Tresiba for Everyone?

He’d be safer on tresiba…

are you referring to @ClaudnDaye’s son?

Referring to all people with t1 diabetes…

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well, whether that’s the case is debatable but certain no matter what, if you’re on insulin, you run the risk of a dangerous hypo overnight. So there still needs to be some plan in place that is robust and can protect people in these situations.
Obviously, situations where hypos are baked in overnight or very likely will inherently be less safe because whatever safety net situation you devise has to catch more situations, increasing the risk of sleep deprivation and poor decision-making.

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I am not sure you are right. What works well for you and adults with a somewhat more regular regimen may not work for kids that have heavily varying basal needs. We have tresiba at home but we haven’t tried it yet because my son’s basal varies so much. I understand tresiba is forgiving, but it could well be actually worse than lantus for a person with highly variable insulin needs.

I guess the only way to know is for such a person to try it out. But until then, I am not quite ready to pull the trigger.

I’ve had zero dangerous hypos overnight. I am certain though that I would have if I had an insulin pump dumping however much insulin into my body it happened to be set on throughout the night. Pumps introduce way too many variables and Lantus just doesn’t work all that well. Tresiba is a godsend. I’d be willing to bet if a lot of parents tried it neither they or their kids would want to go back to a pump or Lantus…

@Michel I suspect your thoughts on variable basal would be different following a period of trying tresiba

What are the significant differences between the Lantus and Tresiba?

If the AP is shutting off when he gets to those points, is that not enough to keep him from still drifting down?

maybe but there are also many parents who have tried it and have gone back, at least based on some of the word on the street I’ve heard. Not to mention it was only recently (like in the last 5 months) approved for use in children so many pediatric endocrinologists will not prescribe it yet.

Also, I think your experience, while certainly an important data point, is perhaps not indicative of what it’s like with a toddler or child with T1D. People who are diagnosed in adulthood typically have much more stable BG profiles than those diagnosed at the youngest of ages – often because you had some stable insulin production left. Adults with T1D, even longtime adults, also typically have more stable BG profiles that are easier to control. The parameters seem to just work out to make it easier to manage. Not to mention that as far as I know you can’t dilute Tresiba, or at least not with any approved product.

it does shut off. His insulin is off most nights for HOURS. Maybe 4 or 5… but sometimes he still goes low. I’ve lengthened the DIA but I suspect there really is a time of night when he literally needs zero insulin. This is corroborated by the fact that when his pump is off all night and he has developed ketones, his BG is still nevertheless not very high…

In my observations tresiba just lasts long enough to stay in a state of equilibrium whereas Lantus is constantly in a state of wearing off or being recharged which threw my whole system into a state of more dysfunction. Also, for me, I don’t have exercise induced lows with tresiba like I did with Lantus… I would assume this is due to its more stable absorption which isn’t accelerated with exerciseike Lantus is

I’m on Tresiba, and it’s great for a regular schedule, but I know if I suddenly change my basal needs (which for me honestly most often happens because I had a few drinks, but same effect can occur from intense activity/exercise) and hadn’t adjusted my dose in anticipation/forgot to go to bed at a higher level, I can have prolonged hypos overnight. They do tend to be slow/gradual ones, but they can be very persistant/hard to treat. So no, even as someone who generally loves using Tresiba, I do not think it would be safer across the board, and would not recommend it for someone with highly variable basal needs.

from what I understand, the way Tresiba works is like it’s a long polymer chain with the insulin molecules integrated into it. It sits in the subcutaneous tissue and one little monomer of the polymer, along with an insulin molecule, breaks or unspools off at a predictable rate every so often, so the odds of having pools of insulin that suddenly enter the blood stream, etc. is lowered. So it can be released more slowly and more steadily.
At least, that’s my very rough understanding.

I do agree with Sam that generally, Tresiba is much more stable than Lantus, and I’d recommend trying it to anyone on MDI with a fairly stable schedule/basal needs. On the whole, my control has improved considerably with it over Lantus. Worth the occasional hypo issue as described above (which I usually I am able to anticipate and prevent).

yeah drinks can cause overnight low trends there’s no escaping that… not really the insulins fault though, and if drinking on a regular basis not difficult to adjust for.

It may not be great for everyone, but I’d strongly encourage parents to not let their thoughts on variable basal rates discourage them from trying it. It was my own insistence that I had variable basa rates that brought me to my doctors office requesting something different… I explained the whole thing to my doc who pretty much said (in as many words) “I understand what you’re saying, but it’s all BS… try this instead”. And it turned out he was 100% right in my case… much to my surprise

Sure, but I find that intense exercise works similarly in terms of driving lows, so if someone sometimes engages in intense exercise but sometimes doesn’t, I don’t think I’d recommend Tresiba.

I haven’t heard any success stories FOR CHILDREN where Tresiba is concerned. Not saying they don’t exist, but I’ve just not read about any. Kids BG’s are so much variable and extreme than adults - there is a reason T1 in babies/toddlers/children/adolescents is often considered an entirely different disease when compared to T1 in adults.

I definitely fit that description precisely and I find that it works great for me in that regard

I haven’t really heard of too many parents using it with their children. I suspect the number of success stories will be directly proportional to the number of people willing to try it.

Same for me. I couldn’t use it for that reason. Plus the different rates I need at night for exercise or other factors.

Ideally, they would have basal insulins that fit into specific durations that you could easily use in a 24 hour day.

Five different basal insulins that were 4, 6, 8, 12, and 24 hours. You could mix and match to fit any profile you wanted.