insulin degludec
Insulin degludec (Tresiba) is an ultra-long-acting insulin. It's used to manage blood sugar levels in adults and children with Type 1 diabetes or Type 2 diabetes. It's injected under the skin once per day. Insulin degludec (Tresiba) comes as a vial and FlexTouch pen. Side effects include common cold symptoms and headache. Tresiba is available as a brand-name medication and an unbranded biologic.
What is Insulin degludec (Tresiba)?
What is Insulin degludec (Tresiba) used for?
How Insulin degludec (Tresiba) works
Insulin degludec (Tresiba) is an insulin. Insulin is a natural hormone your body makes to control blood sugar levels. It helps your body absorb and store sugar from the bloodstream after a meal. Insulin also stops your liver from making glucose (sugar). But people with diabetes can't make insulin, don't make enough insulin, or their body doesn't respond to insulin as it should.
Insulin degludec (Tresiba) is an ultra-long-acting, lab-made version of insulin. It helps control blood sugar levels throughout the day. Insulin degludec (Tresiba) is used by people who don't make insulin or need more insulin than what their body can produce.
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What are the side effects of Insulin degludec (Tresiba)?
Common Side Effects
- Low blood sugar levels (up to 99%)
- Common cold (up to 24%)
- Upper respiratory tract infection (up to 12%)
- Headache (up to 12%)
- Diarrhea (up to 6%)
- Sinus infection (up to 5%)
- Stomach viral infection (up to 5%)
Other Side Effects
- Weight gain
- Reactions where the medication is injected (e.g., redness, swelling, itching)
- Fluid buildup
- Fat deposits under the skin or pitting of the skin where the medication is injected
Serious Side Effects
- Severely low blood sugar: dizziness, shakiness, feeling confused, feeling irritable or anxious, feeling faint, sweating, extreme hunger, can't think clearly
- Dangerously low potassium levels: weakness, muscle cramps or twitches, constipation, abnormal heartbeat, tiredness, trouble breathing
- Severe allergic reaction: rash; hives; swelling of face, tongue, and throat; trouble breathing
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Low blood sugar (hypoglycemia)—tremors or shaking, anxiety, sweating, cold or clammy skin, confusion, dizziness, rapid heartbeat
- Low potassium level—muscle pain or cramps, unusual weakness or fatigue, fast or irregular heartbeat, constipation
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Lipodystrophy—hardening or scarring of tissue at injection site
- Pain, redness, or irritation at injection site
- Weight gain
Pros and cons of Insulin degludec (Tresiba)
Pros
Injected once daily
Each dose can help control blood sugar levels for about 42 hours
Can be stored at room temperature for up to 2 months
Cons
Raises risk of dangerously low blood sugar levels
Might cause weight gain
Can't be mixed with other insulins
Pharmacist tips for Insulin degludec (Tresiba)
Ask your prescriber how often you should check your blood sugar during the day as you take insulin degludec (Tresiba). Keep a log of your blood sugar readings and show it to your prescriber at your office visits. This helps you and your prescriber keep track of how well insulin degludec (Tresiba) is working for you and whether you need dose adjustments.
Using insulin degludec (Tresiba) can raise your risk of dangerously low blood sugar levels. It's important that you and your caregiver know how to recognize symptoms of low blood sugar level, such as sweating, shakiness, anxiety, and hunger.
When you're using insulin degludec (Tresiba), make sure to always carry fast-acting sugars with you so that you can bring your blood sugar levels up when it drops too low.
Store unopened insulin degludec (Tresiba) pens and vials in the refrigerator until the expiration date. Keep opened pens and vials at room temperature or in the refrigerator for up to 56 days.
How to inject insulin degludec (Tresiba):
Your care team will give you training on how to administer insulin degludec (Tresiba). Make sure you review the instructions for use for either the vial or FlexTouch pen to avoid accidentally hurting yourself or wasting the medication. Contact your care team if you have any questions.
Insulin degludec (Tresiba) is available in two different strengths: U-100 (insulin degludec 100 units/mL) and U-200 (insulin degludec 200 units/mL). The U-100 pen dials in 1-unit increments and the U-200 pen dials in 2-unit increments. Make sure you know which strength of insulin degludec (Tresiba) you have.
Insulin degludec (Tresiba) can be used at the same time as other types of insulin, such as mealtime or short-acting insulin. Before a dose, double check that you're using the correct insulin product and that your dose (number of units) that you've prepared is correct. This is important to prevent dosing mistakes that could lead to dangerously low blood sugar if you accidentally inject too much insulin.
Before you inject insulin degludec (Tresiba), check that the insulin in the pen is clear and colorless without any particles (solid chunks). If it isn't, don't use the pen and ask your pharmacist for a replacement.
Inject insulin degludec (Tresiba) under the skin (subcutaneously). You can inject the medication into the skin of your stomach area (2 inches away from your belly button), thighs, or back of your upper arms.
Be sure to rotate injection sites to prevent hard lumps from forming in your skin. Avoid injecting insulin degludec (Tresiba) into skin that has pits, is thickened, or has lumps. Also, avoid injecting into skin that's tender, bruised, scaly, hard, scarred, or damaged to prevent more irritation.
Always use a new needle for each insulin degludec (Tresiba) injection to help prevent infections and blocked needles. Don't reuse or share your needles with other people to avoid spreading infections.
Throw away all used needles and empty insulin degludec (Tresiba) pens in a sharps container or something made of heavy-duty plastic, such as an empty milk carton or laundry detergent bottle. This helps lower the risk of needle-stick injuries. Don't throw away needles and pens in your trash can.
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What are the risks and warnings for Insulin degludec (Tresiba)?
