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Suggested new insulin’s after 19 years...

Discussion in 'Type 1 Diabetes' started by CDM9, Feb 1, 2018.

  1. CDM9

    CDM9 Type 1 · Well-Known Member

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    Hi all.

    19 years as a type 1. No hospital admissions, control generally been good-fair but last few years lots of random highs and lows and no clear patterns on accu chek mobile graphs.

    Today I went for my 12 month appointment at the hospital. My HbA1c was 56 which the consultant thinks is okay but it needs to be much lower in my opinion below 50 and after 19 years I have had no complications until very recently my eye test came back maculopathy from previous background results. Blood pressure is fine so it’s my erratic readings that although produce a semi ‘ok’ hba1c, in reality the highs have caused me some health issues.

    So after a bit of a discussion and my persuasion to try and get a libre and really get more of an idea on my glucose readings , he has put me forward for the libre although I’ve been told it’s unlikely I’ll make criteria so I may have to just buy one - either that or Dexcom 5... I’m still researching..

    He has told me that he thinks a change in both of my insulins would make a difference.. hmmm.

    So he wants me to trial Tresiba ( over my current lantus ) and Masp or hasp of Fiasp?! fast acting insulin over novo rapid( I can’t read his writing ). The change from novo rapid seems to be a push on all patients in Leeds to this new one which is apparently not even available in pharmacy’s for the next 2 weeks. I’ll give them a whirl and see ( I don’t want a pump ). Bit dubious about the real rationale for change ...

    Anyway - anyone tried a) Tresiba - bolus b) masp or hasp?! - fast acting

    Do the doses differ from lantus or novo rapid? He’s told me to start with same dose...

    Also any thoughts re libre V Dexcom If I end up going self funded?

    Thanks all
     
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    #1 CDM9, Feb 1, 2018 at 8:23 PM
    Last edited: Feb 1, 2018
  2. CDM9

    CDM9 Type 1 · Well-Known Member

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  3. therower

    therower Type 1 · Well-Known Member

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    @CDM9 . It's Fiasp. I can't really offer anything on tresiba or fiasp. I get on fine with lantus and novorapid.
    I'll tag @tim2000s as I believe he may have some useful information regarding Fiasp.
    As for dexcom v libre. I can only comment on dexcom ( G4 ) which I've been using for 3 months. Initial outlay was pricey but well worth it. I find it extremely accurate, have managed to get an average of 20 days plus out of the sensors.
    Customer service appears very good and I can't fault anything with dexcom as of yet.
     
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  4. CDM9

    CDM9 Type 1 · Well-Known Member

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    Good to know thanks. Is it similar costings to the libre?
     
  5. catapillar

    catapillar Type 1 · Well-Known Member

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    It's fiasp, I think it stands for Faster acting Insulin ASPart.

    I think the doses would be the same, but you need to remember not to pre bolus or even to bolus after eating if you're having v slow carbs, because it is faster.

    I've not used Fiasp or Tresiba though, but at least you know what to google now.

    I've not used a libre, I use a dexcom because I need the alarms, but a lot of people have managed to get free trials for libre, one or two sensor using your phone as reader, so it might be worth asking your DSN if there are any libre free trials you could access.
     
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  6. CDM9

    CDM9 Type 1 · Well-Known Member

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    Very helpful info re pre and post bolus thanks. Consultant never even mentioned it
     
  7. EllsKBells

    EllsKBells Type 1 · Well-Known Member

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    I'm on tresiba, and for me it's been marvellous. It has a much, much flatter profile than the older long acting insulins, and you may find that some of the readings bringing your hba1c (which is fabulous, by the way) are coming overnight. Tresiba will probably keep you flatter overnight, and it definitely lasts the full 24 hours. Also, curiously, it doesn't make me have itchy injection sites the way levemir used to, so I wonder if the modern insulins have different preservatives in them.

    I have used both libre and dexcom. The libre is cheaper, but it depends what you want from it. If you need alarms, as said above, the libre isn't going to give you that, although I believe you can use something called blu-con or something like that to get it to do that. The dexcom is also more accurate, but if it's trends that you're interested in, then the libre is more than satisfactory. For me, I switched to the dexcom because I wanted the alarm if I had a hypo overnight (it happens), and also because I do a lot of lab work, and sometimes it is very hot in there, which makes it difficult to tell the difference between being a bit sweaty and having a hypo. The real cost difference comes in the transmitter which you need for the dexcom, which is ~ £200 every 120 days or so, although I believe those using xDrip+ on Android have been able to get longer out of them.

    @Scott-C is the one with all the info on blucon nightrider thingy.
     
