Thebearcametoo
Well-Known Member
- Relationship to Diabetes
- Parent of person with diabetes
The pens come in at least red and blue so get another pen on prescription and have one for each insulin. (I’m presuming your pens are the same colour.)
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Help please just took novorapid instead on tresiba
- Thread starter sololite
- Start date
sololite
Well-Known Member
- Relationship to Diabetes
- Type 3c
Thanks for asking Barbara. I didn't need to go to hospital, we were away in our campervan and drove home OK that afternoon.
sololite
Well-Known Member
- Relationship to Diabetes
- Type 3c
Thanks. I do have blue and silver and intend to put some extra markings on the silver .
sololite
Well-Known Member
- Relationship to Diabetes
- Type 3c
Hi Roland, nice to hear from you. I am back to normal thanks. I took the 25 units in one go. I think my Tresiba dose is too high and my carb insulin ratio seems to fluctuate especially if I do a lot of exercise in the morning. When I switched to Tresiba the advice was to use fewer units in total than my levemir split dose and suck it and see. I must get round to doing a basal test but life is getting in the way at the moment. I also need to count carbs more closely than I do. Thanks for your help and interest. Regards, Chris
Lucyr
Well-Known Member
- Relationship to Diabetes
- Type 1
Perhaps an elastic band may work well, then you have a difference you will feel with your hand as well as seeing the colour difference, to bring in more than one sense.
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Must confess that I would need two coloured pens more different than blue and silver. To me they are too similar especially in dim light. I have blue for Levemir and red for Fiasp.... both NovoPen Echoes.
I put some tape on my Levemir pen to make it feel different but over time that got tatty and wore off and now I just put them in set positions in my pen case, so that when I wake up at 2 am and need to do a correction I can get the Fiasp pen out and jab a correction without putting the light on just from the position in the pen case and be back to sleep in less than a couple of minutes, whereas if |I had to put a light on that would really wake me up and take ages to get back off.
I put some tape on my Levemir pen to make it feel different but over time that got tatty and wore off and now I just put them in set positions in my pen case, so that when I wake up at 2 am and need to do a correction I can get the Fiasp pen out and jab a correction without putting the light on just from the position in the pen case and be back to sleep in less than a couple of minutes, whereas if |I had to put a light on that would really wake me up and take ages to get back off.
Proud to be erratic
Well-Known Member
- Relationship to Diabetes
- Type 3c
- Pronouns
- He/Him
Chris, @sololite, about Tresiba and basal testing: I have my view on this fundamental task, which makes it really simple. Apologies if you are already aware of my view and this lengthy "narrative" is not needed.
Many here on the forum, regularly say get your basal right or your bolus is trying to do both jobs of covering for food and corrections as well as trying to manage background insulin requirements. I agree with that; its been my experience. There are a couple of basal testing processes, but these were developed before the majority of those of us had any CGM and (I think most importantly) before Tresiba was in use. Tresiba is a relatively new insulin, particularly in UK and it is sufficiently different that the traditional ways of using basal might not be so relevant. So I don't find I need to use a traditional basal testing process, although there can be merit in understanding what your day by day, hour by hour, basal needs seem to be. I'm retired, active, busy and don't have structured days of waking, working and weekends of recovery (or frantic time squeezing).
Tresiba is, as far as I know, the only basal that lasts some 40-48 hours. It's profile suggests it should take 2 hrs to get going, then it releases very evenly for the next 2 days. Today's Tresiba dose is topping up yesterday's dose which makes Tresiba both inflexible yet potentially extremely dependable. Inflexible, because a Tresiba dose change takes at least 2 days to become effective, better 3 days and needs 2 or 3 days to feel the change or see the outcome of that dose change on your CGM daily graph. Dependable (and reassuring) because once you know your Tresiba dose is right you don't keep adjusting it, you don't have to make that daily juggle between "should I adjust my basal or my bolus today?". You just lean on the certainty that Tresiba is doing it's job steadily in the background and thus look to your bolus. So, how do you know your Tresiba is right?
The harsh reality is that our background insulin requirements vary a lot during any one 24 hr period and vary from one day to the next. Those people on a pump can do a series of fasting tests, say in 6 or 8 hour blocks over several days. They can get a good sense of which parts of the day their body is getting glucose releases, triggered by a multitude of hormones including adrenaline and cortisol, then programme their pump to release different amounts of insulin every hour, every day. We, on MDI, don't have that luxury.
NB: As far as our body is concerned insulin is just ..... well .... insulin! Your body doesn't necessarily recognise what is home grown or delivered extraneously. Nor does it know that it was meant to be there for the food and is short acting, or has been engineered to be very long acting and help manage a glucose surge triggered by an emotion, or that heavy cold you have and don't yet know about (but will reveal itself tomorrow with the sore throat and streaming nose). If there is insulin available in your blood, your body will use it regardless of where it came from. So getting your background insulin right, day after day week after week is potentially a true challenge. [I ought to add that some people may well find some extraneous insulins suit individuals better than others - so we are lucky that we do have choices].
