What long-acting insulin is similar to Tresiba (insulin degludec)?

Long-Acting Insulins Similar to Tresiba (Insulin Degludec)

Insulin glargine (particularly U-300 glargine) is the long-acting insulin most similar to Tresiba (insulin degludec) in terms of pharmacokinetic profile and clinical effects.

Comparison of Long-Acting Insulin Options

Insulin Degludec (Tresiba)

• Ultra-long-acting insulin analog with duration of action >42 hours 1
• Available in U-100 and U-200 formulations 2
• Provides a flat, stable glucose-lowering effect with less day-to-day variability than other long-acting insulins 3
• Forms soluble multihexamer chains after subcutaneous injection, creating a depot for slow, consistent absorption 1
• Half-life exceeding 25 hours 1

Most Similar Alternative: Insulin Glargine U-300 (Toujeo)

• Has a longer duration of action than standard U-100 glargine 2
• Provides relatively constant basal insulin levels without pronounced peaks 4
• U-300 glargine has a longer duration of action than U-100 glargine, making it more similar to degludec 2
• Lower risk of nocturnal hypoglycemia compared to standard basal insulins 5

Other Long-Acting Insulin Options (Less Similar)

1. Insulin Glargine U-100 (Lantus, Basaglar)

   • Duration of action up to 24 hours 4
   • Less stable profile compared to degludec or U-300 glargine 5

2. Insulin Detemir (Levemir)

   • Long-acting basal analog with up to 24-hour duration 6
   • Requires twice-daily dosing in some patients 2
   • Has a more pronounced peak effect compared to degludec 6

Clinical Considerations When Switching

When switching from Tresiba to another long-acting insulin:

• Dosing conversion: When switching from degludec to glargine U-300, doses can often be converted unit-for-unit, but an initial dose reduction of 10-20% may be needed for patients at high risk for hypoglycemia 2
• Timing: Both degludec and glargine U-300 are administered once daily 2
• Hypoglycemia risk: Both degludec and glargine U-300 have lower risk of nocturnal hypoglycemia compared to older basal insulins 5

Important Differences to Consider

Despite similarities, there are key differences to note:

• Insulin degludec has an ultra-long half-life of approximately 25 hours versus the shorter half-life of other long-acting insulins 1
• Degludec offers more flexibility in dosing time due to its very flat profile and long duration 3
• U-300 glargine has modestly lower efficacy per unit administered compared to U-100 formulations 2

Practical Recommendation

For patients needing to switch from Tresiba:

• First choice: Insulin glargine U-300 (Toujeo) - most similar pharmacokinetic profile
• Second choice: Insulin glargine U-100 (Lantus, Basaglar) - widely available but shorter duration
• Third choice: Insulin detemir (Levemir) - may require twice-daily dosing in some patients

When making the switch, monitor blood glucose more frequently during the transition period to ensure adequate glycemic control is maintained, particularly overnight when differences in hypoglycemia risk may be most apparent.