Insulin degludec (Tresiba) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of infections with pen sharing
Never share insulin degludec (Tresiba) pens, syringes, or needles with anyone else. Sharing insulin degludec (Tresiba) puts you and the person who's also using the same pen at risk of getting very dangerous infections and health conditions.
Risk of high and low blood sugar levels
Changing your insulin or insulin routine, such as where you inject insulin degludec (Tresiba), can affect how your body responds to insulin. This can lead to either high or low blood sugar levels. In addition, injecting insulin degludec (Tresiba) repeatedly into skin areas that shows signs of lipodystrophy, such as pitting or thickened skin, can also result in high blood sugar levels.
Don't make changes to your insulin degludec (Tresiba) dose or routine without first checking in with your diabetes care team. Make sure to avoid injecting into skin areas that show signs of lipodystrophy. If your care team instructs you to make any changes to your insulin routine, they'll also ask you to check your blood sugar levels more often to see how the changes affect your blood sugar levels.
Dangerously low blood sugar levels (hypoglycemia)
Risk factors: Changes in diet and exercise | Drinking alcohol | Taking other medications for diabetes together with insulin degludec (Tresiba) | Liver or kidney problems | Not using insulin degludec (Tresiba) as directed
Using insulin degludec (Tresiba) alone or together with other medications that lower blood sugar can lead to hypoglycemia, which is dangerously low blood sugar levels. If not treated in time, it can be life-threatening.
Check your blood sugar level regularly to make sure it's within a safe range. Never mix insulin degludec (Tresiba) with other insulins nor use it with an insulin pump. If you make any changes to your diet or meal patterns, other medications, or how much you exercise, let your care team know because they might need to adjust your dose of insulin degludec (Tresiba).
Make sure you're familiar with symptoms of hypoglycemia, such as feeling shaky, being nervous or anxious, sweating or body chills, and excessive hunger. Keep fast-acting sugars, such as glucose tablets, with you at all times so you can treat an episode of hypoglycemia. If your blood sugar levels don't improve even after you take fast-acting sugars, get medical help right away.
Low blood potassium levels
Risk factors: Taking other medications with insulin degludec (Tresiba) that lower potassium
Insulin degludec (Tresiba) can lower the levels of potassium in your blood, which can be dangerous. You're more at risk if you're already taking medications that lower your potassium, such as certain diuretics or water pills). If needed, your prescriber might check your potassium levels regularly and give you medications to keep your potassium normal.
Symptoms of low potassium levels include weakness, muscle cramps or twitches, digestive problems, or abnormal heartbeats. Call a healthcare professional if you have these symptoms while you're taking this medication.
Swelling and heart failure when used with certain diabetes medications
Risk factors: Taking glitazones together with insulin degludec (Tresiba) | History of heart failure
Taking insulin degludec (Tresiba) with glitazones (also known as thiazolidinediones), like pioglitazone (Actos), can cause your body to hold onto fluid. This can lead to or worsen heart failure because the additional fluid can put stress on your heart and cause symptoms such as trouble breathing or the inability to exercise.
Make sure to tell your prescriber if you have heart failure or if you're taking a glitazone before you start insulin degludec (Tresiba). And contact your care team if you have unusual sudden weight gain, swelling, or trouble breathing because these can be signs of fluid buildup and heart failure.
Allergic reactions
In some rare cases, insulin degludec (Tresiba) can cause a serious, life-threatening allergic reaction (e.g., anaphylaxis). Get medical help right away if you experience swelling in your lips, face, or tongue; rash; or trouble breathing.
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Insulin degludec (Tresiba) dosage forms
Typical dosing for Insulin degludec (Tresiba)
Your prescriber will work with you to find the dose that works best for you. Your dose depends on many things, such as whether you have Type 1 or Type 2 diabetes, your blood sugar levels, and your weight. You might need to use a fast-acting insulin along with Tresiba.
Insulin degludec (Tresiba) is available in two different strengths:
U-100 (insulin degludec 100 units/mL)
U-200 (insulin degludec 200 units/mL)
Starting insulin for the first time
T1D: Your care team will help you calculate your total daily insulin (TDI) requirement. The typical starting dose of Tresiba is about 30% to 50% of your TDI requirement, injected under the skin once daily.
T2D: The typical starting dose is 10 units injected under the skin once daily.
Already taking insulin
Adults with T1D or T2D: The typical starting dose of Tresiba is the same total daily dose of long-acting or intermediate-acting insulin you've been previously taking.
Children (ages 1 year and older) with T1D or T2D: The typical starting dose of Tresiba is 80% of the total daily dose of long-acting or intermediate-acting insulin your child has been previously taking.
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Insulin degludec (Tresiba) contraindications
Taking during episodes of low blood sugar (hypoglycemia)
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References
Best studies we foundAmerican Diabetes Association. (2012). Hypoglycemia? Low blood glucose? Low blood sugar? Clinical Diabetes.
Kadiyala, P., et al. (2014). Insulin induced lipodystrophy. British Journal of Diabetes.
Lewis, J. L., III. (2023). Hypokalemia (low level of potassium in the blood). Merck Manual Consumer Version.
Nasrallah, S. N., et al. (2012). Insulin degludec, the new generation basal insulin or just another basal insulin? Table 1. Comparison of insulin degludec and other insulin analogs. Clinical Medicine Insights: Endocrinology and Diabetes.
Novo Nordisk. (2022). Tresiba- insulin degludec injection, solution [package insert]. DailyMed.
Sharabi, K., et al. (2015). Molecular pathophysiology of hepatic glucose production. Molecular Aspects of Medicine.
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