Yes, Tresiba (Insulin Degludec) Is an Excellent Basal Insulin
Tresiba is specifically designed and approved as a basal insulin for both type 1 and type 2 diabetes, offering ultra-long-acting coverage with a duration of action exceeding 42 hours. 1, 2
Pharmacological Profile as Basal Insulin
Tresiba functions as a true basal insulin through its unique mechanism:
- After subcutaneous injection, insulin degludec self-associates and precipitates in subcutaneous tissue, creating a depot from which insulin monomers continuously and predictably dissociate. 2
- The onset begins immediately with peak levels at 10-12 hours, followed by a slow decline with a half-life of 17-21 hours—roughly double the duration of insulin glargine. 2
- This provides a flat, stable glucose-lowering profile with duration of action exceeding 42 hours, making it suitable for once-daily dosing. 1
Clinical Evidence Supporting Basal Use
The American Diabetes Association guidelines explicitly recognize insulin degludec as a basal insulin option:
- Concentrated formulations including U-200 degludec are available for patients requiring larger basal insulin doses, offering longer duration of action than U-100 formulations. 3
- In clinical trials, insulin degludec achieved similar glycemic control to insulin glargine in patients with type 1 or 2 diabetes, but with lower risk of nocturnal hypoglycemia. 1
- Degludec demonstrates less within-patient day-to-day variability in glucose-lowering effect compared to insulin glargine. 1
Practical Advantages Over Other Basal Insulins
Tresiba offers specific clinical benefits:
- The ultra-long duration allows flexible dosing—trials examining flexible dosing regimens show potential for adjusting injection time without compromising glycemic control or safety. 1
- A 200 U/mL formulation is available for patients requiring large volumes of basal insulin. 1
- Unlike insulin glargine, degludec is miscible with rapid-acting insulin, allowing coformulation products (insulin degludec/insulin aspart). 2, 4
Initiation and Dosing as Basal Insulin
When starting Tresiba as basal insulin:
- For insulin-naive patients with type 2 diabetes, start with 10 units once daily or 0.1-0.2 units/kg/day, administered at the same time each day. 3, 5
- Titrate by 10-15% or 2-4 units once or twice weekly until fasting blood glucose targets are met. 3
- If basal insulin dose exceeds 0.5 units/kg/day and A1C remains above target, advance to combination injectable therapy with GLP-1 receptor agonists or add prandial insulin. 3, 5
Important Clinical Considerations
Continue metformin when initiating Tresiba, as it improves insulin sensitivity. 6
Consider discontinuing or reducing sulfonylureas to minimize hypoglycemia risk. 7
The true 24-hour coverage of degludec makes it particularly advantageous where consistent basal coverage is needed, compared to glargine which may require twice-daily dosing in some patients. 5, 8