Is Tresiba the Best Long-Acting Insulin?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Comparing long-acting insulins? Tresiba may come out ahead. With the exception of NPH insulins like Humulin N and Novolin N (which are now considered to be intermediate acting), 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 is a long-acting or basal insulin?

This is your baseline insulin, the insulin that is secreted to control your sugars when you are not eating (also known as 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 to be an intermediate-acting insulin. Levemir and Lantus were then joined by Toujeo and Tresiba as the main players. These insulins are typically administered once daily to provide basal insulin levels. Think of Basaglar as the Lantus “generic” or copycat.

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 effect. What makes Tresiba a hero is its long duration of action (more than 40 hours) with minimal fluctuations 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 with your healthcare provider. Lantus, Levemir and Tresiba may have some modest advantages over NPH insulin like fewer symptoms or 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 insulin in addition to Tresiba or the active ingredient in Tresiba, insulin degludec, comes mixed in another product called Ryzodeg. Ryzodeg 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 Tresiba 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.

Does Tresiba work?

Studies using Tresiba in combination with mealtime insulin for people with type 1 diabetes or as an add-on to oral diabetes meds for people with type 2 diabetes show it is as effective in reducing hemoglobin A1c as other long-acting insulins.

Is Tresiba expensive?

Yes, but so are Lantus and Levemir. If your doctor believes Tresiba will regulate your sugars better and improve sugar highs and lows, you can ask your doctor about submitting an insurance coverage appeal. Your insurance company may approve Tresiba with a prior authorization—I’ve seen it happen.

Dr O.

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