It might be interesting to try. I will bring it up at our next Endo appt and she what our NP thinks. If we wanted to try it cautiously would it be reasonable for a mix? Like maybe 1/2 the Tresiba dose and cut all the basal rates in half? Or does it really not work like that?
I donāt know what youād be trying to accomplish with 1/2 the dose?
Iād go directly 1:1 with whatever youāre using for basal now and adjust as needed after a few days
Some people do the āuntetheredā thing with tresiba and a pump but that sounds absolutely ridiculous to meā¦
Cause I am chicken for too big of a change. lol
I guess most parents arenāt willing to use their kids as guinea pigs? Until Tresiba is tested and approved for kids (especially kids as young as mine), Iām not really willing to try it. I guess Iām just chicken.
Its approved for use in children (actually now approved for younger children than any other basal) and only those willing to try it will potentially benefit from itā¦ itās not like thereās no going back if itās not a good fitā¦ I just know from my own experience that the assumption that it wonāt work well due to variable basal needs can be an incorrect assumption. Happened to me.
again, a function of it having just been approved for kids a few months ago.Pediatric endos are more conservative than regular endos ā they told me they donāt even prescribe Lantus for kids my sonās age, only Levemir, precisely because of their tendency to be conservative.
Unless thereās AI built into Tresiba, it doesnāt make sense to me that it would, or could, automatically adjust to variable BG levels. That just doesnāt make common sense to me. If, one night, my son starts at 80 and goes up to 250 because .05 or .10 isnāt enough, I donāt know how Tresiba would fix that problem. If, the next night my son starts at 80 and goes down to <50 on the same dosages as the night before, Iām not sure how Tresiba would be able to fix that problem. I guess Iām in the phase where I just donāt understand how Tresiba would, or could, do more for Liam than his Novolog is already doing. Either way, Iāll have to adjust dosing frequently for it to work correctly. One dose amount isnāt suitable for every BGā¦that will never vary regardless of what insulin is used. If BGās are never stable, itās hard to choose the right amount.
I am not AGAINST Tresiba by any means! Iām a fan! Iām just not willing at this point to switch from one insulin to another at this stage in his life because either way, weāll be tweaking w/e insulin we may decide to put him on. When he gets older, SURE!
Unless a large part of the variable levels these kids see is due to the dysfunctional nature of the insulin theyāre using itselfā¦ it didnāt make sense to me either. I argued with my doctor about it and thought he was an idiot and giving me something exactly opposite of what I was telling him I neededā¦ but it worked great and he was right
Iām sure they are because they donāt want little kids having major hypoglycemiaā¦ and because the average parents they deal with are no where near as capable or involved as the ones on this forumā¦ which is also why they see kids running around with sky high bg levels and having major complications by the time theyāre in their 20sā¦ none of that changes my thoughts that tresiba is a vastly superior insulinā¦
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Did you ever use a pump?
Noā¦ zero desire to since switching to tresiba. I suspect if it hadnāt appeared on scene Iād have eventually ended up on one though because I was connvinced that variable needs were my problem and that variable basal would be my solution. Glad I got snapped out of that confusion.
Stephen Ponder is a pediatric endo. He ditched the pump for tresiba himself I believeā¦ what does he recommend for his pediatric patients? I have his book but havenāt read itā¦ I was under the impression that he was an advocate of a steady basal rate and presumably tresiba
Tresiba is active for 42 hours, Lantus for 18 to 26. Tresiba is more forgiving of lows, and very flexible in injection timing, but cannot be adjusted as fast down.
iām not sure if he prescribes it to toddlers. I agree with you that some fraction of people with variable basal rates may simply have variable action of insulin in their body due to how itās delivered via pump ā I suspect that itās not necessarily intrinsic to the type of insulin as much as it is to the vagaries of the pump site, however.
I was having all kinds of false observations of variable basal needs while using Lantus with MDI so itās not just a pump site issueā¦ I guess my main point is thereās no harm in trying it, nothing to lose, and potentially a lot to gain for people to try it even if it doesnāt automatically make sense to them that it might be helpfulā¦ can always go back to what they were doing beforeā¦ although I certainly never will
well for parents of toddlers there is certainly something to lose. For instance my daycare does not administer shots (and in some states there would be many daycares where only a nurse is legally allowed to administer shots), whereas many more caregivers are willing to administer insulin via pump.
Also, the pump shows me all the boluses delivered by caregivers and therefore lets me know IOB at all times, and it allows, for instance, caregivers to bolus for just a fraction of my sonās meal upfront and then automatically bolus more as his blood sugar starts rising. Using this approach he rarely goes over 150 or 160 after lunch and also has a low risk of going low. This would not be the optimal solution for an adult who can be trusted to eat all his food, but i has been a lifesaver numerous times when my son seems like he would gobble something up, only to lose interest or worse yet, puke everything up. And itās an advantage very specific to our pump.
Also, every single shot we give our son, he has to be restrained. Probably at some point that would subside but I doubt heād consent to having, say, four pokes of insulin for his lunchtime meal.
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That does somewhat explain the benefits of bolusing with a pump for a toddler in daycareā¦ but tresiba is still a superior option for basal in my case anyway
This. Itās why I am always saying that itās not easy to compare adult T1 to toddler, baby, or āchild in generalā T1. There are a lot of variables that are easily accounted for in adulthood that arenāt able to be accounted for in childhood. (as you indicated, and the same with Liam, heās so excited about X food! Then I fix it and he says āActually, Iām fullāā¦Just one example of many including inexplicable highs and lows.)
weāve thought about doing something like administering Tresiba for basal and then just leaving the pump hooked on him for meal/correction boluses but our endo doesnāt prescribe it for his age group and itās really not worth it at this point to switch to, say Levemir + pump. Heās doing pretty well right now with just his pump ā sure he is not in the nondiabetic range but his current avg BG is about 125, which is about an A1C of 6.0 in many people.
But I am very cognizant of the benefits of having a long-acting in his system in terms of DKA prevention and if I ever do get my hands on a sample we might try it for something like a vacation to Hawaii or San Diego where weāll be out in the sun and exposed to water all day. I think thatās probably the only way weād change our system right now ā weāre pretty happy with our system, all things considered, and changing it up right now would be too much added craziness.
I get thatā¦ bolusing for a toddlers has to be a nightmareā¦