I think it’s because when I started Tresiba I were already in the middle of hormonal stuff when we started at 36 units and worked up to 40 units… This time I was only taking 18 units when this hit. I’ve worked it up to 28 over the past few days, but that’s still way below the 40 that I was taking before… I’m going to try taking 20 units tonight and see how the weekend goes.
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There’s no way you can get a better stranglehold by adjusting your correction factors, additional corrections, etc? If nothing but chasing it around with basal can work then I’d have to admit MDI might not be best for for you
When I was pumping I used to have to increase both basal rates and bolus ratios by 50-100% to control things. I’ve been doing corrections every hour or so throughout the past few days and the insulin just disappears (I think because it’s “sucked up” by what my basal requirements have ballooned to), so my BG doesn’t lower at all.
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See thats the thing though… it’s the same stuff with a pump… so regardless of what you’re calling it you’re just taking more insulin… with mdi adjusting your basal continuously isn’t really an option… although we conceptualize them differently when we’re talking pumps there really is no difference… there is no difference between a 150% basal rate for 5 hours and a mathematically equivalent extended bolus (for example). As DNS said constantly, “how many legs does a dog have it you call a tail a leg? 4– calling a tail a leg doesn’t make it one”
So with mdi the tools that are available and reasonably practical to adjust on the fly really falls way more into the bolus camp, which is completely seperate and distinct from the basal camp on mdi, and not just conceptually… feel like I’m babbling, am I making any sense ?
I’m not talking about temporary basal rates, though. I’m saying that I would adjust the permanent “background” level of insulin my body got by 50-100%. The difference is that, since rapid-acting insulin is being used in a pump, those changes kick in over a matter of two hours or so as compared to three days. But in both cases it’s “basal” insulin (or background insulin, or pre-programmed insulin, or whatever you want to call it).
In medical terminology, “basal” just refers to background. It’s the level of insulin that counteracts the glucose output from your liver and is supposed to hold you steady overnight and while not eating. Whether it comes from a pump infusing over 24 hours or from an injection that absorbs over 12-24+ hours, it’s conceputalized the same way. “Bolus” just refers to a large amount of something that’s given all at once. With insulin, that’s either an injection or a large amount infused over a short period of time.
On the pump, even increasing my basal insulin from 24 to 42 units and my carb ratio from 1:14 to 1:7 and my correction ratio from 1:3 to 1:1.5, I’d still have to correct more than usual to stay in range.
If I were to not adjust basal insulin at all, I think the only other way to have any semblance of control over all of this would be to give a big correction every hour or two day and night. In fact, most of my experience on Tresiba has been having to give a correction every hour or two throughout the day, even when I was running in range.
I was already finding myself having to do up to 12 injections a day to maintain the decent control I had for that one week (and that level of control was equal to “average” control on the pump, not equal to my best days). So maybe I’d be able to control the present situation by giving up to 26 injections…but I’d say that’s getting a little extreme.
And I haven’t even had a chance to get to how I’d handle exercise on MDI. That’s where I used temporary basal rates the most on the pump.
I understand completely… but with mdi you don’t have that versatility of being able to adjust your basal rate every 2 hours…
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I’m not saying I change them every two hours. Just that when I do change them in situations like this, the changes kick in over two hours rather than three days.
Outside of computer-driven APS systems, I don’t know anyone who goes around fiddling with their basal rates every two hours…
I understand what you’re saying, I promise
I’ll see how a 20/20 split goes this weekend.
I’m almost done my current pen, and I’ll decide when I’m done it whether I’ll go back to my pump or keep going with the other three pens.
I’m feeling like a month is a pretty fair run with Tresiba at this point.
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Last night I actually managed to get down to 6.8 mmol/L and hover there for about two hours before bed. I took 16 units of Tresiba. However, I woke up at 3:00 AM to find I’d risen to 17 mmol/L, so I took a correction. Very gradually came down until I woke up at 6.3 mmol/L at 6:00. I bolused for breakfast and crashed to LOW on my Dexcom (2.2 mil/L on my meter)about two hours later, so hopefully I won’t rebound from that.
This morning I connected my pump and I am not sure if I’m going to take a dose of Tresiba. My third pen has been used up, so I’d be starting a new one, and I dunno. I’ve been increasingly missing my pump and lately SO sick of running so high unless I have rapid-acting insulin in my system every couple of hours.
