Tresiba (Insulin Degludec) is an Ultra-Long-Acting Basal Insulin
Yes, Tresiba (insulin degludec) is a long-acting insulin analog, specifically classified as an ultra-long-acting basal insulin with a duration of action exceeding 42 hours. 1, 2
Pharmacological Classification and Properties
Insulin degludec (Tresiba) has distinct characteristics that set it apart from other long-acting insulins:
- It is an ultra-long-acting basal insulin analog with a duration of action >42 hours 2
- It provides a flat, stable glucose-lowering profile 2
- It has less within-patient day-to-day variability in glucose-lowering effect compared to other long-acting insulin analogs like insulin glargine 2
- It is available in two concentrations: 100 units/mL (U-100) and 200 units/mL (U-200) 1
Molecular Structure and Mechanism
Insulin degludec differs from human insulin in its structure:
- The amino acid threonine in position B30 has been omitted
- A side-chain consisting of glutamic acid and a C16 fatty acid has been attached
- This unique molecular structure (LysB29(Nε-hexadecandioyl-γ-Glu) des(B30) human insulin) gives it its ultra-long-acting properties 1
Clinical Classification
According to the American Diabetes Association and European Association for the Study of Diabetes guidelines, insulin degludec is categorized among the ultra-long-acting basal insulin analogs 3. The FDA label clearly states that "Insulin Degludec is a long-acting human insulin analog" 1.
Comparison to Other Basal Insulins
The 2022 ADA Standards of Medical Care in Diabetes notes that:
- U-200 degludec is two times as concentrated as its U-100 formulation
- It allows higher doses of basal insulin administration per volume used
- U-300 glargine has a longer duration of action than U-100 glargine but modestly lower efficacy per unit administered 4
Clinical Advantages
Insulin degludec offers several potential benefits:
- Allows for flexible dosing schedules due to its ultra-long duration of action 5
- May reduce the risk of nocturnal hypoglycemia compared to insulin glargine 2, 6
- Provides stable glucose control with less pharmacodynamic variability 7
Important Considerations
When using Tresiba:
- It should be injected subcutaneously once daily at any time of day in adults 1
- In pediatric patients, it should be injected at the same time every day 1
- The U-200 formulation creates a potential risk of confusion and overdose, as most other insulins are formulated at 100 units/mL 8
- Rotation of injection sites is important to reduce the risk of lipodystrophy and localized cutaneous amyloidosis 1
In summary, Tresiba (insulin degludec) is not just a long-acting insulin but specifically an ultra-long-acting basal insulin with unique pharmacokinetic properties that distinguish it from other basal insulins on the market.