I don’t understand it either, since Tresiba works for a lot longer than a day. But if it works…
Yeah it was one of dr Bernstein’s televised webcasts, which to put it bluntly are getting kind of sad / hard to watch——- he explained that it lasts so long then said to take it twice a day “because they lie”… whatever that means
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Possibly he means that it is flatter this way? That is the only thing it could be, if you spread the Tresiba load into more injections. But then @Scotteric would see no benefit. Hmm…
I suppose it’s possible that just smaller injections could be better for absorption in some cases for some people in which case 1/2 as much 2x daily would be helpful for some people
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It may come from people’s experiences with Lantus, which was claimed to be a 24 hour insulin but doesn’t actually last 24 hours in most people, nor does it have a perfectly flat profile (lots of people noticed a gradual peak around 6-8 hours). My guess with Tresiba is that it probably lasts 24 hours, but maybe it does have a slight peak and waning to its activity. I haven’t watched that particular teleseminar in a while, so can’t remember what reason Dr. Bernstein gave.
I think tonight I’m going to do 22 units and see what happens with the overnight drop I keep getting.
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I think it is supposed to last at least 42+ hours, with a strong influence over 3 days
So that would mean that last night you saw (28+35)/2 = 31.5 (were you at 28 the night before?), and tonight you will see (22+35)/2 = 28.5.
Then tomorrow night, if you go to, say , 25, you will be at (22+25)/2 = 23.5
So, I know @Sam will probably hate this, but the pumpers may find it interesting in light of my current experiment. This isn’t changing anything, just interesting data.
Out of curiosity, I went back to my pump and looked at the level of the lowest basal rate of the day (the one during the period when I’ve been dropping overnight), and it’s at 0.7 units an hour (when my overall basal rate is at 24 units). If I extrapolate that out to a flat 24-hour basal rate, that equals just over 12.5 units per day.
My basal hasn’t been that low since I was like 10 years old, so I don’t think I’ll be able to lower my dose into that range. Just some interesting data if I find that I keep dropping during that period no matter how low I take it.
During my “high” basal needs, the rate for that same time period is 1.2 units an hour, which equates to 29 units a day if I extrapolate out to 24 hours.
Just thought this is interesting to throw out there, it’ll be interesting to see what I end up taking.
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“When your total basal dose is 24 units”—— Your total basal dose is 24u—— why consider multiplying the lowest hour of the day by 24 ?
Eta Ok I see what you’re saying—- but you’re still applying pump logic which makes sense if we’re using rapid acting insulin trickling in for basal… different ballgame here
Because we’re titrating my Tresiba dose to target that overnight drop, right? That drop occurs when my pump is set to deliver the lowest rate of the day (the rest of the day it’s delivering more insulin, so the total for the day equals 24 units, or 36 units, or whatever depending on where in my cycle I am).
Interestingly, I didn’t find today bad at all for lows. I bolused normally for food and, other than tonight when I’ve sort of purposefully let a high ride (why correct if I’m just going to have to create another high in a couple hours), I didn’t run high and only really had one point when I started dropping rapidly (early afternoon) and had to treat a low.
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I’m also taking this MDI experiment opportunity to read the new edition of Think Like a Pancreas to see what Gary Scheiner suggestes for things like determining basal rate. I read the older edition maybe 12-14 years ago when I was taking Lantus, so it’s definitely been a while.
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It could be an absorption thing, but I tried splitting the dose and taking it at the same time and couldn’t get 24 hour coverage. This is working so far, and I still think it makes Tresiba valuable because I can take it at any time in the morning and anytime at night vs. Levemir which had to be taken at the exact same time or there were problems. I don’t see any ramping down/up between doses either which is awesome.
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This is amazing. I guess, once again, the amount of difference in how our bodies deal with such complex phenomena between us all is staggering.
@Jen, how did the night go?
I’ve been catching up on this thread and what’s up with @Jen’s experiment and was wondering if splitting the dose into two different sites could make a difference? I’m sure I’m falling into the “pump logic” camp presently, but the OmniPod malfunctions after injecting too much into one site. Could the absorption be limited if you’re injecting 20+ units into one spot for MDI? It’s probably a very unscientific suggestion, but I thought I’d throw it out there.
And, Jen, I’m glad you’re fine. I think everyone’s injected the wrong amount/type at some point. It sucks. These things happen.
When EH tried Triseba, his doctor recommended too many units and we didn’t catch the math error until it was too late. Took a couple days to sort that out. He did have those drifting lows overnight though. And it wound up being less Triseba than the other insulins he took.
Congrats for your persistence and willingness to try out something that wasn’t easy!
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I think it’s very unlikely that Tresiba doesn’t last 24 hours in people like Lantus. Lantus seems to last 20 hours for most people, and that kind of makes sense when you look at it’s action graph, that it could end up falling a little short. For Tresiba to do that, it would have to be acting extremely differently in those people. However, what does seem quite possible is that the timing of the tail into the next day as it tapers off screws with people and causes uneven coverage at points, and that effect is mitigated by dispersing that more with multiple injections.
