Yeah that’s pretty much what I was taught with long acting basals too… including the fasting through meals part—-
What I mean is that where your pump basals varies throughout the day but don’t with tresiba would become evident and managed by different ic ratios with mealtime bolus—- the cells in our bodies don’t care where the insulin comes from, they just care that the right amount is there at the right time, if we’re not managing that through varied basal with a pump then we’re managing it with bolus, and we’d likely see those changes as different ic ratios
That makes sense. Even on the pump I had differnet ratios at different times of the day, even with the differnet basal rates throughout the day (hence why I list two rates as “normal”), and that would also vary somewhat by activity level or exercise. But that’s all fine-tuning stuff. First I need to just get to a day where I don’t have massive highs or lows…
I’m also curious what the point of this is, if you can’t adjust basal to deal with it. Is it just so you know that if you want to skip lunch you’ll have to eat a snack, and if you want to skip dinner you’ll still have to bolus, or whatever? I skipped meals incidentally on Lantus, but didn’t do it as part of titrating the dose.
Skipping meals is super valuable with MDI too… it can tell you tons of different stuff… virtually any pattern can be noticed and strategies to cope with it made and applied, but it’s super important to be able to discern what effects are being caused by meals and what’s happening outside of them… only way to do that is to skip the meal
I haven’t tried a one injection a day basal yet (maybe I’ll be the next Tresiba candidate after you have reached the end of your test cycle?). I’m a two injection a day basal user, which I did for many years with Lantus and the last seven or so years with Levemir. With two injections a day, the night and day fasting tests can be used to adjust different timing or amount of the two injections. I have always found that I do better with equal injections in the morning and evening (thus I might be a good candidate for Tresiba), but I had to move the evening injection to be quite late (11 pm) to better address dawn phenomenon in the morning. Timing of the once a day injection of Tresiba might be useful for the same reason (e.g. morning vs evening), but doesn’t sound like it would make a huge difference.
I have a lot of trouble understanding your precipitous drop in the early morning, which sounds like the reverse of dawn phenomenon, since I’ve never seen that myself (except maybe back in NPH days but that would be for a whole different reason). It doesn’t make sense to me that you would drop so much if the only insulin you had active was from your basal injection. You mentioned elsewhere that you take inhaled steroids during the day, is it possible that these lead to insulin resistance during the day, which finally resolves in the early morning leading to the drop? Or could the metformin you take (which I also don’t take) somehow become dramatically more active at that time? Sorry but I’m grasping for straws here.
It’s a combination of metformin and I-don’t-know-what. I used to have a massive dawn phenomenon, but over the years that’s lessened. I started taking metformin this past summer to see if it would a) help me lose weight and b) help with my hormonal fluctuations, and that’s the point at which 4:00 - 7:00 timeframe became the lowest basal rate of the day for me. My only guess is that metformin has decreased my overall basal needs, but that it’s especially evident in that timeframe because it’s when my liver was used to be most active.
Also, over the years I’ve gradually lowered my carb intake until I was at a very low-carb diet (30 grams a day), and I think this probably also contributed to the lessening of my DP.
I take inhaled steroids twice a day, in the morning and evening, so I doubt that’s the culprit.
My 1:6 breakfast bolus seems to have worked brilliantly, as long as I don’t go low in the next hour or two. I did 5u of the bolus as an IM injection and 6u as a regular injection. I ate 60 grams of carbs (cereal) and no rise that I could call a spike (I peaked at 7.2 mmol/L). (And no, this is not a typical breakfast for me, but I have several high-carb things sitting around that I want to use up.)
I am so impressed it worked so well! We are hardly able to get to 15 carbs without spikes at breakfast It is wonderful, especially given your regular low-carb regimen.
Also, if you’re wondering why I did 11 units total and not 10, it’s because my target BG on my pump is 5.0, so I decided to also correct down to that using a 1 mmol/L correction factor.
Two and a half hours after eating my CGM is reading 5.0, but my meter is reading 6.0. So I didn’t get down to what I’d targeted, but I landed literally exactly where I was before eating.
