Steve,
@mitchsi, I suspect that you'll split your Abasglar and tinker with the ratios until you find a formula that works for you. If you do, don't be surprised if your daily total of basal insulin turns out to be a bit less than your single Abasglar dose. By splitting the Abasglar each part MIGHT provide a slightly more efficient use of the overall basal insulin and thus needing a bit less daily requirement. Once you've found that perfect 'sweet mix' also don't be surprised that the following week its no longer perfect and you have to do it all over again; weather changes, different workloads, family needs are just a few of the many things that will come out to play with you!
Should you decide to try Tresiba just be very clear that it's not simply a slightly longer lasting version of Abasglar. It is different and needs an open minded acceptance of that principle of it being different with a different attitude to its use. As already thoroughly stated our basal requirements vary a lot across any one 24hr period. So much so that it is simply not possible to have a basal that provides near perfect background cover hour by hour through day and night. So the stability and seeming inflexibility that Tresiba provides allows you to use Tresiba to provide very steady basal (background) cover for a segment of the 24 hour day - eg from 11pm to 7am (or whatever your normal sleeping and fasting period might be). Once that basal dose requirement is sorted then I find I don't need to change that dose very often - typically from spring into summer and back from autumn into winter. Quite modest adjustments, revealed when needed by my CGM graphs either repeatedly steadily rising overnight (too little basal) or falling (too much basal). Provided those graphs are part of my routine fasting and sleeping period then they are in effect my comprehensive basal testing. Thanks to CGM.
SO NOW any other action on my part to managing my D from when I "break my fast" to going to sleep is managed SOLELY by eating, activity/exercise and bolus. Just doing what my missing pancreas might be doing in conjunction with my ever-changing metabolic needs and responses. I'm providing my carb (future glucose) intake by eating or insulin (my bolus injections) all in consideration of whatever activity and exercise I choose to do. My bolus is relatively short lived (for me NovoRapid with a 4 to 5hr profile), so no waiting for the 'insulin on board' effect of a basal be that Levermir (say 12 hrs) or Abasglar (say 20 hrs)
No tinkering with my basal Tresiba. Whatever Tresiba is bringing to my daytime party "is what it is". It won't be wildly fluctuating - it's just constantly there. It will definitely not be an ideal match to the irregular releases of glucose from my liver store, whether those internal glucose releases are triggered by Adrenalin, Cortisol, or a number of other hormones that are partying out of my sight! How my body manages that daytime Tresiba relates back to how active or inactive I am, as well as the weather, any stress, other medications and indeed there is a list of 42 factors that can and do affect our natural insulin sensitivity, thus how 'on board' insulin (basal and bolus) is utilised and thus our BG.
The Chartered Engineer in me reminds me that these factors are way outside of having a neat set of equations (or a sophisticated computer programme) that can manage up to 42 factors - even if each factor was quantifiable and subject to a scientific or engineering analysis. In practice many of the factors are abstract and not quantifiable, so gauging them is an art not a science. [eg Stress - be that emotional, medical or reaction]. But even if all 42 could be expressed mathematically, they are only the known factors! Sometimes (frequently) a 43rd factor is wearing the wrong coloured socks! The complexity of our bodies has so many known 'unknown' interactions that what might be medically expected doesn't actually occur.
I am NOT saying that Tresiba will turn out to be the best solution for you or anyone else.
We are fortunate enough to have a generous array of treatment permutations including diffferent sorts of insulin regimes AND we can choose how we apply those treatments. Our GPs or Consultants and DSNs can advise us on optimum methods or their preferred way of how we use what is provided - but the reality is we can vary the detail. Even minor aspects like how much time we use for pre-bolus intervals at different times of day and slightly more significant parameters such as insulin ratios for carbs or corrections. We have a great deal of freedom to find what suits us as individuals. Changing from Abasglar to Tresiba - or not, or from Abasglar to Levermir - is just one of those treatment options potentially available to those of us who want to explore and find our own way of managing our D. Taking on a pump and perhaps closed loop technology is not quite so freely available to us - even if one can afford to self-fund that. But that's a different topic for tomorrow.
Do keep exploring and interrogating us. Safely, of course. Over the coming months I'm sure you will gain an even wider understanding of your D management and I'd be surprised if initially that wider understanding didn't lead to more questions and possibly increased uncertainty about what is best. It's all not very precise and the more you find out the less precise it seems to become. But it is manageable.
