Tresiba, Long-term pumpers, R/H users, Pump → Tresiba T1Ds... Help!

So this may be a bit lengthy, but I’m VERY curious about these things:

For Tresiba users/lovers: I am new to Tresiba and MDI.

A. I get a blotchy red spot after I inject for a few days of Tresiba… Anyone else have this? What do you do? Can you inject H/R over/near it for follow up injections?

B. Do you use pen caps and pens? I find that there will be a bauble of insulin still coming out after I inject, hold down for 6-8 seconds, then exit the needle. Isn’t this under-dosing me? Maybe it’s the 32g needle? It is a very thick looking solution for a thin needle like that… Thinking of using syringes and vials.

C. While I injected 14 units of Tresiba, I felt it burn like a mother. The proceeding hours were higher than usual. Anyone experience this? Any input?

D. I am a nursing student right now. Seeing as I will be working as an RN in the coming years, how does Tresiba fit into the whole perfect basal while at rest but too much when overexerting yourself for hours on end? Anyone have a variable workload job on Tresiba and it interferes/benefits them using Tresiba?

E. Are there any good sites to inject Tresiba that are better than others, or is it all good?

Pumpers: I have been pumping for 13 years now. Maybe I need to switch to MDI.

A. Any issues with scar tissue? I find that some sites just keep me high all day and I can’t get my BG down. I usually will change out sets… sometimes even 3 or 4 in one day!

B. I am noticing that my sites are lacking lately. I only use directly under the ribs now, as I have not usually ever touched them… This is very depressing as it might mean my pumping time is coming to an end. How do I continue to pump with all the built up scar tissue around my legs and abdomen??? I love the pump, but not the scar tissue/lack of insulin absorption…

R/H users on for MDI:

A. Dr. Bernstein recommends using R for low-carb meals. R seems a bit outdated to me since I have been using H for ~15 years. Any good experiences with R vs H?

Pump → Tresiba changers:

A. Do you have any difficulty finding good sites from suspected/actual scar tissue that you have from pumping?

B. How much Tresiba do you take daily compared to your basal rates on your pump? My basal is set to 0.7 unit/hour, 16.8 units/day. I tried Tresiba a few weeks ago at 12 units per day. I stayed 220 BG all day flat and borderline DKA. Is Tresiba weaker than Humalog requiring a higher dosage of daily Tresiba?

Random Pump/MDI Question:

So I ordered Medtronic 670g on a whim due to Animas being shut down and me being a United Healthcare insurance (mmhmm). Anyways, I just got the order right now, and I’m thinking of sending it back… Thoughts?

Thank you to anyone who answers, I know this is a long post, but it is needed!

Trevor @ketoeater, I’ve never used Treshiba so I’ll skip by that.
In the 1970’s I worked with a research doctor at Joslin to see if [what is now called] MDI could be effective; this was prior to BG Meters being available. MDI worked well for me and its effectiveness was proven during the DCCT worldwide study in the 1080’s. While practicing MDI, I was able to maintain HbA1c at or about 6.0%. After changing to a pump my A1c remained the same. A CGM [Dexcom G5] has helped me raise my A1c to a higher level, doctors prescribe 6.5 for “old folk”, but while getting my A1c to 6.4 I was able with the CGM to significantly lower my standard deviation get my CV well below 30% - better time-in-range.
I now use a Tandem t-Slim x2 pump for which UHC paid. Okay, the Tandem people did the negotiation.

A medtronic 670g wildly appeared at my door just now… I’m afraid… I think I should send it back!

No really though, I have UHC, felt pigeon-holed into getting the 670g and the reps were really good at convincing me… Also, UHC denied my Tandem request.
I really want the Tandem though, who at Tandem helped you? Can you give me their contact, or do you want to give them mine?

A couple of quick thoughts here @ketoeater Trevor,

Tresiba is a long acting insulin and it compares well with glargine (Lantus). I am a little freaked out about your rash and burning, you should consider reporting this to your doctor as a potential sensitivity to the product.

The little drop at the end of the pen should be ignored. If you need an extra unit dial it into the pen. Otherwise depending on the plunger and trigger that droplet is always there.

You can use all the regular spots to inject but you should get instructions on how far away you need to inject your fast acting relative to the Tresiba BC it could matter.

Pump sites near the top of my butt and back of arms come to mind for additional real estate. Some people change sets at 2 days to reduce scarring. Some people don’t tolerate plastic cannula and may have better results with steel cannula.

R is fine it just takes longer to start working. You have to manage when the sugar hits to match it with insulin starting to work. Probably a good idea for high fat and low carb.

Cheers good luck.

You can be allergic to synthetic insulin, more probably one of the additives of that particular formulary. I’m allergic to Humalog.

Like Joe said, there is always a little drop of insulin that comes out after injection with pens. I used to wait 3 to 5 seconds after injection before removing the needle from my skin just to be sure, but it’s normal when it happens.

You arent always going to hit fat with injections. Sometimes you hit muscle, which hurts more and absorbs the insulin much faster, occasionally you will hit a vein which hurts even more and absorbs the insulin even faster. Very rarely, you will hit a nerve and experience exquisite pain. It’s also important to remember that insulin needs somewhere to go inside you. For larger shots, it is normal to experience pain after injection as the insulin forms a big bubble under your skin. Oil rigs inject fluid into bedock to crack and break the rock, releasing oil or natural gas trapped in the earth in the process known as fracking. Thats basically what happens to your flesh at an injection site, fracking, and sometimes, it’s noticeably painful.

Since you have had a pump, then you might know what dual or square wave boluses look like. Some meals take a long time to break down and absorb, taking R insulin would effectively be like taking a square wave bolus. For most situations, fast acting is superior, such as in corrections or mealtime bolus. In reality, R and NPH are just as effective and useful as fast acting and 24 hour, they are just less convenient on their own. If you had the aptitude to do the math and the patience to lug around multiple vials, the best insulin regimen might honestly be utilizing all 4 types and their various peaks.

As for the pump, it has the potential to solve another problem for you. You asked about varying basal rates at your occupation? The 670g strongest selling point is its “Auto Mode” closed-feedback loop. You don’t set a basal rate in Automode, Automode calculates it based on your CGM reading every 5 minutes. At my last job, I was walking about 5 miles a day, lugging tools or parts to fix industrial machinery. Automode was smart enough to differentiate my basal needs between extreme exertion and sedentary periods. It might work extremely well for you, or you could be one of the people that has a lot of issues with the 670g.