Comparing long-acting insulins? Newly approved Tresiba may come out ahead. With the exception of NPH insulin (the original long-acting insulin—examples include Humulin N and Novolin N), they are all going to cost you. So, if you are already paying big bucks for your long-acting insulin, here are some things to think about:
What does a long-acting or basal insulin do for me? This is your baseline insulin, the insulin that is secreted to control your sugars when you are not eating (in the fasting state). Put another way, basal Insulin is used to suppress liver glucose production and help you maintain normal sugars even when you aren’t eating.
What are my options? The old-school and well respected NPH insulin has been around forever and is considered intermediate acting. Levemir and Lantus were then joined this year by Toujeo and now Tresiba as the main players. Toujeo is basically Lantus (which was losing its patent) and may not gain any traction in the market. These insulins are typically administered once daily to provide basal insulin levels. Basaglar was just approved by the FDA and think of Basaglar as the Lantus “generic” or copycat–that will be available soon and let’s hope it’s cheaper than Lantus.
What is Tresiba? Tresiba (insulin degludec) is the longest acting insulin available and there don’t appear to be any coming down the pipeline that give this duration of coverage. What makes Tresiba a hero is the long duration of action (>40 hours) with less fluctuation in blood levels of the drug. It’s given once a day.
Is Tresiba the best long-acting insulin? This can only be answered on an individual basis and along with your provider. Lantus, Levemir and Tresiba may have some modest advantages over NPH (less symptomatic and nighttime hypoglycemia) in type 2 diabetes, with the important disadvantage of higher cost. Unlike Lantus and Levemir, Tresiba can be mixed with a short acting insulin which is a plus.
What about my short acting insulin? You have two options here–you can continue to use your short acting in addition to Tresiba or—it (insulin degludec) comes mixed in another product called Ryzodeg which is a 70/30 mixture of long and rapid acting insulin. In type 1 diabetes a steady long acting insulin like Tresiba may provide more control and protection over dips and peaks in your sugars.
How is it given? The recommended starting dose of Tresiba in people with type-2 diabetes who have never been on insulin is 10 units, injected subcutaneously, once daily—at any time of day. If you’re already using a long-acting insulin, Tresiba should be started at the same total daily dose.
Show me the studies: Studies using Tresiba in combination with mealtime insulin for type-1 diabetics or as an add-on to oral diabetes meds for type-2 diabetics show it is as effective in reducing hemoglobin A1c as other previously approved long-acting insulins.
Is it expensive? Yes—but so are Lantus and Levemir. If your doctor believes Tresiba will regulate your sugars better and improve the highs and lows, your insurance company may approve a prior authorization—I’ve seen it happen.