Sorry, at risk of causing great confusion for you
@Charl, I must put in some words of caution to what
@rebrascora is saying.
Yes, basal insulin needs change much more frequently than people realize.
Basal (= background) needs do change a certain amount over the year. Warm weather, usually means you need less background insulin; your body's warmth seems to result in decreased resistance to any insulin and so It goes a bit further (or doesn't need to work so hard). BUT Tresiba is a longer lasting insulin, with its 40 hr profile and along with understanding that today's dose is adding to yesterdays dose it is not intended that you adjust your Tresiba frequently: certainly not daily; a change in Tresiba can take 3 days to bring about the adjustment being sought.
Probably not even weekly changes (unless you know something well in advance that might make a change appropriate). Perhaps a 1 week beach holiday, with a specific intent to do very little, when you would normally be busy with daily living.
But generally the only Tresiba (basal) changes are in response to recognising that your daily background trend is not level. E.g. you might consistently be highish as you go to bed and regularly drift downwards (even go towards or into hypo) through the night showing that your basal (background) need is less than you are actually providing. This example is all about getting your background insulin correct.
Mine change most significantly due to exercise or stress.
Where I disagree with
@rebrascora and thus risk causing you,
@Charl, great confusion is I do not believe exercise or stress should be managed by your background (basal) insulin and certainly not by Tresiba.
If the exercise is pretty well a daily commitment, eg daily walking a dog, or walking to work 5 days a week, or even a solid gym workout 5 days a week - then that exercise is part of your background baseline and your Tresiba dose intended to keep you stable with such daily (or near daily) routines.
But if the exercise or activity is noticeably irregular then it is NOT part of your background need and must be managed by food and bolus (quicker acting) insulin. Not by Tresiba. Others may use their shorter profile basal insulins, such as Levermir, to 'switch on or off' according to how they interpret what they are doing or have done daily - but really they are just finding a solution that could be achieved by food, bolus and activity alone. Food, bolus and activity is the fundamental of how you, on Tresiba, should be aspiring to manage your D. Having Tresiba as a basal needs a different mindset to taking other basal insulins.
Stress is a different challenge for all of us. Stress, whether from an emotional response (eg a horror film, or bad news), a physochological circumstance, or a medical circumstance (a cold is developing and your body starts to fight it - often the day before you actually know that you have a cold!) - invariably leads to a raised BG. And that elevated BG needs managing. But I understand that long term (continuous) stress strangely doesn't result in long term elevated BG; somehow the body adjusts for this. But even if my understanding is wrong - long term elevated BG from continuous stress should become part of a basal requirement and so Tresiba would need to be adjusted to help manage that circumstance. But not for the frequent and relatively short term stress circumstances.
When I spent 3 weeks in hospital from emergency surgery I decided to increase my Tresiba by 10%, 1 unit; after 2 weeks I recognised my basal was a bit too much and I reduced it by a half unit, and in due course by a further half unit. When I had to spend 36 hrs in hospital for a planned surgical procedure I kept my Tresiba the same; I got a short term raised BG, which I just took a bolus correction dose for. Both hospital stays were surprisingly easily managed: I realised that one bonus was that I was in a very constrained environment; and I had time to commit much of my attention to just managing my BG; I was also being woken every 4 hours to have my vital stats recorded, so a small bolus correction was easily done, or a biscuit snack if I was a little low. I was not very active!
Obviously exercise lowers my BG levels and reduces my basal insulin needs for up to 48 hours afterwards, particularly during the night for me but we are all different.
We are all different, certainly. I simply don't see that the exercise is altering my "basal" needs. And because Tresiba
can't and shouldn't be used to deal with BG changes from an activity or exercise tha
t is not a daily background event - all such adjustment comes from either increased food to mitigate for that exercise, or reduced bolus insulin.
@rebrascora has an ultra low carb diet and so her bolus doses are relatively minimal; one can't significantly reduce a minimal dose to create a negative dose! So her basal insulin is one way of managing, if she doesn't want to increase her food intake.
I'm not saying that is wrong, but it is not feasible or appropriate to do with Tresiba; and I invariably eat at least 130gms of carbs daily, sometimes a fair bit more - so I have no difficulty with the idea of reducing my necessary bolus insulin for those carbs - or enjoying a snack, including a couple of squares of chocolate, when my BG is dropping because I've either had a busy day (or just got my balancing act a bit wrong!). What I do benefit from is Libre 2 providing me with an easy tracking of my BG.
Stress pushes my BG levels up and I need more basal insulin. Likewise with illness. The change of the seasons also has an impact on many people's basal needs and the heat in summer compared to the coolness in winter.
As I've already said I manage changes from stress, including illness, with my NovoRapid bolus and seasonal changes with my basal Tresiba
With Tresiba as our basal, we have 3 broad ways of managing our BG day by day:
Food, including supplementary snacks to lift BG;
Bolus insulin for the food PLUS extra bolus as a deliberate correction to lower any existing rise; I can make a decision to apply a further % adjustment (increase or decrease) to that initial total bolus for food and correction - when I know my day has been unusual (yesterday I took my son's dog for a huge walk in the sun in Gibraltar - an exceptional action). This further adjustment is something that comes with time, experience and the helpful overview from CGM.
Or I can and do use extra activity / exercise to nudge my BG down. In an evening, particularly, perhaps 10-15 mins after my dinner/supper I can 'nudge' my BG to reduce an anticipated spike from a generous meal by getting 'active', (rather than armchair TV) with c.15 mins on my feet doing any minor thing (could be just clearing the table, doing dishes or anything that keeps me moving around a bit). This minor activity invariably sets me up for the rest of the evening and I notice a difference if I don't do this.
I suggest you should be pushing to get Libre 2 prescribed for you, as an insulin dependent T2. Despite being one more thing to learn about, it should provide you with much better visibility of what is going on and with a great deal less effort Good luck; keep asking questions - we were all new to this once.
