Is Tresiba a Long-Acting Insulin?
Yes, Tresiba (insulin degludec) is definitively classified as an ultra-long-acting basal insulin analog with a duration of action exceeding 42 hours, making it one of the longest-acting insulin formulations available. 1, 2
Classification and Pharmacokinetic Properties
Tresiba is specifically categorized as an ultra-long-acting insulin, distinguishing it from standard long-acting insulins like glargine U100 or detemir. 3
Key pharmacokinetic characteristics include:
- Duration of action exceeds 42 hours, substantially longer than conventional long-acting insulins 1
- Half-life exceeds 25 hours, allowing for once-daily dosing with steady-state coverage 2
- Reaches steady state in 3-4 days, requiring at least 2 weeks of observation when assessing glucose outcomes 4
- Provides a flat, stable, peakless glucose-lowering profile with near-constant effect at steady state 1, 2
Mechanism of Prolonged Action
Insulin degludec achieves its ultra-long duration through a unique mechanism:
- Forms a depot of soluble multihexamer chains after subcutaneous injection 2
- This depot allows for slow, continuous absorption over an extended period 2
- Results in less within-patient day-to-day variability in glucose-lowering effect compared to insulin glargine 1
Clinical Context and Formulations
Tresiba is available in two concentrations:
- U-100 formulation for standard dosing 5
- U-200 formulation for patients requiring large volumes of basal insulin 5, 1
The medication functions as a basal insulin analog designed to:
- Provide relatively constant, peakless insulin levels to control blood glucose between meals and overnight 5
- Primarily restrain hepatic glucose production 5
- Can be used in combination with mealtime insulin in type 1 diabetes or with oral medications in type 2 diabetes 5
Comparison to Other Long-Acting Insulins
While insulin glargine (Lantus) and insulin detemir are classified as "long-acting" insulins, Tresiba represents the next generation as an "ultra-long-acting" insulin. 6, 3