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  8. scotteric

    scotteric Type 1 · Well-Known Member

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    I've used both insulins and I wouldn't say you can expect dramatic results, but everyone is different. A CGM will make a much bigger difference honestly. I went back to NovoRapid because I didn't like Fiasp after trying it for a while, and I was never able to find a Tresiba dose that worked well for me, but I'm a pump guy through and through and will wear it until there is a cure or something better replaces it most likely!
     
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  9. CDM9

    CDM9 Type 1 · Well-Known Member

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    Thanks. This site is so helpful!

    I haven’t lost hypo awareness but usually about a 2.5-3.6 before I realise these days and , touch wood , don’t have major hypos so maybe a libre would suit but seems to be more info about benefits of Dexcom 5 when I have researched. If I’m self funding I want the best..! Why is Dexcom not on nhs trials?!
     
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  10. scotteric

    scotteric Type 1 · Well-Known Member

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    I've used both of them and they have their pros and cons. I'm self funding as pump coverage in Canada (Ontario at least) is outstanding, but getting funding for a CGM is near impossible! The Libre is cheaper overall for me since the sensors last 2 weeks and there is no need to buy a transmitter. I also found I don't need the alarms as I'm extremely hypo aware and cope well with hypos, even when sleeping. The Dexcom is definitely nicer since the results are on your phone without doing anything and you can make adjustments based on the alarms to obtain better control. I found both reasonably accurate with the Dexcom being slightly more accurate by the Libre better at catching BG spikes. I like that I don't have to calibrate the Libre and I'm comfortable dosing off of it, but only because I cope really well with hypos and they are more annoying than dangerous for me. If this wasn't the case I'd go with the Dexcom hands down.
     
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  11. scotteric

    scotteric Type 1 · Well-Known Member

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    It just goes to show how different everyone's experiences are! My basal needs are relatively flat, I only run 2-3 basal rates on my pump and they don't vary by much (just a bit of an increase for dawn phenomenon) yet I could never get Tresiba to give me steady basal for 24 hours. It was always too strong at night/in the morning and then would seem to wear off as the day went on.
     
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  12. EllsKBells

    EllsKBells Type 1 · Well-Known Member

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    @CDM9 I would guess you can't get a trial of the dexcom on the NHS because of the transmitter component - like I said, it lasts 120 days, so it would be a major investment for a fairly small company to make, as opposed to the libre, where they can just chuck one at you for a couple of weeks.

    The other thing that I forgot to mention about libre vs dexcom is that if you are concerned about application at all, the libre is much, much easier to put on and take off. Definitely worth asking about a libre trial, as I know some people have experienced skin irritation with the adhesive, although I never did.

    @scotteric this is my main reason for wanting a pump, which my consultant won't even put me forward for - I am not terribly insulin sensitive during the day, then get to about 10pm at night and WHAM - I'm four or five times as sensitive, so she keeps reducing my tresiba dose, which means I'm needing more and more humalog during the day, with injections between meals, to keep it flat. Levemir was such a nightmare though. People are really different, and I think this is often overlooked, because I've read so many people saying that they love levemir.
     
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  13. Antje77

    Antje77 LADA · Moderator
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    Im on tresiba and fiasp and I like it much better than lantus and novorapid. And I'm really impressed that you could read fiasp in that handwriting! I take roughly the same doses as with my old insulins, but when I started I injected a little less to see what happened. If you do a search on this forum for tresiba or fiasp you'll find lots of useful threads.
    I use the libre and it makes a great difference in managing my diabetes. I think the main reason to choose libre rather than dexcom is that you can just try it out for two weeks for the price of one sensor. You can scan with your phone if you use android, so no need for the expensive thingies that go with dexcom.
     
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  14. Deleted Account

    Deleted Account · Guest

    RE: Dexcom vs Libre, I have tried both.
    First up was Libre. This was easy to apply but
    1. it fell off very easily. My second lasted longer but this was because I stuck it to my arm with tape
    2. the readings were significantly different to finger pricks and not consistently. There is no option to calibrate it (it is "factory calibrated") so once it is off, there is no way to "teach it" to suit you.
    3. by itself, it has no option to alert when your BG is too high, too low or changing rapidly. Some have added gadgets to provide this.
    4. it is easy to attach and not very bulky. However, it is visibly when you wear short sleeves (see our PM)
    5. It lasts 14 days and that is it

