Basal insulin needs vary over 24hrs and day by day, so how could a weekly insulin ever work? You either give ‘enough’ that you risk severe hypoglycaemia, or you’re more cautious and have higher blood sugars than ideal.
I am in total agreement that basal needs vary, hour by hour. I am a strong supporter of Tresiba and quite blatantly use it to keep me stable through the nights - which it does very successfully for me (over 75, physically active but no longer train for half marathons!).
I work on the basis that whatever Tresiba brings to my daytime BG management is "what it is", unseen, unquantified and in the background. Just as my liver's glucose releases are unseen and in the background. So I manage my daytime by bolus related to food, adjusted for activity (past, present and possible future).
I sometimes get that a bit wrong, but rigorously let my CGM alert me to an incoming drop or low and make a judged response from ignore for now to a big snack. I'm inwardly smug about very rarely going hypo. No deep hypo this year and rare mild lows (invariably from my "pushing my luck" with ignored early responses). My low TIR is miniscule.
Likewise I let my CGM alert me to highs and again make a judged response; I ignore higher alerts more often, sometimes anticipating that I'm about to be active and sometimes out of laziness. My longer term TIR is comfortably above 70%; right now my 30 and 14 day TIRs are 64% which is not ideal, but I've had an enduring heavy cold and been living in hotels for 17 of the last 20 nights eating out with no scales or measures and essentially guessing carbs meal by meal.
My point is that CGM provides for me what a pump does for you,
@Inka, in terms of tech "helping". A 40 hr basal profile takes a huge amount of stress away from daily BG management; I know it's very fixed and inflexible and I blatantly trade on that - I have upped my basal as my cold continued and I have seen that help on my overnight graphs. My CGM graphs quickly show me when mynovernight basal is adrift. But I would willingly move to a 7 day basal (once suitably trialled and approved) and do more of what I do today in terms of using bolus, food and activity to manage myself while awake.
I can foresee that as I get older this will become even more helpful and as my cognitive ability continues to decline the simpler my BG management becomes for MDI the better that will be.
The whole idea contradicts the proven success of pumps. Pumps work because you can finely tune basal hour by hour, day by day. These insulins actually do the opposite of that and remove all ability to finetune aanything.
I also can see that a 7 day basal could sit in contradiction to pumps. But my vision is to have a weekly basal injection and my future pump managing my active daytime needs. OR my pump delivering both the weekly background basal and my hourly bolus needs.
I think the contradiction with your "successful" pumps (with or without HCL) is your vulnerability to quickly having no basal should your pump fail and you needing to have basal pens handy at all times, as well as bolus. You all blithely talk about your pumps providing background (basal) needs from bolus insulin and ignore the contradiction of concept in that explanation. I do understand what is meant, when you pumpers refer to the short acting insulin covering basal needs as well. But there is a complexity in how you guys explain the concept.
In practice, and very wrongly, until now I simply have not met the eligibity criteria for having a pump. There is a glimmer of hope now. I have asked my Consultant to give me a priority above normal T1s (but not above children - their needs are far more important than me). I have explained that as someone with absolutely no panc'y there is far too little understanding of the juggling I have to do just to stay alive (too few of us to become visible in the requirement assessments). I have pointed out that I already have a diagnosis from 10 yrs ago of mild Impaired Cognitive Ability. I am concerned that if I don't get a pump soon my ability to learn (and for my identified future carers to learn) (yes I know this is Crystal Ball speculation) how I (or they) should manage me when pumping, will become an unrealistic solution. I have also pointed out that failure to approve a pump for me in the last 3+ years because I manage too well on MDI is a blatant disregard of responsibility for my care; I'm not sure this reasoning stands up!!
I want to be on a pump. But meanwhile I need to make MDI as successful as I can. I most politely and courteously say,
@Inka, to make an argument that a weekly basal is a contradiction to the success of pumps is a flawed argument. There aren't enough funds to provide pumps wherever needed or wanted and until that is sorted a reliable 7 day basal would be great for me and I suspect many others. Don't underestimate how much stress reduction there is in not needing to think deeply about basal. It does need a different mindset for MDI. But so does pumping (along with those essential reserves of basal / bolus pens and in-date cartridges needed in relatively easy reach!).
Sorry this is lengthy.
