As I’ve never had to worry about a pen expiring once open (Yay high insulin resistance - noooooot!), I never really paid attention to how long a Tresiba pen is good for once open. “Once in use, Tresiba® FlexTouch® can last up to 8 weeks at room temperature (below 86F).” - wow. I was figuring most T1s wouldn’t be able to use up a U-200 pen before it expired, but with a 8-week open shelf life, I guess there’s a better chance of making a decent sized dent into that 600U.
Plus the additional benefit of not injecting as much liquid into your tissue which I would have to assume will reduce scarring, lipodystrophy, etc… In effect if you’re injecting half as much it’s like you’re rotating twice as much
Hi!
I have had been wondering if I was the only one “wondering” about splitting Tresiba…
I either stay flat overnight and gradually climb in the afternoon and when I have tried increasing the dose to curb the afternoon rise, I end up tanking around 4am.
A friend of mine was having the same issue with Tresiba but loves it so much for its all around “flatness” she mastercrafted the idea of trying one small injection of NPH during the day somewhere to smooth out that little rise. She is like the inspector gadget of insulin. lol! Verdict is still out…
I think many of us would inject 17 times per day if it meant flat lines and good times all day every day!
Dear Insulin,
Can you please just show up when I need you!
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It’s called a pump, cynthia! 
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oh… I wish! I would plug that thing back into my middle in a heart beat! Lol! I just abandoned after 20 years! who knows??? Thanks for making me smile! @BeastOfGevaudan !
Crazy, as this was my “plan B”!
I picked up the “Think Like a Pancreas” book of the shelf to see if there would be any info that might apply to my situation in there and that graph of people using long-acting combined with NPH just jumped at me and I thought that might be even better than splitting Tresiba!
If your friend is doing that, any chance you could report back on her behalf? Maybe get her to join here as I’d love to pick her brain regarding this. 
I’ve managed for 30 years without a pump and don’t think I’ll get one anytime soon. I love not carrying diabetes on my body physically as it’s already on my mind 24/7. I was able to achieve an A1c of 4.7 on MDI, low carb and exercise alone so I think I can keep making it work for me, just need to get creative! 
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I would also consider old fashioned Regular to smooth out an appropriately sized bump.
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@MayaK Here is the link to Kate’s post on Facebook about adding a little NPH to smooth things out. She loves to chat about anything diabetes and I am certain she would welcome a message if you would like to find out more ! She follows the same path you mentioned, low carb, exercise, and also has an a1C under 5 without a pump! Have a great day! cheers!
Redirecting...
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@Terry4 I know a few folks who use Regular for both themselves and their kiddos to cover protein delay. I keep forgetting to get a bottle of good ol’ R to try it out. Protein seems to visit me up to 12 hours later! Have you tried this?
No, I haven’t done this but am aware that Dr. Bernstein uses this protocol with some of his patients. He favors MDI and prescribes rapid acting analog insulin to cover carbs and then NPH or R to provide extended coverage for protein and fat. I use an extended pump bolus (in addition to a carb bolus) for every meal I eat.
Thank, @cynthia_rogers. I can’t open the link, it says “content unavailable”. I wonder if her privacy settings don’t allow for strangers to view her page?
Thanks, @Terry4! It crossed my mind as well. I’m not sure if R would have the range I need to cover that bump as the rise seems to happen in the hours just before getting up (last night for example, it was 60 around 1am, I didn’t correct and it was 130 at 8am). I might try it first as it seems to be a bit safer to me, at least at first. I will set an alarm for 3am to check BG, just in case. I do have some fears regarding NPH especially since I remember the days when it was pretty much the only option. That’s why it would be nice to hear from other people as well who currently use it this way.
Your sense of your needs is better than mine. In the scenario you describe, I think I would consider a small dose of NPH in addition to your usual basal regimen. If memory serves me, NPH peaks around six hours, just about the amount of time after going to sleep that most dawn phenomena starts the BG rise. Maybe start conservatively with a unit or two and then sneak up on the right dose.
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Absolutely you should Split Treaiba. I was on Lantus and it was hands down better after splitting and so was Tresiba after splitting twice per day, but Tresiba was still better than Lantus at once per day. I find it prevents earlier night time lows wheb splitting. The problem is that every diabetic reacts different to insulin. So its better to just jump right in and try it. It won’t do any harm other than more injections.
And MikeP. I remember you were one of the pioneers to first start Afrezza. Back then were you using only Afrezza and not comboing with Novolog? I tried Afrezza for the first time a few weeks ago and found you have to follow up a lot. So it got costly. I tried comboing Afrezza with Apidra but still hard to get consistency. With a CGM and unlimitrd Afrezza follow-ups, I would think using only Afrezza as a bolus would be best. What made you start comboing Afrezza with Novolog? A cost thing or are you finding comboing better? What ratio do you combo Afrezza/Novolog at?
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HI!
I am sharing this link here as many of you in this thread are Tresiba users!! If you are willing to “Share your Tresiba Story” you can read this post Have you tried Tresiba insulin? Willing to share feedback?!
or you may go directly to www.sharemydiabetesstory.com (It took me five minutes to complete!)
Thanks for considering the opportunity!
Cynthia!
I’ve been taking Tresiba since April. I notice I have higher basal needs during the day than at night so I split tresiba, AM and PM dose and in the morning I take 3 units of NPH along with tresiba, 10-15% of my total basal. Seems to work well. NPH is one of those insulin that is particularly prone to altering it’s peaks and duration of action when taken in large doses so when you take a small amount, you don’t get the strong peaks typically associated with NPH.
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Hi Richard - sorry for the delay in response.
Long story short, I’ve found I cannot use Afrezza solely for my bolus/correction needs. Reason being, I would get a pretty constrictive cough. So that’s why I was attempting to combine Afrezza and a rapid acting analog like Novolog, Humalog or Apidra while using Tresiba.
As mentioned, loved Tresiba but a pesky need for more basal in the 12-4pm time frame forced me back to the pump.
So my current regime is : Omnipod with Humalog, Afrezza for post-prandial control with typically an extended bolus of 1 or 2 hours depending on what I eat. Each meal is different but I’m probably on average of a 70/30 combo of Afrezza/extended bolus.