    And Dexcom G4 (not tried the G5 but understand it is similar)
    1. it sticks well
    2. the readings vary but it is calibrated daily to bring it back in line.
    3. it can alarm when your BG is too high, too low or changing rapidly. This can be useful but when it is out of calibration, this can be annoying.
    4. it is a little harder to attach but easy to get the hang of.
    5. It is more bulky than the Libre because it has a transmitter on it but it is usually warn close to the waist so easily hidden
    6. it is supposed to last 7 days but can be extended. The longest I got was 23 days but this seems to be less if I exercise a lot
    7. costs more than Libre as you need to purchase both transmitter and sensors

    Both
    1. can be inaccurate. I have spoken to some people who find them accurate and others, like me, who find no CGM or Flash monitors are accurate
    2. are not replacements for finger pricks
    3. react slowly when your BG is changing quickly so do not catch a hypo during exercise
    4. itch after more than 10 days even when using SkinTac as a barrier
    5. can be purchased VAT-free if you have diabetes
    6. are useful to detect trends such as which foods cause your BG to rise fastest or how quickly your BG rises when climbing (ok, bit of a specialist one but could be applied to other non-vertical activities)
    7. should be trialled to work out if they work for you before spending lots of money
     
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  15. scotteric

    scotteric Type 1 · Well-Known Member

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    That sucks, are you able to see another consultant? I'm not too familiar with the NHS/UK health care system but I'm learning a lot from reading this forum! It's up to the doctor/endo where I live (Ontario, Canada) and luckily mine is a type 1 on a pump himself, so he's very receptive to helping those who want them. I'd highly recommend a pump if you can obtain one, I tried MDI for a few months and honestly felt like I had stepped out of a time machine back in 1995. I'm not bashing it at all, it's very possible to obtain excellent control on either regimen and many people prefer MDI and should. For me at least it just seemed like so much more work and effort to obtain the same (and often worse) results.
     
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  16. leahkian

    leahkian · Well-Known Member

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    Your consultant may be thinking that your body has got used to the insulin and may not work as well as it did before. I also think that some doctors run out of ideas and put you on a new insulin, when i was in my late 20s i changed insulin about 6 times but sometimes it comes down to money. The hospital you attened may have a deal with a company which works out cheaper for them, i have seen this happen with insulin pumps there may be many to choose from but when you go they may be only a choice of 2 due to the hospital getting them cheaper. I know people want the best available pump but sometimes the trust will not allow you to have it on the NHS.
     
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  17. tim2000s

    tim2000s Type 1 · Expert
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    In most cases, NHS hospital selection of pumps is down to two or three major factors. Cost is only one of those. The others are reliability (which is why very few trusts offer either Cellnovo or Omnipod) and staff training (due to the NHS H&S requirements you must be trained on a pump before it leaves the hospital with you these days).

    I've done a large amount of observation of Fiasp on myself. It's all documented here: http://www.diabettech.com/fiasp

    Whilst most people don't require any changes in dose on Fiasp, a significant minority of people have suffered issues with it and in discussions with various HCPs that I've had I've learned that a significant proportion of those that have been put on it by hospital clinics have since come off due to issues with consistency of action. It's turned out to not be the panacea everyone thought for a significant minority.
     
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  18. CDM9

    CDM9 Type 1 · Well-Known Member

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    Great comparison thanks :)
     
  19. Engineer88

    Engineer88 Type 1 · Well-Known Member

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    Tim, just wanted to let you know I left a hospital without being trained with a new pump. I then legged it up the road and got trained January 2nd.
     
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  20. jackois

    jackois Type 1 · Well-Known Member

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    Lucky you. I don't see a consultant or diabetic team. I have an annual HB1AC, followed by a diabetic nurse check for weight, feet and so on. Then I have a ten minute appointment with my GP. As my numbers are generally in the low 50'she usually declares himself quite happy and chases me out of the door. I did bring up changing from Novorapid to Fiasp, this year as I felt I could lower the peaks after meals but he wasn't having any as he couldn't see any benefit as my current medication was doing fine.

    Onto to CGM. I've used both, self funded, Libre and Dexcom 5.

    The libre was fine other than the skin reactions I got from the adhesive which were horrible. readings were generally in line with blood testing, it was easy to apply and the scanner was super easy to use. At around £100 a month is was affordable for the info it gives back.

    The dexcom was better for my skin with no reaction in the 6 months I used it. Again readings generally close to blood tsting. A bit more complicated to fit but a bigger choice of places to stick it. Price is the stumbling point. I'm currently having a couple of months off as I can't justify the £425 cost for 4 sensors and a transmitter, especially as the sensors are only guaranteed for a week, even though they can be restarted and I was getting them to last for almost 3 weeks. Another plus with the dexcom is the phone app that takes readings automatically via bluetooth and will alarm if you go low or high.

    Hope that helps you.
     
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