For those that have switched over to Tresiba:
Have you continued to dose two times a day if you had been doing a split dose with your last long acting insulin?
Have you continued to dose one time if you were previously dosing one time per day?
And WHY?
Once. Because IMO it makes zero sense to dose twice daily with an insulin that provides consistent coverage for 40+ hours. And it works perfectly 1x daily.
Like @Sam19, I do once a day with Tresiba. Before Tresiba, I had to split Lantus to get 24 hour coverage.
I have gone 36+ hours between doses while traveling, with no problems. Twice I have gone 48 hours without a spike. It makes no sense to split doses of Tresiba when it lasts 40+ hours.
I started out doing one shot at night with Tresiba but saw over time that every day in the late afternoon before dinner my BG levels would start creeping up. I also started experiencing pretty bad dawn phenomenon (DP) in which I saw a jump of more than 70 points at times.
I then decided to split it in the same way I used to split Lantus (2/3 at night, 1/3 in the morning). It solved both issues for a bit, but recently my DP is back with a vengeance. I’ve also put on weight and I find that I have to take larger doses of rapid to cover meals despite my levels being good in between meals.
I honestly don’t know what’s happening but I’m seriously considering going back on Lantus. I just don’t see the point or advantage of using Tresiba so much anymore. 
split it to when you go to bed and when you wake up
This is the confusion. Dr. Bernstein says to split. And others including two Endocrinologists that I have talked to thus far say one time a day based on how it works in the body.
Very Confusing!
Dr Bernstein is marching to his own drummer on this one.
It’s not like there is any harm in splitting a Tresiba dose, but I agree with @Sam19 on this, there’s no reason to.
It would make sense that Bernstein would say split. Not too much at any one time with some space in-between. You can not take exogenous insulin and think that the body is going to treat it like a healthy body would. It see’s it as a foreign invader. But there is a whole different science in which this new insulin works. That is the part that I do not understand as of yet.
Bernstein says to split but he hasn’t said why. There could be two reasons. Split doses would be smaller allowing better absorption. And having two injections means that if you accidentally miss an injection the consequences would be mitigated. I am splitting my doses of Tresiba, I’ll have to see how it goes.
Keep Us Posted!
I listened to the video once - his reason was that “Nordisk lies” when they say it last 2 days (they don’t say that), and that (roughly quoted) in his experience (though he has never used it) it does not last 24 hours.
Yeah I’m a fan of Bernstein in general but think he’s slipping…
When I listened, I heard he has all his patients on Tresiba now. It is the only one that will last all night. He wants the night and morning dose to be close, not 12hr apart.
Are you doing the bedtime and rising timing? Do you take more at bedtime than in the morning? I’m curious since I have enough Tresiba left over from my last trial to try it again. I’m thinking splitting it may give me good basal control both overnight and late afternoon.
I had split my Levemir into uneven doses but have split Tresiba into even doses and take it right before bed and upon arising. Dr. B had recommended that Levemir be dosed at bedtime and then less than nine hours later upon arising but I had not heard him say anything similar about Tresiba.
That’s exactly how I do it. Still have horrible DP. I can go to bed in the 70s and wake up anywhere from 120 to 150.
It sounds basal, do you do a 3am to see if you are dropping before the spike? bernstein is saying take it when you go to bed and wake up
I would run a full Basal testing plan. you either need less or more.
A workbook (the certificate ran out but the site is safe)
If that doesn’t work you may need to go on a pump or bolus a correction in the early hours, as per bernstein’s book on what he use to do.
he is also saying 30g of carb a day, under 50-60g is also good. If you are high carb it can mess your insulin resistance and liver up for DP
@jack16 I follow Dr Bernstein’s 30g a day and have been for about 2 years now.
It worked great for me for a long time (A1c of 4.7) but I’ve noticed many changes in the past few months.
I’ve done basal testings. My BG seems to be fairly stable during the day. I tested at 2am as well (though not 3am) and it is stable then too. When I test in the morning (fasting, anywhere from 6:30am to 10am) it’s always double digits numbers. I do take my nighttime injection fairly late (9-10pm) and my morning early (7am).
I also noticed that I’m more sensitive to food, any food, now with Tresiba. I have to bolus more than I used to. Tried changing insulin and everything. I also use R to cover high protein meals as per Bernstein’s advice. I have his book and watch his teleseminars, I just wonder if maybe the fact that I’ve had type 1 for so long, plus the fact that I’m female have me in a unique situation? I don’t know. I feel like I do everything right (I even tried eating much less than 30g before with no difference). I exercise in the evenings as well. Just feel like I’ve hit a wall as far as my management goes.
@MayaK I’m guessing and you should see a HCP…but for the next couple of weeks test at different times during the night, to see if you can see a pattern.
Don’t exercise for now at night and I would test when you first wake up, before you get out of bed in the morning.
If that is ok, It’s not DP but an awake morning liver dump, you may be able to bolus for that and sometimes eating something before you get out of bed can help too
when it’s stable, put the exercise back in and see if there are any change
If you increase your current night time dose you hypo?