Tresiba - A new long acting Insulin

Apr 20, 2018

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Tomorrow, and tomorrow, and tomorrow, creeps in this petty pace from day to day to the last syllable of recorded time, and all our yesterdays have lighted fools the way to dusty death. Out, out, brief candle! Life's but a walking shadow, a poor player that struts and frets his hour upon the stage and then is heard no more: it is a tale told by an idiot, full of sound and fury, signifying nothing." I think Shakespeare must have been channeling the angst of a teenage gamer separated from Fortnite in his Scottish Play. My son Eric's newest favorite game, ironically, seems to take him about two weeks to play. And to increase my morning rage, when I interrupt Eric to get him to wash the dishes, he says I'm wasting his time.

Rage inducement notwithstanding, things that take longer can be better. There is a new type of insulin call Tresiba that lasts 42 hours. But before we get to how Tresiba is works differently, let's do a diabetes review. In Type 1 diabetes, the body can't produce any insulin. Type 1 diabetics must inject insulin or die. Insulin acts like a key to open doors in the cells to let sugar in. Without insulin keys, there is no way to open the doors in the cells. The sugar stays in the blood stream. That means the blood sugar level stays high, but the cells have no energy to use. Type 2 diabetes is a little different. The pancreas produces insulin. It may even produce higher than normal amounts of insulin. The problem seems to be with the little locks on the sugar doors in the cells. The little locks seem to have gotten rusty. Even if insulin keys go into the locks, the keys can't turn and the doors won't open. We call this insulin resistance, and we think this is the main problem in Type 2 diabetes.

In Type 1 diabetes we must inject insulin. In Type 2 diabetes, insulin is not a necessity, but an option. We can treat Type 2 diabetes with pills that act like WD-40 to help those insulin resistant locks to open. Or, with enough insulin keys, we can force those rusty locks open by injecting insulin. One form of insulin both Type 1 and Type 2 diabetics use is called basal insulin.

Basal insulin means long acting insulin where one or two shots keeps a nice steady amount of insulin all day long. The idea is to try to mimic the basal, or background amount of insulin the pancreas steadily releases all day long. The long acting insulins can be broken down into three groups: the cloudy NPH's, the long acting insulin analogues and the ultra long acting insulin analogues.

About 80% of diabetics out there are Type 2 diabetics. For Type 2 diabetics, there isn't a lot of difference between the three longer acting insulins. They all lower the HgA1C about the same amount when used properly. HgA1C is a three month average of the blood sugars, and it is the blood test your doctor orders to see how your blood sugar control is going. Why might we pick one of the longer acting insulins over another?

The NPH or cloudy insulins are the cheapest, by far. They might not last quite 24 hours, but for most Type 2 diabetics NPH can safely and effectively be given once a day at bedtime. But NPH insulin does cause a few more low blood sugars, especially at night. If low blood sugars at night becomes a problem, the doctor will often switch to the newer, but more expensive long acting clear insulin analogues like glargine or detemir. The glargine and detemir last about 24 hours in most people, but not everyone. Some patients end up having to take glargine and detemir twice a day.

If patients are still having low blood sugars at night on glargine or detemir, then the doctors might consider the newest, ultra long acting Tresiba or insulin degludec. Degludec lasts about 42 hours and might be appropriate for patients who get really bad night time low blood sugars or people who needs large amounts of glargine or detemir. If a patient needs more than 80 units of basal insulin per day, the Tresiba or degludec pen can give shots up to 160 units per dose.

Like many things, it can come down to price, though. Fifty units per day of Tresiba or degludec costs about $120 per month and that is about the same for detemir. There are different brands of glargine. Fifty units per day costs about $100 per month for Lantus and Toujeo but about $75 per month for Basaglar. And cloudy NPH? For fifty units per day, it only costs about $50 per month.

"Take the win a go!" That was Emily's response when I got blindsided this morning. You see Emily agreed to walk to the dog and Eric agreed to unload the dishwasher without any yelling from me at all. It completely threw me for a loop. No morning yelling wrecked my routine. The morning calm lasted too long. The peace and tranquility was overwhelming. So, with apologies to Dylan Thomas, "Do not go gentle into the end of that good night, old age should burn and rave at start of day; rage, rage against the rising of the light." Phew. That's better.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Canadian Diabetes Association -

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