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Tresiba
- Thread starter Tom1982
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Lily123
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Normally you could run a basal test. This is to see if the basal insulin holds BG steady in the absence of bolus and food.
Given that your daughter’s age I don’t think a basal test is a good idea so there might be another way
Given that your daughter’s age I don’t think a basal test is a good idea so there might be another way
rebrascora
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As I understand it, with Tresiba, because it is a very long acting flat profile basal, you optimize the dose to give as horizontal a line as you can overnight avoiding hypo land and ideally nicely in range, then adjust the daytime bolus carbs ratios to keep things steady during the day. Maybe @Proud to be erratic can explain it better than I have above.
Proud to be erratic
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Hello Tom1982,
If you look back to the post you raised under the title "Tresiba question" I explained about the 40 hr profile of Tresiba and thus its longevity, with today's dose topping up yesterday's dose. This is viewed by some as making Tresiba an inflexible basal insulin, because any changes take 3 or more days to be fully effective [in adults - perhaps in young children the profile is different and the flexibility also different]. Others, including myself, see it as a very steady and dependable basal insulin.
It is unrealistic to expect or hope that one's basal needs are constant throughout any 24 hr period - adults or children. So you can only aspire to optimise Tresiba for either part of a day or, more appropriately, for the night. Therefore, in theory you need to do a single basal test for nighttime and no need, or point, in repeating the basal tests on other days across the rest of the 24hr period. If the night basal test confirms Josie's BG remains very steady throughout her night - then you are "on the money". It doesn't matter if she starts at say 10 and ends at c.10 - although that is possibly higher than you might wish - it confirms the dose is right. Likewise if she started at 5 and ended at c.5 - but that would of course be lower than you'd wish. Either way you've got the Tresiba about right; and if it doesn't keep her level, then adjust and try again probably at least 3 days later. Josie's D team should advise you, particularly in how Tresiba affects youngsters.
All other insulin needs are managed by bolus doses and you'd make a bolus correction if Josie was higher than you wish as she goes to bed. That bolus will do it's stuff and be fully used up roughly halfway through her night and her CGM will show the correction and then steadying for the rest of the night (if the Tresiba is on the money). This is assuming Josie sleeps reasonably solidly through most nights! Our 2 did - once finally asleep nothing disturbed them! Of course if she regularly gets disturbed during nights then things will become more complex - because a broken sleep pattern can, in itself, introduce turbulence with her BG. I GUESS here - I'm not in any way medically qualified and I was the parent who always heard when a child did wake up, but they invariably then wanted their mother and I was allowed to go back to sleep!
So, while I have no idea if this theory of basal testing applies to 5yr old Josie - it seems to me it probably does (or should) apply - otherwise why would any specialist switch Josie onto Tresiba? While my recollection of our 2 children as 5 yr olds is now hazy, my instinct is that once the nightime routine is established that routine is naturally providing a basal testing scenario.
You will find Josie's basal needs will vary a bit across any one year - for example a bit less in summer than winter is normal for me. Watching our 6 Yr old granddaughter and 9 Yr old grandson, they each seem to be "full on" from waking to sleeping and probably their basal needs wouldn't be so much altered by exercise and activity in any one day, in the way that perhaps we adults are; but that is just my perception of their possible needs. I can well imagine that when our grandchildren (and thinking back our own children) are having 'growth spurts', then all normal bets would not apply!
I am curious, though; I thought you'd got Josie started on a pump - or have I imagined that? Perhaps you're just sorting the contingency plan for when she has a pump break. Anyway, good luck - you and your wife have had a lot to learn in the last 16+ months.
If you look back to the post you raised under the title "Tresiba question" I explained about the 40 hr profile of Tresiba and thus its longevity, with today's dose topping up yesterday's dose. This is viewed by some as making Tresiba an inflexible basal insulin, because any changes take 3 or more days to be fully effective [in adults - perhaps in young children the profile is different and the flexibility also different]. Others, including myself, see it as a very steady and dependable basal insulin.
It is unrealistic to expect or hope that one's basal needs are constant throughout any 24 hr period - adults or children. So you can only aspire to optimise Tresiba for either part of a day or, more appropriately, for the night. Therefore, in theory you need to do a single basal test for nighttime and no need, or point, in repeating the basal tests on other days across the rest of the 24hr period. If the night basal test confirms Josie's BG remains very steady throughout her night - then you are "on the money". It doesn't matter if she starts at say 10 and ends at c.10 - although that is possibly higher than you might wish - it confirms the dose is right. Likewise if she started at 5 and ended at c.5 - but that would of course be lower than you'd wish. Either way you've got the Tresiba about right; and if it doesn't keep her level, then adjust and try again probably at least 3 days later. Josie's D team should advise you, particularly in how Tresiba affects youngsters.
All other insulin needs are managed by bolus doses and you'd make a bolus correction if Josie was higher than you wish as she goes to bed. That bolus will do it's stuff and be fully used up roughly halfway through her night and her CGM will show the correction and then steadying for the rest of the night (if the Tresiba is on the money). This is assuming Josie sleeps reasonably solidly through most nights! Our 2 did - once finally asleep nothing disturbed them! Of course if she regularly gets disturbed during nights then things will become more complex - because a broken sleep pattern can, in itself, introduce turbulence with her BG. I GUESS here - I'm not in any way medically qualified and I was the parent who always heard when a child did wake up, but they invariably then wanted their mother and I was allowed to go back to sleep!
So, while I have no idea if this theory of basal testing applies to 5yr old Josie - it seems to me it probably does (or should) apply - otherwise why would any specialist switch Josie onto Tresiba? While my recollection of our 2 children as 5 yr olds is now hazy, my instinct is that once the nightime routine is established that routine is naturally providing a basal testing scenario.
You will find Josie's basal needs will vary a bit across any one year - for example a bit less in summer than winter is normal for me. Watching our 6 Yr old granddaughter and 9 Yr old grandson, they each seem to be "full on" from waking to sleeping and probably their basal needs wouldn't be so much altered by exercise and activity in any one day, in the way that perhaps we adults are; but that is just my perception of their possible needs. I can well imagine that when our grandchildren (and thinking back our own children) are having 'growth spurts', then all normal bets would not apply!
I am curious, though; I thought you'd got Josie started on a pump - or have I imagined that? Perhaps you're just sorting the contingency plan for when she has a pump break. Anyway, good luck - you and your wife have had a lot to learn in the last 16+ months.
Thebearcametoo
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- Parent
To be honest we relied on the clinic reviewing all the data Which was much easier to do with the sensor than when he was just finger pricking.
But yes if going to bed in target and have a flat profile all night that’s a good indicator. Basal testing during the day is hard to do with kids and we’ve never done it.
But yes if going to bed in target and have a flat profile all night that’s a good indicator. Basal testing during the day is hard to do with kids and we’ve never done it.
Proud to be erratic
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And no point with Tresiba - if optimised for night period, then it can't be changed for daytime.
Amity Island
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- Type 1
If one wanted to use tresiba, then getting it level when you are asleep is the right way around. You could adjust during the day with food or bolus doses etc.
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