With Tresiba, I firmly believe the more traditional basal thinking process needs a different mindset. Tresiba needs a minimum of 2, much better 3, days for any change in dose to take effect. It has a very long lasting profile, typically 40 hrs, so today's dose is topping up yesterday's dose.
Our basal needs are constantly changing throughout any 24 hr period. So there is a very valid school of thought that taking such a long lasting and seemingly inflexible basal is in contradiction to basal needs. But unless you are able to alter your basal doses hr by hr (which is what people with pumps do) then that apparent contradiction is not so valid. For you ladies with varying hormonal behaviour across a single month, there is a stronger case for not taking Tresiba at all, but rather a much shorter lasting basal, to allow you to alter your basal as any month progresses. But this does mean you have to be very alert to basal needs and adjusting, say Levermir (which is one of the shorter lasting basals) very frequently and that can add to the relentless pressure of close monitoring one's BG and doing something about one's BG often.
So my mindset for Tresiba is to find the optimum dose per day and then leave it alone, for much of the year. As today's spring weather is mimicking summer, I have already adjusted my Tresiba down (from winter 9 to now 8 and this week I'm assessing whether to now go to last year's summer dose of 7.5. Incidentally, don't get distracted by my needs being in single figures daily and yours is currently 28. We are all different and for whatever reason 7.5 - 9 works for me; I presume my natural insulin resistance is lower than some other people, so I need less basal.
I work on the basis that during my late evenings and night time my basal needs are noticeably very even - even if I go to bed a bit higher than I'd like and I choose to take a small correcting bolus; I see that correcting fall over the next 4 hrs, then a steady lower BG - provided by my Tresiba.
So I just look at my overnight graph each morning and if my going to bed reading is about the same as waking up then my Tresiba dose is about right. If I start high and end high, my Tresiba is doing what I expect and I either take a small correction last thing, or on waking OR use exercise/activity to help nudge me down OR (rarely) less food to encourage a tweak down. If I start high and end up noticeably lower, a few nights in a row (after allowing for any bolus corrections, late night parties, or just broken sleep) - then I'll cautiously adjust my Tresiba as necessary.
This does give me one big advantage that I appreciate: I don't need to think very critically about my basal. It's there, doing what is needed by night and whatever it brings to my daytime party is what it is. I can't change that, so I don't try to change that; I don't even think about it. While I'm awake I manage my BG by bolus insulin for food or corrections, OR exercise and activity. This doesn't mean that I don't need to keep track of how active I was yesterday, today or might be tomorrow. Nor what the weather is doing, whether I'm out of kilter from a cold or similar, or experiencing excessive stress and hassle from something; there are many other factors that can affect our BG - I can only mitigate for those if I realise I've bumped into one of those other factors.
Something that caught my attention:
Breakfast
At 9.50am I was at 4.1. I ate one jelly baby As arrow pointing gradually down and took 3 units. At 10.05 I ate 33g carbs, a slice of toast and jam
Two hours later I was 8.1.
Your one jelly baby as a modest "nudge" to intercept a falling BG is fine. At 4.1, I might have been tempted to take 2 JBs. But I would not have then promptly taken any bolus. I find when my BG is low, my insulin resistance is very mild, my response to insulin is very prompt - even though it's breakfast time and you might effectively "dilute" the benefit of that JB. Indeed your toast and jam so close to that JB was also diluting the benefit of that potential rapid response to that JB. I find these are moments when I have to hold myself in check, wait for the potential hypo treatment to take effect before doing anything else. I do have the advantage of having no responsibility for looking after anyone else at such moments. I certainly would not include any bolus for that JB; indeed I never consider bolus for any carbs when so very low as 4.1.
Your recovery to 8.1 2hrs later would be fine for me, under the circumstances - you are in range. We know too little about how busy you were yesterday (so nothing about any effects of exercise and activity; nothing about what was going on before your toast - not just actuvity but how rushed or harased you kight have been, etc, so whether a stressful or very relaxed start to your day.
I'm reluctant to draw too much conclusion from your graph. I'd need to know what your BG was at 11pm the night before. But there seems to be insulin taken at c.0530 while you were in the 12s and so the fall to 4.1 suggests that early insulin might have been too much if it was bolus. I'd struggle to believe it was Tresiba at 0530 producing that dramatic change on its own - it's release profile is very, very steady taking effect some 2 hrs after injecting.
I certainly agree with half-unit pens in principle, but for a 28 unit dose the half-units are not really justifiable. They certainly are for a 3 unit bolus dose. That thought attracts me to wonder what proportion of your total daily dose is for bolus, day by day.
@ink my basal appears brilliant some days and other not it depends on whether I've walked or not. But mostly it's stable. Take 28 tresiba x
Perhaps you could explain what effect your walking is having on your BG (ie is the walking reducing your BG stability and whether you are aware if yesterday's walk is carrying over into today, with a consequential sting in its tail of pushing your BG down today. Do you walk most days and typically for how long in time or how far? Is there a push-chair involved, hence extra exercise? Do you apply a reduction factor to your bolus calculation because of exercise? I've been in the garden most of the last week and my bolus has needed to be halved, plus snacks to counter gentle falls.