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Also, glad everything worked out ok @Jen! I’m kind of amazed you’re still trying this, and impressed!
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I took 22 units last night.
I went to bed at like 22.8 mmol/L or around there. I did take a couple units with the food I’d eaten, so I came down to about 14 mmol/L by midnight, drifted down to about 10 mmol/L, up to about 14 mmol/L again, and then at around 3:00 AM began the steady drop down. At 6:00 it hit about 7 mmol/L and levelled out quite a bit (in that it wasn’t quite so steep), but continued down to about 5 mmol/L, where it was staying pretty level when I woke up at 10:00.
This seems promising to me and, really, just waking up having been in a normal range for the past five hours—which I think is the longest time I’ve spent in target range since starting Tresiba—I feel soooooo much better (and happier) than I have most other mornings. 
I’m probably going to skip breakfast this morning because I woke up so late and am not really that hungry and have some errands to run.
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I figure that if I’ve started this, I may as well give it a fair run. I figure three weeks is a fair run to find a ballpark correct dose, and if I’m still trying to find where that is come Sunday night, I may still call it off. But it really depends on how I’m feeling on Sunday…if I feel like it’s going well, I’ll keep it going, even though I am curious/nervous about work and school changing up everything again.
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So, I am very late to this conversation, but I think that @Sam and @Jen are both right in a way. To me, basal/bolus is a conceptual framework that doesn’t tie so neatly to physiological processes in the body as much as all the experts claim. Whether the reason Jen needs more insulin is because she has higher basal needs or because she needs more insulin for her food during the day is ultimately not the most important issue: In the end, no one wants “the perfect basal” or “the perfect bolus” values: What they want is to have the flattest and most predictable blood sugars on average with the least number of interventions (either shots or tweaking of ratios and rates).
To me it’s like this: On any given day, you have an amount of insulin that you needed at each time point that would have kept your BG perfectly flat that day. For any given day in the past you could calculate this, and you could calculate an average insulin profile for any given past period of time (days/weeks/night/day), but you have to make a guess as to what will be needed tomorrow. This “perfect” insulin delivery varies day to day and just how much it varies depends on the person. From what I can tell, @Jen seems to have more unpredictable insulin needs than average, even with meticulous tracking and logging.
On the other side of the equation you have a big arsenal of tools – mostly insulins with different activity curves – which you can combine to try to create the perfect amount of insulin delivery for all times during the day.
The best insulin treatment is therefore somewhat subjective, but roughly speaking it’s one that requires the fewest number of steps to remember or interventions (aka low treatments) on average and does best at dealing with times when insulin need varies from what you predicted it should be… For some people it may not be possible to keep you absolutely flat all the time without increasing the possibility for huge and dangerous excursions.
Anyways, the long and short of it is that I believe it’s theoretically quite possible to achieve the right insulin profile on any given day using either pump or MDI, but for some people it may be more parsimonious/convenient/effective/safe to use shots, while for others pump may come out ahead.
But I don’t think it’s productive to try to define the underlying physiological reason is for a specific patter seen on any given day or week. The reality is you need more insulin during the day than during the night, @Jen; if you want to stick with shots, the task is then just to figure out what MDI regimen could conceivably match your insulin needs reasonably well. That may mean you have to take huge meal boluses and have a very strong “correction factor” while using a very low dose of long-acting insulin. And maybe that just won’t work very well, because realistically achieving your ideal average insulin profile would require too many shots or some opaque reasoning that’s not very reproducible. But you won’t know till you try it.
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Yeah, I think this is what’s going to end up happening. Today I skipped breakfast and lunch and I rose by about 2 mmol/L, which isn’t bad, but it’s something that I would have given a correction for if I’d known about it. Then I ate 17 grams of carbs but miscalculated and only dosed a unit for them, which was off by enough that I went up to 10 mmol/L. So I took a correction for that, which did not quite bring me down into range, so I took a second correction. So it appears both my carb and correction ratio are going to have to be quite high compared to what they normally are, and that when I want to skip meals I may have to take a correction to offset any rises that happen, even without food. Especially when you consider that my 35-unit mistake is likely still affecting me to some degree today.
But overall today has been the best day I’ve had so far, even though I’ve been skirting my high range for most of it. I’ll continue with 22 units tonight and see what happens.
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This is ultimately what it will come down to for me. Even if I get to a Tresiba dose that keeps me pretty steady, if it requires that I take 10 shots throughout the day to stay steady, that may be reason enough for me to go back to the pump. I will probably extend this experiment at least until the end of my first week at work to see how that plays into everything before deciding one way or the other. I’d also like to keep going until hormones hit again, because how I’m able to cover those changes with Tresiba will be another factor in what I ultimately decide.
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