Are you attributing that to tresiba? Sounds like a breakfast problem…
Well, it’s identical to the breakfast I had for the week so far (bacon and eggs). Typically I’ve been rising in the morning and doing 1-2 unit boluses throughout the morning (including at breakfast) to stay stable.
I think it’s probably the start of hormones. I usually have a few days where all my doses get very inconsistent before I start running high constantly.
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@Jen, one thing I can’t quite understand is that you had these big daytime peaks when you were on a higher dose of Tresiba.
I understand that you don’t drop at night any more, since you lowered your dosing a lot compared to the early days. But it is strange that you don’t have these high daytime peaks: I was expecting they would get worse as you lowered your dose. But they mostly went away. It seems to me that these may be two different phases in how your body reacts?
I am really pleased that you seem to be ironing out how Tresiba works for you, though. I really admire how persistent you were: I would have been stressed by the constant highs and lows for 3 weeks. You are a gutsy person! Even if you don’t stay on it in the end, it is really good to know that you may come back to it and trust you can have a way to make it work (eventually…). Fallbacks are good to have.
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I think the highs earlier on were due to hormones. They’ll be back in a few days, most likely. I’m curios to see whether I’ll be able to ramp Tresiba up quickly enough to deal with them.
So far, I’d say my experience with Tresiba has been “okay” now that things are more stable. I’m still not seeing overnight flatness other than that one amazing night, and I’m having to make numerous adjustments during the day to stay in range (which is much more annoying with shots). At this point I’ll likely return to my pump, but I’m willing to stretch this experiment out until my box of pens is used up as long as things continue to be decently controlled.
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Just a historical aside …
Actually several brands of pump were in use in 1995. I got my first pump in 1981. I think the MiniMed 506 was launched in '92, and when I started using the 507 in '94, there were a couple of other makes on the market (can’t remember which). True, they weren’t as common as they are now, but neither were they novelties in the mid-'90s.
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In 1995, I recall that Novo pens were around and pumps were expensive so I didn’t get one (I recall that they are probably the same price then as they were now in actual dollars).
I started on MDI and began using pens in 1996 with good old R and NPH.
So you were an early adopter 
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Just an update on the rest of the day before I head to bed:
After my post-breakfast low, the high peaked at about 13 mmol/L, which I corrected. I proceeded to gradually come down over the next five hours, went low again, treated, went low again, treated. Had dinner which caused me to go a bit high. Let that ride for a few hours while I was in class, then corrected, and proceeded to go low two hours later on the way home.
I’m going to stick to 10/10 and see what happens overnight tonight. Usually I have several up-and-down days like this before I need to ramp all my doses up significantly.
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Update before leaving for work:
Stay in range until 2:00 when I dropped low. Of course, I slept through the alarms all night (somehow, even though I do remember waking up to check!) until I woke up. So I spent about five hours in that low before treating.
I’ll stick with 10 units of Tresiba this morning, but may go down to 8 tonight, at least temporarily, if I continue to run low.
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Aaaaand I’m halfway to work when I realize my insulin case is sitting on my bathroom counter.
Tofay’ll be interesting. I work a 15-20 minute walk away from a pharmacy. I have a 45 minute lunch break. So I suppose I could try running up theee, but then I wouldn’t eat.
I think since I’m eating so low carb I’ll just go without blousing. I may run high, but it shouldn’t get ridiculous.
That’s one advantage of the pump. lol
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Maybe a good day to do a forced basal test? I hate it when I leave my insulin case at home, and always turn around (swearing to myself) since it also has all my testing supplies. Luckily I don’t have a class of kids to teach and I live pretty close to work, so I can be more flexible. Sorry, I really empathize with you.
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Sounds like basal test day…
Also, and this is clearly way outside of my wheelbase, but have you considered ovulation testing to better predict when your basal needs are going to shift? Could be useful when on a pump, but particularly when using a basal like Tresiba with a longer dosage change lag time? Anything we can do to minimize insulin uncertainty seems worth trying.