This is why, in my non-medical opinion, taking Tresiba needs a very different mindset to using other basals. I optimise my Tresiba daily dose to keep me very steady through the longest fasting part of my 24 hr day, from late evening to breakfast. Breakfast can be early or midday; my overnight fast can be 6 hours or over 14 hours. Of course Tresiba is also still releasing steadily while I'm awake and so whatever Tresiba is providing to my daytime party "is what it is". I can't accurately reconcile for that daytime background need and so must manage daytime insulin requirements with food, bolus and exercise/activity, aware that Tresiba is also at my party, steadily releasing insulin in the backround. The lifesaving tool in this juggling is my CGM. So much information, showing trends as well as the equivalence of spot checks from a finger prick test.
I optimise my Tresiba to give me decent horizontal graphs overnight. If a night gets interrupted from my norm - then that night graph may not be usable. So a late party, ending with a very late snack, doesn't count. But that different activity often gives me explanation for the consequent different night graph. I use exercise and/or bolus corrections to try and manipulate my BG ahead of the start of the long fast to be around 6-7 mmol/L. For me, with no pancreas whatsover, if lower than 6 I can crash very quickly; although my CGM alerts will wake me up it's still an interrupted night's sleep! If my straight overnight graphs are steadily (and repeatedly) sloping down my Tresiba is too strong. If my overnight graphs are repeatedly rising, my Tresiba needs increasing. If a series of 3 or 4 overnight graphs are level (after discounting non standard nights) my Tresiba is right.
Thus my basal test is nothing more than monitoring my overnight graphs. How hard can that be?
Over a 12 month period I expect to tweak my Tresiba between winter and summer, then reverse that from summer to winter. My basal needs definitely change with the seasons: I need 7.5 units in summer and so far last winter I was taking 9 units. Because of the 48hr profile of Tresiba I won't change it for short overseas trips to a different climate. But I did change it a couple of years ago when I found myself in hospital for nearly 4 weeks and that period of enforced limited mobility, plus post op recovery, did noticeably show that my basal needs had changed.
Tresiba in 2022 was still sufficiently new in UK, that the pre-op advice in my then Bucks Hospital for insulin dependent people was very wrong. I was told to stop my basal on the day of hospital admission and had to point out that the written advice from the Hospital's Endo dep't was out of date and inappropriate for my long lasting Tresiba. The pre-op Nurse agreed with me and suggested the Endo Dep't review their Guidance. I have also found that Health Care Professionals (HCPs) don't have much awareness of quite basic differences between T1 and T2, never mind how different managing MDI can be between using Levermir or Tresiba as a basal insulin.
But do only change one thing at a time! If you are needing a modest regular correction bolus to bring your starting levels down a bit, then don't change your basal at the same time. Conversely if you need a small bedtime snack - again don't tinker with your basal.
Sorry this is a long meander, offering more insight in using Tresiba. You may already know all of this and it could be your body and your lifestyle just needs a fundamental review.
I can't remember, have you come across Gary Scheiner's book "Think Like A Pancreas"? I found it helpful.
Many here on the forum, regularly say get your basal right or your bolus is trying to do both jobs of covering for food and corrections as well as trying to manage background insulin requirements. I agree with that; its been my experience. There are a couple of basal testing processes, but these were developed before the majority of those of us had any CGM and (I think most importantly) before Tresiba was in use. Tresiba is a relatively new insulin, particularly in UK and it is sufficiently different that the traditional ways of using basal might not be so relevant. So I don't find I need to use a traditional basal testing process, although there can be merit in understanding what your day by day, hour by hour, basal needs seem to be. I'm retired, active, busy and don't have structured days of waking, working and weekends of recovery (or frantic time squeezing).
Tresiba is, as far as I know, the only basal that lasts some 40-48 hours. It's profile suggests it should take 2 hrs to get going, then it releases very evenly for the next 2 days. Today's Tresiba dose is topping up yesterday's dose which makes Tresiba both inflexible yet potentially extremely dependable. Inflexible, because a Tresiba dose change takes at least 2 days to become effective, better 3 days and needs 2 or 3 days to feel the change or see the outcome of that dose change on your CGM daily graph. Dependable (and reassuring) because once you know your Tresiba dose is right you don't keep adjusting it, you don't have to make that daily juggle between "should I adjust my basal or my bolus today?". You just lean on the certainty that Tresiba is doing it's job steadily in the background and thus look to your bolus. So, how do you know your Tresiba is right?
