Hello
@digihat,
I switched to Tresiba from Levemir in c. Feb 21 and that has proved to be great for me. My original motive was principally to reduce from 2 x daily basal injections to one; at that time my BG management was almost non-existent, including no explanation at all about how I might get a better service from that original Levemir. I'd certainly had no guidance about the idea of basal testing and trying to get my basal correct as a fundamental, before trying to improve my (then) effectively blind bolus dosing.
Anyway one thing that I have learnt is that a lot of Health Care Practicioners, including (disgracefully) Hospital Diabetes teams do not appreciate that the extremely long duration of Tresiba's profile at 40 hrs means that using it requires a very different mindset. Some people consider this long lasting insulin is too inflexible and a big disadvantage; but whenever I look more carefully at such suggestions I can't help concluding the strength of Tresiba is the stability that it provides. I have increasingly moved to making sure my basal is solely my true background insulin, slow release and there to help me manage whatever my liver glucose store is
routinely generating; and my bolus is for everything else.
In practice almost nobody has a constant, even, internal glucose release during any 24 hr period. So no basal can be a perfect match throughout an inevitably irregular 24hr requirement. Therefore I quite deliberately optimise my Tresiba to give me a very steady safe basal cover through the night time fasting period, essentially from mid evening to breakfast. Whatever my Tresiba brings to my daytime living is what it is; but my bolus (NovoRapid) in conjunction with my very varied exercise and activity is what I use to manage my day time BG needs.
One consequence from this mindset is that I very infrequently change my Tresiba doses. Inevitably I have a small increase between endcof summer and the colder autumn and winter weather and I reduce for the warmer spring into summer weather. Any dose change of Tresiba can take up to 3 days to take full effect. With a 40 hr profile today's Tresiba dose is topping up yesterday. Using Tresiba has been likened to being the Captain of a massive super-tanker crossing the Atlantic Ocean and changes for the super-tanker course need to be made well in advance of when they are needed; so it is with Tresiba. I had 4 Hospital stays during 2022 and I made extra Tresiba adjustments during that year, just because of the blatant sedentary enforced routines while in Hospital. Some people talk about splitting their Tresiba into am/pm half doses; there is absolutely no point in doing that. It was manufactured to be a very long lasting basal. Splitting Tresiba can not produce any change between half doses, for am and pm since the effect of adjustments from a changed Tresiba dose are delayed by yesterday's dose still driving what is happening today. So no possible gain from trying to 'be clever' and hoping to manipulate Tresiba's 40 hr profile.
When I moved from Levemir I was taking 28 units and my initial Tresiba doses were (I think) 16 units, which was adjusted pretty quickly to 14 then 12. I was truly surprised at the difference in quantities. Today my doses have switched from 9 /8.5 units in winter to 8 units in summer. For me Tresiba is very efficient. Basal testing is extremely easy - I just monitor my 8-10 hr overnight periods and if I stay very flat overnight it's correct. If there is some fall my Tresiba needs tweaking down and if there's some rise it needs a small tweak up. I never use a single nights graph, I always at least look at the last 3 or 4 overnights. I also take due consideration if the last couple of days have not been very "normal". Earlier this week we were out for dinner and had a very late meal, so that overnight graph showed instability until about 2am; on Thursday I spent 10 tough hours in the garden and in the sun, so this morning's overnight graph showed some glycaemic variabilty, not helped by overnight cramp from doing too much yesterday. The instability does not mean my Tresiba is wrong.
I would send you a couple of my overnight graphs, but I can't do that simply. Dexcom prevent me from taking screenshots off my G7 sensor app, for "security" reasons. So this would need me to get someone to take a photo or go rummaging into my Dexcom Clarity web-based data, which is too much faff for my android phone. Please let me know if you have other questions.
