Tresiba issues

hello! I’ve been reading and researching like crazy to try and find a solution, but thinking maybe tresiba just might not be a good fit for my daughter… unless someone has some suggestions for us! sorry - it’s going to be long…

My daughter is 15 and we recently (just over a month ago) switched from lantus to tresiba. She requires much more basal insulin between the hours of 10-3pm. With lantus we were able to split the dose - 28 units in the am and 20 in the pm with an hour overlap to help combat the increased need during that time of day…

We had high hopes with tresiba, but are having a heck of a time figuring out how to make it work for us… she was taking 40 units at 9pm - seeing a slight peak as soon as she fell asleep and then a gradual decline the rest of the night - as soon as she wakes - she rises slightly, is completely steady for 3 hours or so and then starts the slow and steady climb into the 300s ?! Dr suggested we move her dose to 6pm and it has helped perfectly to level out the evening/ overnight hours, but we are still seeing the ridiculous rise during the day! (beyond that he had no suggestions) It is not related to carb ratios - as she does not eat lunch at school… its an ongoing conversation, but she just isn’t hungry and it’s apparently not cool to eat lunch at high school … we have tried pre-empting the rise before it starts with a dose of humalog and it has done nothing. it takes MULTIPLE corrections to bring her down and then she more often than not goes back up again - I have adjusted sensitivity during this time of day and nothing is working! I’m seriously tearing my hair out…

I know it isn’t supposedly necessary to split the dose as it essentially it lasts 42 hours in the body - but has anyone had success in doing so??? Should I try moving the dose to the AM instead of PM? Does this sound like it is wearing off early ??? Could I try alternating say 40 units one night and 42 the next to help with the tail that is wearing off ??

do any of these ideas make sense? I feel like a mad scientist trying to figure all this out…

She really wants to stick with tresiba - because lantus burned like crazy - but I’m wondering if it’s worth it ?? everyone else seems so happy and stable…

would love input and ideas please!

I use Tresiba, and a single dose has worked really well for me. However, I have read on another forum of other people benefiting from a split dose. The thread is long (she splits the dose on the 418th post), but I’ll post the link if you want to look through her experiment of using Tresiba and eventually splitting the dose. She ended up switching back to the pump, but she experienced much better results on a split dose of Tresiba than a single dose. Another poster on the thread also said that he benefited from a split dose. I’m not entirely sure why splitting the dose helped so much, but it may be worth a try?

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I have a 16 year old daughter on tresiba since October. We were having a similar problem in that we felt the tresiba was wearing thin just before the next injectionat 6pm. What we found helpful was to split the dose in half and inject half in each leg at the same time EG. 20 units in one thigh 22 in the other. We think the absorption was much better this way.
Like your daughter, my daughter needs much less insulin at night than during the day. We set the dose to keep her steady all through the day but she ends up dropping three to four mmol between 3 and 6 a.m. We make sure she is about 10mmol before bed and she wakes up in perfect range. I guess tresiba works perfectly for people with a very steady basal requirement throughout the day but for those whos needs fluctuate it can be more challenging. Overall, we feel like tresiba works much better than Levemir. If you set it high enough to keep her steady throughout the day what happens at night? Is the drop too severe?

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I don’t personally split my Tresiba dose, but I have a good friend with similar issues to yours, and he said splitting the dose solved it for him.

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I just use 20 units in the morning. No problems. What kind of problem do you guys have ? Tresiba is used to allow your cells absorb glucose. I use Humalog to lower my numbers.

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thanks! this is great info… unfortunately, we havent found a way to keep her steady during the day AT ALL… she plays basketball and has late games and practices - those days of course her nighttime drop is more pronounced… with no basketball nights, we have now managed to get the downward drift to a more manageable level by moving dose back by 3 hours… (from 9pm to 6pm) … interesting that you have been able to inject the same amount split in different legs and have better results! I decided I’m going to experiment by switching to giving full dose in the morning - I gave her half tonight and will do half tomorrow to transition and cross my fingers! if that doesn’t work - I will try the split dose idea! this disease sure is crazy and annoying! thank you so much for your input!

she had a HUGE slow and steady spike between 11-2pm and corrections don’t touch it… she can be a perfect 80-90 heading to school at 7.30am and by 3pm is 300+ … the rise starts at around 11 and nothing we do seems to be able to stop it. we have even tried bolusing ahead a couple of units before the rise starts to stop it happening, with no luck… she is not eating during this time so it is not a carb ratio issue

I’ve been using one dose since starting Tresiba last year and it was working great but recently I’ve been having dawn phenomenon so I decided to split the dose for the first time today. I took two thirds this morning and the last third this evening so I’ll let you know how that goes. Dr. Bernstein says that Tresiba doesn’t really last 24 hours and for any patients he has on Tresiba their dose is split.

