Only suggesting that some might not need variable basal with tresiba. Would make no such suggestion for any other basal regimen. Actually strongly disagree with the assumption for any other regimen…
I’m not a scientist and can’t offer you an explanation to that standard but can share with you my own life’s experience…
doc, i really appreciate you chiming in here. there was a post i made during this past summer (although from the weather, it would seem as if the summer is still in session) about a back-up plan in case my pump breaks while on vacation and i am not near a pharmacy. i was getting totally lost regarding how to handle my basal needs.
i was taking all the suggestions i could get, but unfortunately few people agreed and i just became more confused. i keep Lantus in my fridge, ready to go at any time, but not many people here think that Lantus is a good replacement than my pumps Novolog basal.
and, as you and many others know by now, my idiot endo was the last person i was about to ask for help from
DM, I have great respect for both @docslotnick’s and @Sam’s opinions on Tresiba vs Lantus. I think they are proof that Tresiba can work extremely well for PWDs. If you were asking about replacing your pump with a long-acting basal insulin, and if you weren’t a swimmer. I would advise you to try both.
But you are talking about a quick backup replacement. Tresiba takes 3 days to come up to speed to its stable level, and is harder to tune up since it takes longer to stabilize. You may only need to be on a backup long-acting insulin for a small number of days. For a backup to a pump, I would not consider Tresiba – imho it is simply too slow to bring you to a stable level.
This consideration is highly over rated imo… for an emergency backup I think she’d be fine with Lantus, tresiba or levemir split 2x daily and probably notice little difference between the three in the short amount of time she’d be on it… I’ve talked to many people who’ve disconnected their pumps or stopped Lantus and went strait to 1x daily tresiba with no hiccups at all in the transition— actually the only people I’ve seen have trouble with it were the ones who tried to over complicate it and dream up bad ideas like take too much the first day then less the second day etc to engineer up a perfect transition…
Disagree. I understand why you’re thinking that in a mathematical sense, but it does not match my experience… and even if it did work out that way it’s not like it’s a terrible big deal to take a correction or two as needed
@Sam@Michel Actually I did start too high with Tresiba and suffered night time lows. For two days after reducing the dosage for the last time I also had night time lows. After a couple of days regulating on the correct dose things settled down.
Tresiba might be a “set it and forget it” basal, but it does seem to take several days (in my case a couple of weeks) to zero in on the correct dose.
Why’d you start too high? Did you start with more units than your previous regimen? Or you just mean you ended up needing less with tresiba? and I agree it takes a while for a dose adjustment to settle in… I’m just saying that it’s not ineffective on day 1 or day 2 and wouldn’t be an inappropriate short term emergency backup due to that concern imo
@Sam, you are a very strong proponent of both Tresiba and Afrezza, which is great! But sometimes I get the feeling that you are possibly too willing to oversee weaknesses in either. Looking from the outside, I think that both are very strong products – in fact, I would love to have my boy able to use both – but I don’t think they are perfect for everyone and everything.
Feel free to tell me that I don’t know what I am talking about That is true!
Michel, I’m not advocating for or against it. I’m saying that your assumption that because it lasts longer than a day means that it won’t work well for a while just doesn’t match the reality of actually using it… I’m saying that in my experience it will work just as well on day 1 as Lantus or levemir. I understand your mathematical perspective on why you think that might not be the case… but it doesn’t match my firsthand experience… I don’t think that is unreasonable. I think anyone would be just as well equipped for an emergency short term backup for a pump failure with any of the three
It’s really simple though. It roughly lasts 3 days in your blood. It would have to be magical if after 3 days of repeated doses you did not have more Tresiba in your bloodstream than after 12 hours. If you have more Tresiba in your bloodstream it will not have the same effect as if you had less.
I am not being original here btw – many people in the DOC write that it takes them several days to find a balance with Tresiba, going up or down. I feel bad arguing with you when you are the one who knows about Tresiba, while I don’t have first-hand experience.
I understand what you’re sayjng… and I can assure you that before using it I had all those same concerns… but none of them materialized. Mathematically what you’re saying makes sense, but it just doesn’t work out that way. It’s not magic, is just that physiology and pharmacology are a little more complex than 2+2 =4 which is how you’re framing it… I don’t claim to understand the science of it-- but I can assure people that works just fine on day 1…
They are two different things, yes after several days they may come to the realization that they need to adjust their dose upwards or downwards and they would be acting on incomplete history if they adjust dose too frequently (I’ve commented on that extensively) but, no that doesn’t mean that they were being starved for insulin on day one.
Btw it’s advertised to last up to 42 hours not really 3 days… it’s just good practice to not adjust dose more frequently than every 3 days— thats actually pretty standard guidance for all basal insulins— at least I’ve always been told that by docs and cdes… even with lantus-- but I would agree it’s appreciably more beneficial to heed with tresiba-- especially if you’re titrating your dose for long term forever use
@Sam First, I agree with you that Tresiba would be as good an emergency pump replacement as Lantus or Toujeo or any daily basal insulin. But for longer term use it does behave quite differently than the other two.
When I transitioned from Toujeo to Tresiba I was taking two doses of Toujeo per day, and I knew I was taking too much basal insulin because of how my Bg was acting. I reduced the TDD of Tresiba to 80% of my TDD of Toujeo right from the start. It was still too much and I had more nighttime lows than I had been having with Toujeo.
When I finally titrated my correct dose it was almost 40% less than what I had been taking with Toujeo.
But it works great! One dose per day, steady Bg on basal test days, and greatly reduced nighttime lows. I couldn’t be happier with it!
Interesting… I actually ended up increasing slightly over what my Lantus dose had been… hard to know if that’s due to the insulin or things were just changing though
@EricH switched from Toujeo to Triseba a couple of weeks ago. So far, no miracles.
His doctor suggested a dose of 16u with Triseba injected at night, but he’d been doing 20u of Toujeo, divided into two doses, at that point. Unfortunately, the Triseba on top of the existing AM Toujeo that was still on board made him have a long night of lows that needed frequent apple juice administration and caused us some stress. He’s fine now, but it wasn’t fun.
Turns out 16u of Triseba was too much. He’s now down to 11u. Still not magical. I think this has to do with the exercising and crazy travel and whatnot. I’ve been waiting to report back until we do some more successful and controlled trials, but I thought I’d toss that little tidbit.
That is true!