Most of today was good up until tonight, when I’ve again spiked to 18 mmol/L despite taking 20 units of insulin at dinner, between carbs and correction. I just took a big correction, so hopefully I’ll be back in range by bedtime.
My 1:6 ratio today (and 1:5 at dinner) has seemed too low, so I’m going to go with a 1:4 ratio tomorrow, which also seems to fit with @TiaG’s suggested way of calculating things.
I’m really beginning to wonder whether the strength of Tresiba does wax and wane rather than being perfectly steady… Maybe it’s stronger during the first 8 hours (when I’m getting the huge drop) and becomes weaker closer to the time of the next dose (when I’ve been spiking). Maybe “stronger” and “weaker” aren’t the best terms, but I’m wondering if splitting it might help even those two times in particular out a bit.
I haven’t skipped dinner - but it happened the other night with a salad, which is inexplicable to me (the sala salad didn’t contain enough anything to drive my blood sugar up that high), and has happened with other low-carb dinners. There have also been nights the rise has started before I actually started eating.
Last night I ended up going low after my big post-dinner correction. But I treated and managed to actually go to bed in range (4.8 mmol/L).
Howver, at around midnight I rose rapidly to 9 mmol/L, and then began a gradual rise to 15 mmol/L until 4:00 AM, when my BG turned around and began dropping. I was 8 mmol/L when I woke up around 8:30 AM.
I’m a bit confused at this point as to whether 22 units is too much or not enough. The last two nights I’ve had both significant rises and significant falls overnight.
I’ll admit, I’m struggling with whether to continue this. I’m almost three weeks in and am still trying to figure out this initial baseline dose. As of Monday, things are going to get much more complicated with my regular worktime routine resuming. If I’m struggling this much to find a baseline dose when I’m on holidays and each day is largely identical, I’m feeling a bit pessimistic that I’m going to find a dose once I add in all the variables that come with work and school.
One useful piece of information I’ve seen so far is that my blood sugar variability doesn’t seem related to pump site absorption issues. That’s something I really wondered about. So even just three weeks has been useful in that regard.
Could it be that you have to look at the average of 2, or even 3 consecutive injections to correlate results? You have not been at 22 for 3 nights on a row, so you cannot quite compare the two consecutive nights as having equal Tresiba.
If Tresiba ends up affecting you for 3 days (that’s what my endo clinic says, which I do not take at face value, but I do know that, for many, Lantus has a tail effect over 2 days even if the dose does not last that long, or even a day for some), I would be inclined to use the following formula for a current dose:
Yes, I’ve done 22 units three nights in a row now. The 35-unit mistake was on Tuesday night, so I’ve done 22 units Wednesday night, Thursday night, and Friday night.
I think the dose you inject is probably stable in the first 24 hours, but the tail from the previous day or so may not be, since that eventually needs to taper off. If you look at the function graph, you’d expect some variability/wave-like action as a result of that. Might be very mild in some folks, with the waves overlapping enough to create even coverage, but maybe less so for others.
Hi Jen- After 7 1/2 years of pumping (adult onset T1D 8 years ago), I too am doing a trial of Tresiba (and Novalog injections for boluses) due to allergic reactions at pump sites. I am now on my third day of Tresiba and have been experiencing highs in the afternoon/evenings and lows at 2:00 a.m. Last night I remained low for the rest of the night and into the morning, even with repeated glucose treatments. Frustrated, I did a google search and found your thread. I could relate so much of what you shared- right down to the concerns about going back to work in schools on Monday! I’m going to try lowering my Tresiba dose from 14u to 12u tonight and see if that helps. This requires so much patience! I really miss the ease of bolusing and correcting with the pump and the ability to set temporary basals for exercise. I also have a separate basal profile for PMS on my pump, but as I enter peri-menopause, it isn’t always so predictable. I also miss the ability to micro-bolus since the smallest I can do with a pen is .5u. Thank you for sharing your journey- it’s comforting to know I am not alone!
It is wonderful, especially given your regular low-carb regimen.