What Is the Best Long-Acting Insulin? A Review of Tresiba and Other Brands

If you have Type 1 or Type 2 diabetes, your healthcare provider may have you take insulin to help control your blood sugar levels. But there are many insulin options available. So how do you choose one that’s right for you? 

Long-acting insulins are a common choice. They provide stable amounts of insulin over the course of an entire day. And some long-acting insulins, like Tresiba (insulin degludec), last even longer. Tresiba is sometimes called an ultra-long-acting insulin since its effects can last over 24 hours. In fact, it’s the longest acting insulin available.

The best long-acting insulin for you can depend on your preferences, cost, and other factors. 

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Let’s take a closer look at Tresiba and a few alternatives to see how they stack up.

What is a long-acting or basal insulin?

You can think of long-acting (or basal) insulin as your “background” insulin. It provides your body with a consistent amount of insulin over the course of 24 hours or longer. This helps you maintain normal blood sugar levels, even when you’re not eating. Given how long it lasts, you typically only need to inject long-acting insulin once daily.

Some people only need to take a long-acting insulin. But sometimes faster-acting insulins may be added to your regimen for more blood sugar control. For example, a rapid-acting insulin can help control blood sugar spikes that happen after eating a meal.

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What are my options for long-acting insulins?

There are several different options for long-acting insulin. Some contain the same kind of insulin, but under different product names. There are also a few biosimilars — insulins that are highly similar to another FDA-approved insulin product. Check them out below.

• Insulin degludec: This type of insulin is available under the brand name Tresiba. It provides blood sugar-lowering effects for up to 42 hours. 

• Insulin detemir: This type of insulin is available under the brand name Levemir. It can last up to 24 hours. But some people need to inject it twice daily.

• Insulin glargine: Lantus, Basaglar, and Toujeo all contain insulin glargine and last for at least 24 hours. Toujeo lasts the longest (up to 36 hours). There are also several Lantus biosimilars that have been approved. These include Semglee (insulin glargine-yfgn) and Rezvoglar (insulin glargine-aglr). Both contain a slightly different form of insulin glargine. 

What is Tresiba?

Tresiba is a long-acting insulin that’s FDA approved to help control blood sugar levels in people with Type 1 or Type 2 diabetes. This includes adults and children, age 1 and older. It’s available as a multi-dose vial and prefilled injection pen. 

How is Tresiba given?

Tresiba is injected under the skin of your stomach, upper arm, or thigh once a day. Be sure to rotate injections sites each time. This can help prevent lumps, thickening, or pits from forming in your skin where it has been injected.

Because it lasts for up to 42 hours, adults can inject Tresiba at any time of day. This can give you some flexibility with your dosing. Just make sure you wait at least 8 hours between injections, and don’t wait longer than 42 hours. Children should be given Tresiba at the same time every day.

How much insulin you’ll inject depends on your individual needs. If you have Type 2 diabetes and are new to insulin, the starting Tresiba dose is typically 10 units once daily. If you’re switching from other insulins, your healthcare provider may have you adjust your dose to start.

Does Tresiba work?

Tresiba is a great option to help control your blood sugar. It has been shown to provide similar blood sugar-lowering effects compared to other long-acting insulins, including Lantus and Levemir.

Your healthcare provider will discuss your blood sugar goals with you. And they’ll have you regularly monitor your blood sugar levels while taking Tresiba. Your hemoglobin A1C will also be measured occasionally. This gives you an idea of your average blood sugar levels over 3 months. 

If your blood sugar levels or A1C is too high, your healthcare provider can adjust your Tresiba dose to meet your individual needs. As mentioned earlier, they may decide to add a rapid-acting insulin before meals to help with any post-meal blood sugar spikes. 

How to save on Tresiba

There are several ways to save on Tresiba, which is available as a brand-name and unbranded medication.

• Save with GoodRx. GoodRx can help you save over 60% off the average retail price of the unbranded version. Unbranded Tresiba’s price at certain pharmacies is less than $87 with a free GoodRx discount.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Tresiba’s patient assistance program, which offers the medication free of cost.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $25 for Tresiba using a savings card from the manufacturer.

How does Tresiba compare to other long-acting insulins?

There are several similarities and differences between long-acting insulins. But how do they stack up in terms of effectiveness and side effects? Let’s review a few examples.

Tresiba vs. Lantus

A systematic review and meta-analysis looked at studies comparing insulin degludec (Tresiba) with insulin glargine (e.g., Lantus). Researchers didn’t find significant differences in blood sugar control between the insulins. However, hypoglycemia (low blood sugar) was less common with insulin degludec.

Tresiba vs. Levemir

In the same systematic review and meta-analysis, insulin degludec was also compared to insulin detemir (Levemir). Blood sugar control was comparable between insulins. People taking insulin detemir gained less weight. But more people with Type 2 diabetes stopped taking it due to side effects.

Tresiba vs. Toujeo

There aren’t many head-to-head studies with Tresiba and Toujeo. But the recent BRIGHT trial compared them in people with Type 2 diabetes who were new to insulin. Researchers found no significant differences in blood sugar control or hypoglycemia overall between the two insulins.

What is the best long-acting insulin?

The best insulin for you can depend on your preferences, cost, and other factors. If you have health insurance, your plan may also prefer one type over another. 

Long-acting insulins have been shown to work similarly well at controlling blood sugar. But what other factors might you want to consider?

Dosing: Since it lasts longer, Tresiba can offer more flexibility with your dosing. Most other long-lasting insulins need to be taken at the same time each day. And for some people, once-daily Levemir may not work well enough. In this case, twice-daily dosing may be required.

Availability: All long-acting insulins are available as convenient prefilled injection pens. But if you prefer a vial, you could consider Tresiba, Levemir, or Lantus.

Biosimilars: One way to save on your long-acting insulin is by switching to a biosimilar. Lantus has an interchangeable biosimilar called Semglee. That means your pharmacist may be able to switch you to Semglee if you’ve been prescribed Lantus.

It’s best to discuss the pros and cons of any insulin with your healthcare provider. They can help determine which is best to help you meet your blood sugar goals.

What about my short-acting insulin?

If you’re taking a long-acting insulin, you may still need a rapid-acting or short-acting insulin. These insulins are taken before meals to prevent blood sugar spikes. 

There currently aren’t any products available that combine long-acting and short-acting insulins. Ryzodeg (insulin degludec and insulin aspart) used to be available. But it has been discontinued by the manufacturer. 

If you’re using both long-acting and short-acting insulins, it’s important to check the label before administering your dose. Using the wrong insulin can result in your blood sugars getting too low or too high. Making sure you’re using the right product and right dose at the right time can help you avoid medication errors. It’s also important to store each insulin product properly.

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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