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I am so sorry 
Raging.
Any way you could leave a set at work, in the future? Just in case? We have a spare set at school for that reason. It has helped before.
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I wasn’t able to do a full-fledged basal test because I did end up eating some bacon and eggs before leaving. I also decided to take 8 units this morning, just because I’ve been having so many lows lately. I know not all lows are related to basal, but when I’m having 6-8 lows per day plus overnight, my endo suggests lowering basal.
I rose from 3.3 mmol/L in the mornign to around 6.5 mmol/L, and stayed between 5.5 and 6.5 mmol/L all morning, so that’s pretty great (I didn’t bolus for breakfast). Around noon and early afternoon, however, I dropped by about 2.5 mmol/L, so did end up eating part of my lunch to avoid a low. (This time period corresponds to another low period in my basal rate, along with the early morning hours.) Throughout the afternoon I’ve had to eat about 15-20 grams of carbs to avoid going low, althoug by doing that my blood sugar has been running between 4.1 and 5.1 mmol/L, so it ended up being a great line.
On my commute home I ended up dropping low for real, despite trying to head it off with three glucose tablets. This is a time period that I had ongoing issues with lows for about a year before I began setting a temporary basal rate for about an hour and a half an hour before leaving work. Not sure how to deal with it on MDI other than eating a snack without bolusing.
I’m not sure how much Tresiba I’ll do tonight. Probably 10 units and then start splitting 9/9 tomorrow.
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You’re a pump free champion!
That’s pretty awesome. You made it through the day as well as could be.
Heh, I’m not sure I’d consider myself a champion yet. Aside from my one great day, all these other days have needed boluses or eating at regular intervals for at least half the day and overnight to stay in range. Sure, today I stayed in range very well because I could eat every 30-60 minutes during the afternoon since I was sitting in an office doing administrative stuff all day. If I were actually out teaching or consulting, that would be a whole different story (that’ll be next week - a much more varied schedule).
What I’d like most is to start spending most of the night in range. So far, out of 23 days, I’ve had 1 night where I stayed in range. All other nights have had hours spent high or low. It would be nice to figure out how to fix that.
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I understand full well that it seems exceedingly complex… but to dial it in for mdi we want to narrow it down to what’s going on betweeen, say, 6 hours past dinner and when you’re waking up…
I also want to tell you I’m proud of what a great job you’ve done… you had a hell of a handful and it wasn’t easy. I also want to congratulate you for trying this despite your preconceived understandings. At the same time I want to caution all others to understand that their preconceived understandings don’t dictate their future—- that’s the very concept of progress is moving beyond our preconceived understandings and it applies just as much to basal insulin as any other topic…
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I thought people may be interested to know that, since beginning to split the dose, my standard deviation has gone from 5.1 mmol/L to 1.7 mmol/L. Really dramatic difference!
Otherwise, for the five days since starting to split the dose, I’ve had 78% of readings in range (4-8 mmol/L or 70-140 mg/dl) and an average BG of 6.0 mmol/L.
Overall, this is similar to control I’d achieve with my pump (while eating low-carb). Certainly much better than the first two and a half weeks!
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If titrating Tresiba to such a narrow window, does it hold you steady throughout the night and day without having to make 6-10 interventions (outside of eating) to keep it in range? That’s been my experience the past several days. I’ve had good control, but even on that amazing day, I had to do multiple boluses and eating carbs (basically sugar-surfing) to stay in range. If I’d just forgotten about diabetes for a few hours, I think I’d have drifted high or low. That type of micro-management gets really tiresome and difficult after a while.
Anyway, if just focusing on that overnight period (which would probably be 10 pm till morning), then I’m holding steady for the first half and experiencing drops during the second half. Not as much of a drop as before, but about 3 mmol/L (54 mg/dl) each night.
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