I’m convinced more than ever my first time with Tresiba wasn’t a fluke or giving up too early - it just isn’t right for me. I am still waking up with the worst DP I’ve ever had. I need more basal when I am in court for my job due to stress/anxiety, which I could easily do with my pump or simulate pretty well with Levemir by taking my morning shot earlier and taking slightly more. Even though peaople complain Levemir peaks cause lows, they can be used to an advantage. There is no way to do this with Tresiba - it’s just flat and runs at the same rate all day.
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That is also its strength, of course. You certainly have a valid point.
Are you intending to try @cardamom’s MO (adding metformin)?
Yep, it’s a strength and a weakness depending on what your needs are. For many the flatness is probably a godsend since it prevents nighttime lows. I do well with lows, it’s the highs I can’t take! I don’t think metformin is a bad idea, it’s something I might look into!
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So I’m finding this challenging even with metformin, although it certainly helps that I have no DP, in a way it’s just created another problem.
Yesterday I was high after breakfast, spent some time in range in the afternoon, then high again after dinner. This pretty much corresponds with how I have my pump’s basal rates configured (i.e., I think the highs are due to basal variations, not carb ratio variations).
I went to bed at around 8 mmol/L. At around 2:00 AM I dropped to about 4 mmol/L. But then at around 4:00 AM I again dropped low for hours and hours on end (even with snacking on glucose tablets for the remainder of the night).
I’m debating what to do next. I can’t keep having massive drops overnight like this, which has happened for a majority of my nights on Tresiba. So I think I need to lower the dose until I stay pretty flat overnight, or at least can go to bed high without dropping so much that I still end up extremely low. But then I’ll have more massive highs to deal with during the day. And of course all of this is just for now, knowing that in two weeks or so I’ll probably get hit with massive highs again like when I started Tresiba. But if I can get this dose set mostly right, then maybe when the highs come I could just up the dose by 10 units and be successful that way.
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Not that it helps us in any way, but I think we’re definitely proving those wrong who think the variations are caused by pumps!
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@Jen, could the daytime highs be due to needing to cover more of the fat/protein in your diet? Maybe that was being covered by the increased basals in your pump? Although if that worked well, there’s no reason not to do it that way, and I could def see an argument for that being an easier way to handle low carb eating.
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@Jen, I am sorry this start appears so challenging :wince: I have a feeling that major regimen changes often become major endeavors for many of us. It is certainly true for us and the pump.
I wish we could help more. At least I hope you know we are all pulling for you;
I also think this thread will be a major help to others in the upcoming years. Thank you for being willing to write it up!
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The basals in my pump I set by fasting through meals, so I don’t think they were covering any fat/protein. Fat/protein is something I did feel (even with pumping) that I should cover, especially when eating low-carb meals. I don’t think what’s causing my highs during the day at the moment, though, but of course I could always be wrong.
But…there’s a limit to how nitpicky I’m willing to get on MDI. Part of the value of switching to MDI, I thought, was simplicity compared to the pump—not having to deal with as many variables and choices. On MDI, I’m finding boluses way more of an effort than they were on the pump (on the pump I could do a quick 0.5 unit bolus in five seconds without moving; not the case with shots). Doing micro-corrections and extended boluses to cover fat/protein after every meal is something I’d be willing to tackle with the pump, but not so much with MDI if it would add even more shots to the 7-8 per day I’m already doing.
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Makes complete sense!
Maybe at some point I’ll consider doing and documenting the reverse experiment—I can definitely imagine both ways the pump could improve control and simplify things as well ways I would dislike it, but hard to say without trying. It seems like a lot more time, learning, and money involved to do that experiment though.
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Yeah, it’s definitely more effort to go from MDI > pump than pump > MDI.
Both have pros and cons. I think the key thing is that there’s no one “best” insulin or regimen or technology. Diabetes and all of our lifestyles are so varied that we each find what works best for us individually.
I’ll stick with MDI for at least another week and a half. But if I’m still trying to nail down a reasonable dose by then, I’m switching back to my pump (in fact may give OmniPod a try, if they’ll lend me a PDM).
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Yep, they all suck in one way or another. The best I’ve read about is the MiniMed implantable pump, but of course Medtronic stopped development of it.
I agree if you’re having consistent lows overnight then it’s too much… the night time trends are a much more sterile environment than daytime to evaluate for this… lot more going on in the day
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I agree with this but would add that we need to find what works best for us through experimentation not just assumption… just like you’re doing with this experiment
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A lot of people do this, though. Keep in mind that everyone currently on a pump has (with very rare exceptions) done MDI before moving on to the pump, many for years and through multiple insulins. I spent 15 years on shots going through several types of insulin as they became available before deciding on the pump, and then tried several types of insulin in my pump as they became available. So I actually think most people on pumps, if they gave MDI a fair run first, have done experimentation before making their decision, which can’t be said of people who have just always done MDI and never given the pump a try. Granted, some people may just land on what works for them from the beginning and not need to experiment any further.
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True, but there have been some pretty phenomenal advances in mdi, (and even more if we include afrezza in that category), since the time many people made the decision that pumping is superior… I would wonder what percentage of people went strait from R and NPH to pump even
I wouldn’t really consider R and NPH to be “MDI”, though, at least not with two or three shots a day the way most people did it back in the day. So, yeah, if someone went from R and NPH to a pump, then doing modern-day MDI might be worth trying.
Like I said in an earlier post, I don’t know any pumpers who say the pump is “superior” without also mentioning the downsides (which is always covered in pump training). Maybe there are some out there, but most people I see praising the pump are praising it for the way it helps their lifestyle, not necessarily the best treatment out there for everyone with T1.
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I think out of the nine nights I’ve used Tresiba so far, seven or so have been low or dropping. So tonight I’ll probably do 35 units or maybe 34 and see how it goes.
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@Jen, looking back at your first 2-3 days, now that you are deeper into it, what would you have done differently? Do you have advice on the early startup sequence?
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I think I wouldn’t have bothered to increase the dose to 40 units and then back down. Although it’s so hard to say how much is Tresiba “kicking in” over that first week, how much are my own changing insulin needs, and how much might be other factors (such as the holidays).
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We have failed miserably at trying to find that perfect time to make big changes, we always seem to plan well, then life jumps up and bites us in the butt. With that said, we have not made a big change and settled everything in without at least 3-4 weeks of trial and error. It sounds to me that you are right on track.
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