Day 13 – Afrezza and Tresiba in Russia

I had a hard time picking the subject of this post. It came down to Afrezza and Tresiba in Russia as they were an easy subject for me.

Afrezza and Tresiba an Easy Subject

Why are Afrezza and Tresiba as easy subject?  It is because life has been simple while in Russia, using these two drugs. I have been able to live a fairly “normal” life as a diabetic with Type 1 diabetes, without worrying about diet and without worrying too much about exercise.

Pros and Cons of Tresiba

Let me be clear: I love Tresiba as a basal insulin. Of current options, I would not change from it nor go back to the pump. One injection a day for the flexibility and control I get is worth it.

The advantages I have seen while traveling are that time zone changes do not affect me. I took my Tresiba a bit late on the day I left the US, and took it at noon the day we arrived in Paris. The switch to Moscow time was easy, as it was only an extra hour. My first dose in Moscow was the morning of the next day.

The con I see with Tresiba is that my basal needed lowering, and it took a good week to find out how far to lower it. With the increased walking I am doing while in Russia, and the healthier food I am eating, I ended up lowering my basal a total of 30%. The problem is that I had lows for several days, while waiting for the dose to adjust. It also meant that I did not know if I had cut it enough, or cut it too much, for several days.

I did take it down in two steps. First, by 20%, then another 10% 3 days later. The result is a flat basal rate when I am not exercising, with a slight rise in the afternoon when I normally am doing a lot of walking.

Pros and Cons of Afrezza

The big advantage I have had with Afrezza is that I can take it with me easily, and dose as needed without having to offend others, or to find a private place to inject.

I find that I use very little Afrezza with the foods I am eating in Russia. Some of it is because I am eating a lot of tasty fruits and vegetables, and I believe a good part of the fruit sugars are eliminated through the extra exercise. However, potatoes are a big part of Russian food, and I do find I use less Afrezza to cover those bolus points.

I am usually taking Afrezza after my meal, and only when my blood glucose hits 130 with a single upswing arrow on my Dexcom. That wins me a puff of 4 units. If I eat ice cream, a large serving of potatoes, or drink some of the deliciously sweet Crimean wine, it wins me an 8 unit puff.

In the US, I average use of about 2.5 boxes of Afrezza per month. That configured as 6 packages of 4 units, and 3 packages of 8 units.

In Russia, over two weeks, I have used exactly 1 pack of 4 units, and under 1/2 pack of 8 units. Average that out to a month, and we get roughly one box.

The cons?

I really have not found any.

Adjusting for the basal anomaly

For the slight rise I have in my basal in the afternoons, I find that the amount of walking I do pretty much offsets that rise. I still have a slight rise in the 6pm timeframe, but my Afrezza dose with dinner usually clears that up right away.

I do think the basal is a couple of units too high, but I need a “no activity” day to really figure that out.

Today is the first day I am actually getting to sit back and do nothing, so we will see how my basal reacts. Thus far I have been fairly flat today, starting at 114 on rising, dropping to 95 just before breakfast, up to 124 after breakfast, and back down to 107 up until now.

I do have a rise to 119 at the moment, with a flat indicator from Dexcom. I did just eat about 200 grams (1 cup) of ice cream, with no Afrezza dose.

Final Notes on Dexcom

Just a couple of notes on Dexcom that I find while I am traveling.

If I stick to the “mobile receiver” (my iPhone) I have had no problems at all with my Dexcom, nor the data uploaded to Dexcom Clarity.

The problem I ran into was when I connected my Dexcom G5 receiver to my laptop today, to upload the missing holes from losing Bluetooth connectivity the past few days.

Because I had not changed the date on the Dexcom receiver, I ended up with some up and down patterns on Clarity. At the same time of the day I have readings that might be 107, with a minute later the readingOdd Dexcom Readings showing 206, then a low one, followed by another high one.

Note to self: Change the date on the receiver if traveling and using it as a backup to the Bluetooth on the phone.