Confused again.

[helli]

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.

I was advised by the endo who treated Steven Redgrave to reduce basal for 48 hours after intensive exercise. I am not talking about walking the gym. I am talking about a gym workout including 30 minutes on the rower, a spin class, a night at the climbing wall. And the reduction is different for the first 24 ours compared to the second.
It is rare to exercise intensively 7 days a week (unless you are an elite athlete your body will need rest and time to repair) so there will be days between when basal is less.
You cannot treat lower insulin requirements by eating during the night if you want to sleep. Therefore, it is important to reduce basal insulin.
I know this from personal experience of nearly 20 years managing diabetes and exerciseing intensively 4 or 5 days a week.
I agree this is difficult with very long acting insulin such as Tresiba. That is why Tresiba is not recommended for people with varying basal needs through for example, exercise or hormones.

In other words, I agree with @rebrascora (who, from my understanding, eats a low carb, not ultra-low carb diet which is under 20g carbs per day ... not that that makes any difference in this scenario) and apologise for derailing the thread for @Charl

 

[rebrascora]

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.

I agree that exercise cannot be managed by Tresiba as a basal insulin but to my mind, my basal insulin is there to balance my insulin needs in the absence of food, which is why I love my Levemir because I can adjust it for exercise and illness and stress and whatever else.
I find my diabetes management incredibly frustrating when my basal is not well balanced and I have to firefight with bolus insulin and I certainly couldn't be bothered with adjusting bolus ratios for each time of the day after exercise although mostly my basal needs during the day stay reasonably stable even after exercise. It is during the night after exercise, that my levels drop dramatically whilst I sleep. If I did not reduce my evening Levemir dose I would hypo badly overnight. The only way to prevent that would be to eat carbs at bedtime to push my levels up to mid teens or maybe even higher at bedtime and I find that I sleep very badly at those levels, aside from the fact that I do not want my levels that high anyway. It would also be "feeding my insulin" rather than adjusting my insulin to my needs. There are plenty of times, if I am doing intensive work for several days in a row that I hypo even when i have reduced my evening dose down to zero and then I need to reduce my daytime dose.
As I have said before, I have a large disparity between daytime and nighttime needs. Levemir works well for me because of this and this is what it is designed for. Tresiba will work for some people who have a more even basal requirement but not for others. Understanding how those basal insulins work, their profile of activity and length and looking at your own lifestyle and body/glucose rhythms will give you an idea of which might be best for you and how to adjust it to make it work for you. There isn't a one size fits all. By all means twiddle about with Tresiba doses to see if you can make it work, but be aware that there are other basal insulin options which work quite differently and might be a better fit for you as an individual.

 

[Amity Island]

@helli @rebrascora @Proud to be erratic
I really enjoyed reading your posts, lots of valid points!

 

[Amity Island]

Carb counted Novorapid,

Carb counting is less than half the equation. Bolus ratios need to also be right for the amount of carbs. Plus of course, basal effects ratios too.

The points @rebrascora @Proud to be erratic and @helli made are really good.

I also use tresiba, on 19u each morning. It was like for like dose from previous insulin (lantus solostar). Its not very forgiving if I undertake any spontaneous exercise as I cant reduce it quickly enough on the following days to prevent background blood sugars dropping. It would rely on eating more carbs and or reducing bolus insulin doses on the following days plus eating during the night.