The harsh reality is that our background insulin requirements vary a lot during any one 24 hr period and vary from one day to the next. Those people on a pump can do a series of fasting tests, say in 6 or 8 hour blocks over several days. They can get a good sense of which parts of the day their body is getting glucose releases, triggered by a multitude of hormones including adrenaline and cortisol, then programme their pump to release different amounts of insulin every hour, every day. We, on MDI, don't have that luxury.
NB: As far as our body is concerned insulin is just ..... well .... insulin! Your body doesn't necessarily recognise what is home grown or delivered extraneously. Nor does it know that it was meant to be there for the food and is short acting, or has been engineered to be very long acting and help manage a glucose surge triggered by an emotion, or that heavy cold you have and don't yet know about (but will reveal itself tomorrow with the sore throat and streaming nose). If there is insulin available in your blood, your body will use it regardless of where it came from. So getting your background insulin right, day after day week after week is potentially a true challenge. [I ought to add that some people may well find some extraneous insulins suit individuals better than others - so we are lucky that we do have choices].
This is why, in my non-medical opinion, taking Tresiba needs a very different mindset to using other basals. I optimise my Tresiba daily dose to keep me very steady through the longest fasting part of my 24 hr day, from late evening to breakfast. Breakfast can be early or midday; my overnight fast can be 6 hours or over 14 hours. Of course Tresiba is also still releasing steadily while I'm awake and so whatever Tresiba is providing to my daytime party "is what it is". I can't accurately reconcile for that daytime background need and so must manage daytime insulin requirements with food, bolus and exercise/activity, aware that Tresiba is also at my party, steadily releasing insulin in the backround. The lifesaving tool in this juggling is my CGM. So much information, showing trends as well as the equivalence of spot checks from a finger prick test.
I optimise my Tresiba to give me decent horizontal graphs overnight. If a night gets interrupted from my norm - then that night graph may not be usable. So a late party, ending with a very late snack, doesn't count. But that different activity often gives me explanation for the consequent different night graph. I use exercise and/or bolus corrections to try and manipulate my BG ahead of the start of the long fast to be around 6-7 mmol/L. For me, with no pancreas whatsover, if lower than 6 I can crash very quickly; although my CGM alerts will wake me up it's still an interrupted night's sleep! If my straight overnight graphs are steadily (and repeatedly) sloping down my Tresiba is too strong. If my overnight graphs are repeatedly rising, my Tresiba needs increasing. If a series of 3 or 4 overnight graphs are level (after discounting non standard nights) my Tresiba is right.
Thus my basal test is nothing more than monitoring my overnight graphs. How hard can that be?
Over a 12 month period I expect to tweak my Tresiba between winter and summer, then reverse that from summer to winter. My basal needs definitely change with the seasons: I need 7.5 units in summer and so far last winter I was taking 9 units. Because of the 48hr profile of Tresiba I won't change it for short overseas trips to a different climate. But I did change it a couple of years ago when I found myself in hospital for nearly 4 weeks and that period of enforced limited mobility, plus post op recovery, did noticeably show that my basal needs had changed.
Tresiba in 2022 was still sufficiently new in UK, that the pre-op advice in my then Bucks Hospital for insulin dependent people was very wrong. I was told to stop my basal on the day of hospital admission and had to point out that the written advice from the Hospital's Endo dep't was out of date and inappropriate for my long lasting Tresiba. The pre-op Nurse agreed with me and suggested the Endo Dep't review their Guidance. I have also found that Health Care Professionals (HCPs) don't have much awareness of quite basic differences between T1 and T2, never mind how different managing MDI can be between using Levermir or Tresiba as a basal insulin.
But do only change one thing at a time! If you are needing a modest regular correction bolus to bring your starting levels down a bit, then don't change your basal at the same time. Conversely if you need a small bedtime snack - again don't tinker with your basal.
Sorry this is a long meander, offering more insight in using Tresiba. You may already know all of this and it could be your body and your lifestyle just needs a fundamental review.
I can't remember, have you come across Gary Scheiner's book "Think Like A Pancreas"? I found it helpful.
sololite
Well-Known Member
- Relationship to Diabetes
- Type 3c
Roland , this is super useful and reassuring for me. Like you I don't alter my background insulin or basal test. Things seem to be set about right for me at the moment and the great thing is that my overnight BS is way more stable than when I had the op and was on Levemir for next 2 years. I too am retired and have the luxury to adjust my BS through exercise or fruit. At the moment I am getting more Lows and have just reduced insulin(s) dosage by 25% as I think the heat is having an effect. Too early to tell yet. I did read Think Like A Pancreas when first diagnosed with LADA 7 years ago and thought about giving it away as I no longer have a Pancreas! Are there things I can still learn from it as Type 3c? Thanks once again for your support. . Kind regards, Chris
Lucyr
Well-Known Member
- Relationship to Diabetes
- Type 1
Surely that just means you have even more reason to think like a pancreas not less, if you don’t think like a pancreas your body isn’t you going to cover its functions for you