I feel like even if I did fiddle around enough that I could get Tresiba to work for me (which I think would take much longer than another month) that it would overall be far more work than it is with a pump. So far my life has been so repetitive and I have not seen any long-term stability in my BGs or settled on a “right” dose for me that holds me relatively steady all day without constant attention from me. I feel like my BGs are still highly variable even without infusion set issues, which is something I always wondered about when I was pumping. But overall, I felt very limited in my ability to adjust doses with Tresiba. Bolus adjustments are great, but unless you’re willing to pay attention to diabetes constantly throughout the day and night (which I am not, I like to sleep!), there are limitations to what they’re good for.
In my (totally subjective) opinion, I’d say the pros and cons of the last month have been:
Pros:
- Tresiba is a very steady insulin, if that’s what works best for your body
- It was nice not to have to worry if a site was working
Cons:
- I’m not sure why, but I found splitting the dose more successful than one injection a day
- For me, 10+ injections of rapid insulin a day to maintain control is not sustainable
- I dislike doing injections in public spaces, which is necessary when doing 10+ a day
- For me, Tresiba did not hold me in range even overnight - I had 3 out of 32 nights where I stayed entirely in range and didn’t drift high or low
- About 3/4 of the last month have been spent with the worst control I’ve ever had
- I greatly dislike the Tresiba pen - Novo, please come out with Penfills so people can use NovoPens!!!
- Having to remember to put insulin in my bag each morning (I forgot once)
- Having to remember to take a shot before bed (several times I went to bed and had to get up again to take my shot)
- Having to get up to do corrections overnight
- I hate having to manually log and manually calculate everything
- I miss having access to insulin on board
- I miss being unable to suspend insulin delivery
- I don’t like being stuck with a mistake or wrong dose for 24-72 hours
- I don’t like being unable to rapidly adjust basal insulin to fine-tune control
Anyway, that is just MY experience using Tresiba for a month. Tresiba undoubtedly works great for many people! I wouldn’t let my experience stop you from trying it. I may give it another try in the future, but right now I’m feeling extremely burned out from the whole experience. I have another three pens left plus some refills, so I could give it a longer run at some point if I wanted to. But right now I just need to gain some tight control over my numbers so that I actually feel like I’m in control of my diabetes again.
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Sounds like it wasn’t a good fit for you… the only way to determine that was to try it, like you did… i think everyone owes it to themselves to give it a try… and if it’s not a good fit they shouldn’t hesitate to go back to something that works better. I still think that it will be an excellent fit for many people who are currently using pumps…
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@Jen, you gave it a pretty darn good try, and you endured a lot. It’s too bad it did not work out 
Thanks SO MUCH for sharing all your experiences with us in this try-out, @Jen. This is one of the best threads that I have EVER read.
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I hope this thread is useful for others transitioning from a pump to Tresiba, especially those who may have highly variable glucose readings. If I do give Tresiba another try at some point, I feel like I’d be in a better position from this experience. I hope others will document their trials of Tresiba and other treatment options. My next trial will be of the OmniPod! 
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Ha, I’ve been running a total basal of 40 units through my pump today PLUS the 16 units of Tresiba I took last night, plus correcting every hour or two, and I’ve STILL been above 11 mmol/L (200 mg/dl) all day (except for my random low this morning). Just crazy!
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Have you considered trying the untethered method with Tresiba? I’m thinking of trying it as the lack of ability to extend boluses or bolus discreetly in public is getting on my nerves lately!
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I’ve thought of this, and I think Tresiba would be really good for it. I tried it with Lantus a while ago and didn’t see any huge benefit.
Currently I spent the whole night running low, so I think at the moment I just want to get Tresiab out of my system and my basal rates set. lol.
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Looking forward to it!
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I totally agree. I commend you for your willingness to give it a solid try. I’m hoping soon your numbers will be back to a point where you’re feeling healthy and in control.
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I spent the last two or three nights with a flatline and my daytime numbers aren’t above 8 mmol/L unless I eat high-carb stuff like I am today. The pump is definitely a much better fit for me. Out of interest, my basal on my pump ended up at 43.5 units currently, so I would have had to increase Tresiba substantially to have it cover those basal needs.
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Thank you for sharing in such detail. It was very helpful as I conducted my own trial of Tresiba. I could relate to so much of what you experienced. I am now back on my pump, hating the inconsistent skin reactions that cause me to go high until I figure it out, but loving the convenience of varying basal rates, being able to turn down the pump for exercise, and the ease of bolusing on the run (or even while I’m working with children)! Take care and I wish you well!
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