Tresiba looks like a good basal, but honestly, being able to vary basal is only one of the many reasons we like the pump therapy. Below is a list of reasons we use a pump, in no particular order.
Variable basal settings that are able to deal with dawn phenomena
The ability to give insulin in front of others in an unobtrusive way
The ability to turn down basal when trending low or suspend basal when in a prolonged low
The ability to superbolus for difficult but tasty food choices
The ability to dose in 0.1 unit increments
You only have one âinjectionâ every three days.
Its âeasyâ; and it is well known that pump users are âextra coolâ diabetics.
While you can achieve most of the above with MDI, it is a lot more work, and so we pressed the easy button.
If we could put Tresiba in the pump, Iâd be more prone to trying it. My son HATES MDIâs and thatâs the primary reason we switched to the pump. One âshotâ every 3 days instead of 4 - 8 per day. Also, we have ability to dose in .05 unit increments with the Omnipod.
another disadvantage in my mind is that you canât really dilute it â or at least as far as I can tell thereâs no equivalent to diluent offered for Novolog or Humalog. Although an adult who uses normal doses probably could put it in a pump and see what happens. Wouldnât recommend it though.
Itâs just basal Iâm not sure why itâd need to be diluted⌠who takes less than 1u of basal a day? Even adjusting a pumps basal rate by .05u/ hour is more than 1 unit per day⌠thatâs the minimum adjustment increment for an omnipod⌠isnât it? Am I missing something or does that actually make he minimum deliverable basal rate (assuming youâre not just turning it off) with an omnipod .05x24 =1.2u per day vs a u100 insulin pens 1.0u/ day
No, we can TOTALLY DISMISS basal if we need too. I had to go back a while to find a day, but I have had days under 1u/day of basal. Thatâs our point, thoughâŚwith such small bodies, sometimes we have to totally turn off basal (especially during the nights). We just donât know until whatever situation happensâŚhappens.
But I can an just not take tresiba alsoâŚthe minimum dosage without suspending it would be 1.2/ day wouldnât it? Or am I not understanding what they mean by minimum increment
No, youâre correct. But the pod (or any pump) allows us to a) dismiss basal and b) re-administer (re-start) basal without one, or more shots. If you donât mind shots, youâll be more prone to MDI (thus experimenting with different insulins such as Tresiba). If you donât like shots (and I donât know a toddler who loves them), youâll want to do whatâs best for your baby to give them as little pain as possible. Whatever the easiest route is to cause the least inconvenience and pain to our children, weâll always choose that. At least, I will.
ours has a minimum of 0.025 units/ hr basal.At the beginning our son definitely used that amount and even now there are likely some times of night where thatâs his effective rate.
One issue coming up here is that I donât think the perception of needing different basal rates because of Lantus is at all the same as needing different basal rates because of a pump using only short-acting insulin incrementally delivered. @Sam, I suspect you are like me, in that you have fairly flat actual needs (and would have had fairly flat needs on a pump), but didnât absorb Lantus very consistently/evenly (as many people do not). So your perceived needs on Lantus werenât real, they were an artifact of the not great long-acting insulin as you suggest. However, thatâs unlikely to be the same issue at play for people using a pump, since the insulins used and delivery mechanism are totally different (not to mention the issues discussed for kids with the super low doses). So I donât think you can extrapolate that just because you (@Sam) were on Lantus and thought you needed more variability but didnât actually, that the same would likely be true for small child pump users.
Thatâs probably a pretty fair analysis⌠that said, I also donât think it holds completely true that people who observe a need for a great deal of adjustability while using a pump will necessarily experience the same if using a long acting insulin with a completely different absorption mechanism. But theyâll never know unless they try⌠to put it in perspective-- pumping rapid acting analogs is technology dated 25 years already⌠insulin degludec is cutting edge next generation technology⌠amd one will get nowhere trying to understand the benefits of it without trying it, because weâre still stuck in a Windows 3.1 world in terms of our conceptual understanding of how insulin therapy works
Sure, I think people would have to try it to know. Iâm just saying I wouldnât extrapolate across the two fairly different scenarios. I know there are some pump users who have switched from pumps to Tresiba on the other forumâwould be interesting to know if any of them had highly variable basal rates.
Iâd suggest that perhaps they have perceived highly variable basal rates just because theyâre chasing their insulin around all day and night. Iâd also suggest that thatâs a really tough and stressful way to go through life and that there is a potentially better way thatâs at least worth a try
All I think when I hear this statement is MDI is better than pump. And to me, as a father of a 3 year old who hates shotsâŚthis is just untrue. Toddlers prefer LESS shots, not more. So all else even, Iâll always go for LESS shots above more. And MORE shots equate to more âtough and stressfulâ situations than pumping.
And that goes to one of the hundreds of differences betweeen toddlers and adults.
