Thankfully, right after I posted that it appears to have started dropping. 
Yay! I’m getting a bit of physical activity by trying to figure out where the plug for my Christmas lights (which are attached to my fake Christmas tree) are. LOL.
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After a few more corrections, BG is down to 6.1 mmol/L! Assuming all the food and insulin equal out, now the real fun can begin. 
Insulin on board should be mostly out of my system in an hour and a half to two hours, so I’ll report back in the morning about whether I flatline overnight or not.
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I hope it levels out! I’m tempted to try Tresiba again given your bold experiment and that I have 4 pens left in my fridge! As well as Levemir works for me, I find I spike if I eat a late dinner around the time my morning dose is wearing off and evening dose hasn’t kicked in yet - I have yet to find a carb ratio that consistently prevents this!
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Sadly, no flatline nor in-range readings last night.
Last night I went to bed at around 6.5 mmol/L at 11:00 PM (with food and insulin on board), but then rose to about 15 mmol/L by 4:30 AM, and then that turned around and started slowly dropping until I was 11.6 mmol/L by the time I woke up at 8:00 AM. So it seems to me that maybe Tresiba is stronger, since I dropped last night but not the night before.
It would still seem that the Tresiba dose is overall too low, since the only thing that got me down into range was a massive correction last night, but on the other hand, I did drop by 3-4 mmol/L over the last part of the night. I’m definitely going to skip dinner tonight to try and get a clearer picture of what’s going on.
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Well you’ve had many high trends and zero low trends since starting it, it seems… so I would agree that overall, thus far, the dose appears too low… I suspect an increase may prove to be necessary, although I’m hesitant to suggest increasing before day 3, given the rates at which your bg seems to be generally climbing I’d be having a hard time talking myself out of it if it were me
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I was just thinking maybe it was stronger because I never have a downward trend unless insulin or exercise is causing it. If I’m high and don’t take insulin, I’ll flatline there for hours. So the fact that I dropped from 15 to 11.6 makes me think maybe the dose is getting stronger. If I’d actually been 6.5 overnight, that kind of drop would have ended up in a low.
I’ll see what happens today and decide later today if I’ll increase the dose by a couple units or keep it the same.
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If in doubt I’d keep it the same… after 3 daily doses I think you can be reasonably certain that you’re getting the full value of it…
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I feel like I might increase the dose by four units tonight. Or maybe just two. Not sure. But yeah, if I run high all day today, I’ll increase the dose.
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Well those are very small increases compared to what you’re saying you’ve done with the pump suxh as 50% increases etc… and they won’t kick in fully on the first night, so they aren’t unreasonably high risk imo
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I thought I’d done all my increases by going from 22u basal to 36u basal a week ago. But I guess Tresiba works differently, so maybe I need more of that than rapid insulin in the pump.
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I’ve heard a lot of times that pumped basal just tends to require less units than long acting… sure that varies to everyone, but it’s just kind of an apples to oranges comparison even though it’s not supposed to be in theory
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Yeah, I’ve heard some say to decrease insulin by 20% when using the pump compared to shots because the basal is distributed in a more efficient way that exactly meets the body’s needs. When I started on the pump I’m pretty sure my doses stayed the same, though. But that was 11 years ago, so I’m sure things may have changed since then with my body.
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I heard the 20% less thing but it wasn’t true for me. I assumed it was a “safety” number that they give you until you get all the rates figured out correctly. I know it’s different for everyone. Quite possibly someone’s MDI dose was too much or too little before starting the pump, so they always want to start you at less to be on the safe side.
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I remember reading in several well reputed books that pumped basal generally requires less Due to to its absorbtion/infusion mechanism, so I think there’s more to it than just the safety factor… although that’s likely a consideration for any insulin switching.
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The 20% number is funny because there is some online thing that gives advice on switching all kinds of insulins. Levemir, Lantus, NPH, whatever. And somehow, remarkably, no matter what you are switching from, it is always 20% less. Wow, what are the odds!
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Well yes the 20 percent less under any circumstance is a safety margin that makes sense but I have read the pumped basal versus long acting thing well outside of that context also
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Levemir to Lantus, 20% less.
Lantus to Levemir, 20% less.
I wish I had the computing power to decrypt their algorithm!
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Always remember that a unit is unit, except when it isn’t. That advice right there will keep you safe.
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I have to say that EH and I don’t have an emotional bond to insulin pumps. 11 years on MDI until this November. Loved being unteatheared and feeling as normal/unlimited as possible.
However, it is so much easier from a bolus perspective (yes, yes, I know this thread is about basal insulin testing) with the pump it’s amazing. No finding the bag, the kit, the pen, the needles (and EH had it down and is very organized), no priming, no putting it all away. Just. Press. Some. Buttons. No need to haul it all out again in two hours when you realize the 1u correction didn’t do anything for some reason.
When he started with Triseba from MDI the endo made a calculation error and EH went low for about 24 hours. So stacking with the long duration of Triseba is something to keep in mind for any future readers of this thread looking for hints on how to switch. Also, doing distance running and using Triseba didn’t seem to be a good fit for EH. It just wasn’t up to not causing lows.
I think everyone should try a variety of options if at some point they find what they are doing is not working for them. However, everybody is different.
@Jen , I really hope that this will be a great thing for you, and you’ll have better management than you already do – I think you’re doing a great job, even though it doesn’t feel that way sometimes.
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Thanks! It really doesn’t matter to me which turns out to work better - MDI or pump - I just want to explore all my options.
And I agree about not having an emotional bond to my pump. I used injections for 15 years and pump for 11, and in many ways the pump is superior for management (well, we’ll see on that one) and my lifestyle. I don’t really care which tool I use, but I’ll use whichever one has the most benefit for me (which may be different for different people). I feel like 15 years and 11 years are both enough time over a long enough period that I have a pretty good handle on all the pros and cons of each.
Also, with a pump I could literally bolus a correction in the middle of the night in bed without ever turning on a light or even moving, aside from moving my hand to the touch bolus button on my pump. I did the same things while in the middle of teaching, in meetings, while waiting in a lineup at the bank, while walking down the street. Sure, I also did shots in lots of public places, but there’s no comparison about how quick and discreet a touch bolus is.
I’ll probably persevere through this box of five pens I have (plus the one I’m using), which will last me about a month and a half to two months in total, and at that point decide what to do long-term. The only way I’ll stop early is if my control continues to be totally messed up for weeks, in which case I’ll go back to my pump on the weekend of January 6-7 (I go back to work on January 8).
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