Thanks Inka and Barbara. I've just changed health authorities and met with my consultant who explained Levemir is being phased out. He felt Tresiba might improve my overnight control and we agreed to try it. We had a good chat about this and pumping and I trust him. I hear what you say about sticking with Levemir until I go onto a pump but if my control improves with Tresiba I might be less inclined to switch to a pump. It's all go in my diabetes world at the moment!
Thank you for clarifying this,
@sololite. Its also really good to hear that you are getting solid and reassuring personalised support from your new Consultant.
In some ways Tresiba could be a very viable basal for underpinning someone progressing to a pump, but in the meantime I have found my switch to Tresiba was perfect for me and my BG management quite quickly became a lot better. That was in Feb '21 and continues today.
The profile for Tresiba is that it takes a couple of hours after injecting to get going and then releases very evenly for the next 40 hours. In practice I am blissfully unaware of that 2 hr start up window because today's dose is topping up yesterday's dose. So a few days after starting Tresiba it has built up to providing this constant background insulin. Some people argue this makes it very inflexible; a dose adjustment today takes at least 48 hrs to have any effect. Consequently Tresiba needs a mindset change from, say, Levermir. There is no possibility of looking at yesterday's CGM graph and deciding you need a basal adjustment, nor looking to tomorrow when your activity level is planned to change and thus changing your basal in anticipation. With Tresiba you become akin to the Captain of an ocean going super tanker, who needs at least 40 hrs to see the benefit of a course change
Personally I think this is a major strength of Tresiba and I understand it is a basal growing in popularity in the US where long haul flights and time zone changes are fairly common. Because of its stability and enduring characteristics, you don't need to get bogged down in timings of dosing; +/- a couple of hours for that daily dose is fine - one's body doesn't seem to notice whether your dose is early or late. Tweaking your dose is infrequent once you've got settled; that doesn't mean you never change, but I look at a minimum of 3 days consecutive graphs - specifically my overnight portion of those graphs - and only consider a basal dose adjustment if for 3 consecutive nights it has become apparent that an adjustment is needed.
For example last summer I was taking 7.5 units from late spring to late autumn. As the colder weather came in I stepped up my doses in 1/2 units to 9.0u. In March , as we had that warm spell I dropped to 8.5u and recently, despite the very recent return of the cold weather, I have lowered again - so now 8.0u. I think the weather, combined with the start of spring, slightly shorter nights and the call of necessary garden jobs have made the need for this week's tweak. Throughout the summer my activity levels wee very varied but my basal requirement was remarkably level - during the nights. Irregularities during those nights were one-offs and could easily be reconciled with identifiable events.
I said that Tresiba needs a change of mindset. Because frequent tweaking of Tresiba simply is not a practical proposition, I found I needed to accept that my fasting basal should be left alone, once established. But, of course, that 40hr basal is bringing insulin to my daytime parties. I just accept that once awake and up, whatever my Tresiba is bringing is what it is and I manage my D while awake by diet, bolus and activity - alone. No consideration of whatever is coming from my basal. Actually this really simplifies matters: no need to try and decide if basal changes might help my daytime; one of the multitude of variables is no longer in the equation.
If you adopt this new mindset then basal tests become remarkably easy. You use your overnight CGM graph to establish how steady your BG is during the long fasting period. The important thing is to stay level, ideally at your preferred baseline; I have 6.0mmol/L as my preferred target; if I'm lower I'll take a small snack to nudge myself up; if higher I won't correct anything below 9.5 until the morning and my high alarm is set for 11 while sleeping. I can't easily attach a picture of a decent overnight graph, since Dexcom unhelpfully prevent screenshots. I need 3 consecutive graphs showing repeated drift up or down before I consider adjusting my Tresiba.
Regarding starting doses for Tresiba: I don't recall exactly what my transition dose was, but it was well over 50% of my outgoing Levermir and that proved to be very excessive. Apart from the carry over from yesterday to today with Tresiba (and it's release is remarkably even over the 40 hrs) my Glycaemic Variability quickly became steadier and this steadied my overall total daily doses; as they reduced so did my basal requirement. I think I started on 16u and have progressively got to 7.5 in summer.
Sorry my comments have taken me so long to get these written. The last few days have been pretty full on with various things. I hope this helps and wish you good luck with the change.
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