I think ultimately, whatâs âreally tough and stressfulâ is totally subjective for who you are, and your circumstances. If youâre an adult, self-administering with no dislike of numerous shots per day, you would be more prone to trying different insulins via MDI. If, on the other hand, youâre a caregiver of a toddler who totally HATES shots (as most toddlers do), youâre going to have more of a rough time, and be more stressed by administering MDIâs, than using a pump.
I donât disagree with anything youâre saying⌠and might feel the same way if I was taking care of a toddler myself instead of a type 1 adult⌠but kids wonât be toddlers forever⌠as they get older things may change.
Yes, I agree! Thatâs why I say when he gets older I think weâll be more prone to experimenting. Right now, small changes in doses (Iâm talking as little as .05) can really mean the difference between life and death for toddlers. As he grows, his body wonât be as susceptible to potential harmful effects of experimenting with small doses to see what they do for him.
Terry also noted that his average bg and standard deviation were actually reduced while using tresiba vs pumping⌠but apparently it just want enough of a hobby for him.
Did the same thing with afrezza⌠noted significantly tighter range and reduced hypos while using it, then declared it didnât work well except for corrections
It is my understanding from an explanation that a CDE had given me some time ago and confirmed by wikipedia:
"Pharmacology[edit]
Mechanism of action[edit]
Insulin glargine has a substitution of glycine for asparagine at N21 (Asn21) and two arginines added to the carboxy terminal of B chain. The arginine amino acids shifts the isoelectric point from a pH of 5.4 to 6.7, making the molecule more soluble at an acidic pH and less soluble at physiological pH. The isoelectric shift also allows for the subcutaneous injection of a clear solution. The glycine substitution prevents deamidation of the acid-sensitive asparagine at acidic pH. In the neutral subcutaneous space, higher-order aggregates form, resulting in a slow, peakless dissolution and absorption of insulin from the site of injection.[7] It can achieve a peakless level for at least 24 hours
Acceptance and repartition in the body[edit]
Insulin glargine is formulated at an acidic pH 4, where it is completely water-soluble. After subcutaneous injection of the acidic solute (which can cause discomfort and a stinging sensation), when a physiologic pH (approximately 7.4) is achieved the increase in pH causes the insulin to come out of solution resulting in the formation of higher order aggregates of insulin hexamers. The higher order aggregation slows the dissociation of the hexamers into insulin monomers, the functional and physiologically active unit of insulin. This gradual process ensures that small amounts of insulin glargine are released into the body continuously, giving an almost peakless profileâŚ"
It would seem that the release profile of Lantus seems to be pH dependent. If for any reason, the injection of Lantus is not into the subcutaneous space; or perhaps the patient has less âfatâ than the way Lantus was designed to perform, then, the patient can experience problems. I used Lantus for quite some time without too much trouble many years ago (although, I did not monitor my BG as closely as I do now). After about 1 year, I experienced an unexplained hypo which I can only attribute to have been caused by the Lantus injection, The condition must not have had the proper pH environment.
Iâve been using Tresiba, probably for over 1 year now and am liking it alot, once daily. After Lantus, I switched to Levemir, it was ok - but I took 2 injections daily.
How long do you think you would need to give Tresiba a fair chance, @Sam?
Tresiba is coming to Canada soon (not approved yet, though), and Iâd be willing to give it a try as someone with quite variable basal needs (and a childhood-onset T1). I not only have variable basal needs throughout the day (times of day I always go high or always go low when using a flat basal profile), but my basal needs can jump by 50% throughout the month from hormones, and I find a -10% to -20% basal overnight after days I exercise to be very helpful for avoiding lows. I also have, at times, very unpredictable responses to food/activity and use temporary increased or decreased basal rates to help deal with those. And I also have a highly variable schedule, sometimes sitting behind a desk all day, sometimes out walking around all day, and sometimes travelling across time zones. Iâm skeptical that Tresiba will provide me with better control than the pump, but Iâm curious what impact it might have.
I do think that different people react differently (and individually) to different insulins. Iâm finding Fiasp far better than I ever found Apidra: I have a lower average blood sugar, lower standard deviation, higher percentage in range, and much lower percentage low than Iâve ever had in my life. In fact, I have some Apidra left over that I need to use up and so went back to it temporarily. I only lasted a few days before I couldnât handle the chaos and switched back to Fiasp and things settled down again immediately. This was all using a pump, of course. So I think itâs conceivable, as someone else said, that Tresiba works well for you when Lantus did not simply because your body reacts better to one insulin over the other, not necessarily having anything to do with having variable basal needs.
Regardless, Iâm curious about what Iâve heard so am willing to give it a try when it arrives. If I asked my endocrinologist for a box of penfills as a sample, which would last me about a month using my current basal dose, would that be enough to give it a fair test, do you think?