When I posted last fall about feeling like tresiba was wearing thin just before injection time, someone suggested that because it was a 42 hour duration insulin, perhaps it was wearing thin on the second day, which makes sense to me.


Bernstein now uses Tresiba, and he splits the dose. Why don’t you ask him at his next online seminar.

At the time he made this statement, he hadn’t actually used it. I know if I inject at 7 am on Monday, and forget my Tuesday dose, I don’t start to rise until after 11 pm Tuesday - so about 40 hours.

But that is just my experience. YMMV

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I don’t think it’s remotely possible that Tresiba doesn’t last 24 hours. What is possible is that someone has uneven coverage due to how the long tail wears off for them—the issue isn’t therefore the first 24 hours, but rather the part that is active from the day before. Splitting the dose would diminish possible variability from those overlapping waves of insulin (which for many people seem to provide a steady dose, but not everyone).


I does last more than 24 hours for me but I’m splitting my dose because my BG rises significantly after I get up in the morning. I’ll go from 80 to 145 in an hour with no food and that is so annoying that i’m trying this experiment.

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I was one of the people on the other forum who had success splitting the dose. However, for me Tresiba had a peak regardless of how it is supposed to work, and I started to notice that by splitting it I was experiencing 2 peaks causing lasting lows in the morning and at night. I changed to 1 dose and tried taking it in 2 shots. I still found it way too strong at about 9-12 hours after injecting, and that the dose would wear thinner throughout the day. Overall I wasn’t impressed by Tresiba and returned to pumping which is a better option for me for many reasons. It seems to be an insulin that is either absolutely fantastic or absolute crap depending on the person using it!

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I used Tresiba and split it. In the low carb Facebook group I am in virtually everybody that use Tresiba split it. - Essentially it is a group that follows the Dr Bernstein regimen. Many also use Levemir which is very similar to Lantus and most of those split it either two or three times. The three time split is often required to combat the Dawn Phenomena. Tresiba can be a little difficult to manage exactly because the effect lasts so long. It is hard to figure out what happens. When you split the dose like I did it can add a level of complexity because changingnone dose will affect the other. Having said that Tresiba is really forgiving and nothing dramatic happens if you move doses around between am and pm. BUT, because of the difficulty In nailing the dose I finally moved to Levemir because of its shorter action. And now I have the problem that I go high in the evening and have to correct with bolus shots. I haven’t been using it long enough so the jury is still out, but I am wondering if my final solution will be a morning shot of Tresiba and a small night shot of Levemir.

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There are so many things that effect bg, skipping meals can make your bg,s high. Also when I was younger, my by would spike one full week before my menstrual cycle. I feel for you and your struggles.

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thanks everyone! appreciate your input and honesty about how it just might not be that great for us… everywhere else I’ve asked - people LOVE it and probably thought I was crazy :wink: … we have mostly transitioned from PM to AM shot - and today is the first day we have seen DECENT numbers during the day… that could in part be because it’s the weekend and her routine was very different too - she started the day with an early morning basketball practice so could very well be helping to keep numbers down … we will inject full dose tomorrow AM and the next few days will tell the full story. fingers crossed!

thank you - yes… we thought for sure the missing meals part was a huge component… but the day I MADE her eat a meal to test the theory she was just as high :frowning:

You’d think that missing a meal meant less glucose in the bloodstream which would mean lower blood sugar levels.

That’s what a lot of non-diabetics think and it was true when people were on insulin regimens that required them to eat during the extreme peaks of the insulin they were taking. On modern MDI or a pump, there is no reason skipping a meal should cause a low blood sugar unless the basal insulin is too high.