aim for tighter control. And then I moved and got referred to a new endo anyway, so it all worked out in the end.
My current endo has T1 himself and is amazing. He’s on top of all the new developments, recognizes that I know a lot about my own diabetes, and is happy to let me try anything I ask for. What city do you live in? I’m not sure if mine is taking referrals for new patients (he seems pretty busy), but I believe @Aaron managed to get in to see him and is just as happy as I am.
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I’m not in your city (though I did live there in my 20s). I’ll ask around. But my CDE is brilliant and I would hate to have to move away from her – after close to 25 years she understands me and my relationship with my diabetes (does that make sense?) and respects my limits and reasoning (I am not at this time, for instance, going low-carb, except by accident), and it’s actually her rather than the endo who introduces me to pumps and the CGM and suggests different insulins and reading interesting studies and stuff.
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So has he every used any exogenous insulin himself? Endos know so much that isn’t true.
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Highly recommend Dr. Bruce Perkins at Mt. Sinai (used to be at Toronto General) if you’re in my city and able to see him. He’s a t1 himself, is up on all the lastest technology, and always treats me like an adult.
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I like Jen’s endo. He is pretty awesome but only lets me visit him every 6 months for a chat.
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I just took dose three. Kept it at 36 units because of the downward trend I had overnight last night. I’m currently at 5.8 mmol/L and am going to try really hard to keep that in range for the next six to eight hours so I can go to bed in range tonight.
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Question:
Is there any reason I couldn’t take two or four extra units of Tresiba this morning (rather than waiting until my usual dose time in the afternoon/evening) and then take my same 36 units this afternoon/evening, and then take 38-40 (depending on whether I take two or four extra units) tomorrow?
I’m still running high non-stop, so clearly made the wrong call about not adding some extra units to my dose.
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Per the package insert here in the USA (I don’t know if Canada’s is exactly the same) you could take today’s entire dose any time that’s more than 8 hours past yesterday’s… so you could just take 40u sometime this morning and then take 40u again whatever time you want again tomorrow…
I think taking an extra 4u would be like peeing into the wind at this point!
Okay, I’ll take 40u at some point this morning. I’m pretty sure the information is the same here in Canada. It just seems so weird!
I’m going to start with 4u and then go from there. Will it take another three days to see the full effect?
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Well… in a scientific sense I suppose so, but if your levels are continuing to skyrocket I’d take the 3-day advice with a grain of salt… the main thing is to just not end up constantly adjusting within its stabilization period and chasing your tail… if it’s clear you don’t have enough then it’s clear you don’t have enough
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I’m being conservative because I’m nervous that my insulin resistance will suddenly end and I know Tresiba takes a few days to ramp up or down… I could just see myself adding eight units and then in two days suddenly needing 20 units less than I’m currently taking…
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Interesting development. I’ve been hovering between 5.0 and 5.5 mmol/L for the past two hours. No increase in dose. I’m about to eat a low-carb lunch, so will see if it lasts. If it does, I’ll stick with the same 36-unit dose for the time being.
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