Jen, you have variable basal needs.
Now that we’ve established that, please bear with me to understand that the way we’ll tackle that is by determining what the baseline is within those variations, and applying tresiba, then managing the remaining fluctuations with bolus.
I understand full well that your circumstances make your diabetes more challenging to mange than my own. That does not in any way make any lesson I’ve learned less valid, though…
We can figure this out!
So what if I fast through a meal and rise (or fall) without eating or bolusing? To me, that would indicate variable basal needs, not bolus.
Given the fact that we have been on MDI for 1.5 years vs 4 months on the pump, and that all of our reflexes are based on MDI, I am afraid your diagnosis is wrong. In fact, if you read back far enough, you’ll see that while on MDI (Lantus), we actually used additional NPH to get the effect of a short-term basal change when we needed it, at times when we had prolonged highs.
But it does not matter whether you are on the pump or on MDI: if, after you have done 3-4 consecutive corrections and you still don’t get where you need to be, clearly, there is a longer term phenomenon underway than one which can be resolved by a bolus.
It is not reasonable to expect someone to keep on injecting for many hours on end every 1.5 hours: this simply does not work in some circumstances that I know we face (we had to use NPH for that when on MDI, and it was a true cross to bear), and that, quite possibly, @Jen is facing too.
I would never say the lessons you’ve learned are less valid.
But I would say that everyone’s physiology and experience with diabetes is different. Just because one person has flat basal needs doesn’t mean it applies to everyone.
It’s the same as how some can eat whatever carbohydrates they want and maintain good control, and they may have valuable lessons to impart. But there are other people who insist that they have to eat a low-carb diet to maintain good control, and they also may have valuable lessons to impart.
Just because two people have different experiences doesn’t mean they can’t both be right.
You can categorize it in your mind however you like. The reality is that to succeeed with mdi that you’ll have to consider them as bolus requirements…
See, to me that is mixing up basal and bolus.
To me it is the opposite; it’s keeping them completely distinct and pure— and through that method I am able to find the results I seek
How is it pure if you’re using bolus insulin to cover basal needs that aren’t met by the basal insulin you’re taking. I suppose you can call it whatever you want, but I think 99% of people (diabetics, endos, CDEs) would call that a basal problem. You’re just using bolus insulin (or food) to correct it, because you don’t really have any other options on MDI.
But that’s because you have fairly flat basal needs. If I recall, you’ve always had pretty tight control, even on Lantus. So you are probably making tiny tweaks throughout the day, not making up for huge deficits (or surplusses) of basal insulin that isn’t matching what your body needs, because Tresiba matches what your body needs almsot perfectly.
Can I ask—and I’m truly curious—if you’ve had any of my experiences so far (highs and lows way out of range that last for hours despite multiple attempts at correction) when you were setting your Tresiba dose? Or ever? lol
Anyhow, none of this discussion changes my plan to stick with 25 units tonight, and up to 28 units tomorrow if I experience a rise overnight. I suppose if I experience a drop overnight tonight I’ll lower my dose more and see what happens.
Ultimately I would like to skip breakfast and eat a late lunch and see what happens.
If I have to bolus every two hours to cover unmet basal needs during the day, I’ll admit, can’t say I’ll be keen to do that long-term.
But we shall see…
Every day you go high and low with results that don’t respond to corrections? That’s really surprising. I think this is a downside of online communities. I tend to see people who have an A1c in the 5% range for years and feel like their control is significantly better than mine, because I’ve never been there over several decades, no matter how hard I’ve worked at diabetes. It’s helpful to know that people with such a good A1c still have stubborn highs and lows on a daily basis. I wish people would share more of that.
I didn’t mean my comment to imply that your diabetes was “easy”, I’m sorry if it came across that way. No one with any type of diabetes has an easy road.
Ah, crap.
I accidentally took 35 units. 
I did double-check the dose. I don’t know what I was thinking… Realized it as soon as I finished injecting. Obviously by then it was too late.
This’ll be a fun 36 hours. 
And so much for deriving any meaning from the next two days or so…
How did that happen? And how’d you realize it happened? Sorry to hear it… this will not make it easier… please use appropriate cautions to stay safe… sorry to hear this
I counted up to 35 and looked at the number 35 before injecting. I have no idea why I had the number 35 in my head and not 25. Maybe because I was doing units in the 30s up until last night and so I just had the 30s in my head…
Well darn
Let me know if you want a remote night buddy tonight/tomorrow night.
I’m going to bed with a BG of 18.6 (ate without blousing). So don’t worry, I should be fine. Also, my mom usually calls me if she doesn’t see me log onto Facebook in the morning, so I’ve got a safety system.
Unfortunately I have the G4, so no follow option.
I’m up. If I’m to glean one useful thing from this experience, it’s that 35 units is definitely WAY too much insulin. I think I need to go buy some food with carbs today, I don’t have much sitting around here. I ate cereal before bed last night (with no bolus, plus I was 14.1 with some leftover IOB from a correction before eating), but that basically used up what I had here, aside from glucose tablets.
My Dexcom was useless for most of the night last night (first sensor day and spent a lot of the time showing HIGH or ???s), but I did get up several times to test:
11:30 - 18.4 (331)
1:30 - 22.4 (403)
4:30 - 16.4 (295)
8:30 - 5.4 (97)
I thought I’d overshot by driving my blood sugar up so high before sleeping, but it looks like it was about where it needed to be.
I’ve got double down arrows on my Dexcom at the moment, so time to go eat.
I’m trying splitting the dose and so far stable coverage all day, which I’ve never been able to get with it before. I woke up at 6.7 which is a reasonable number after late-night wine and pizza, and no noticeable DP like I was experiencing before when I tried it again (my line was near flat on my Libre all night). I thought Tresiba was too flat for me but now I am thinking it just wasn’t lasting 24 hours at the dose I take. Who knows if this will continue to work, but I’d suggest giving it a try if you reach a point where you are ready to give up on Tresiba.
Interesting! I’ll definitely give this a try down the road. You are not the first person who’s reported much better readings with a split dose. When I was on Lantus, splitting the dose made such a dramatic difference that when he saw my blood sugar logs at the next appointment, my endocrinologist said if he didn’t know better he’d think he was looking at someone else’s numbers. So it wouldn’t surprise me much if Tresiba had a similar effect.
Hi @Jen, I am sorry you took too much basal 
It happened to me once with lantus to make a big mistake and I was low a lot for a whole day. Except that for you it will be two days, really sorry.
I have been reading your thread every week. I am also hoping to experiment with tresiba when the swimming season is not on. My basal varies also. I figure if it can work for you maybe it will work for me. I really hope that you can make it work.
So I am sending you many good luck thoughts, Kaelan
Yep, I was splitting Levemir which worked pretty well but I was starting to get frustrated because of the way it still levels off/ramps back up between doses. I was starting to see the impact of this when I would eat late dinners around the time my daytime dose was wearing off and unable to find a carb ratio that would consistently address this. I’m hoping splitting Tresiba will work better since it’s supposed to reach a flat “steady state”, and that I can be more flexible with the times I take it if I sleep in or am not at home.
Good to see you back @Kaelan … I’d not let someone else’s successes or frustrations discourage you from trying all the different options out there!
@jen I have heard of some people splitting the dose… I know dr Bernstein has mentioned it but his explanation of the logic made no sense to me… but if it helps you out then why not… certainly worth a try…