Fact Checked

What is The Best Time to Take Tresiba?

Approximately 422 million people worldwide currently have diabetes. According to the American Diabetes Association, about 10.5 percent of all Americans had diabetes as of 2018. Diabetes is a chronic disease in which blood sugar cannot be processed by the hormone insulin. This results in abnormally high blood glucose levels that can lead to serious health complications like heart attack, blindness or kidney damage if left untreated. Type 1 diabetes is usually diagnosed in childhood and is an autoimmune disease in which the body cannot produce insulin at all.  Type 2 diabetes accounts for more than 80 percent of all cases of diabetes and affects mostly older adults. In type 2 diabetes, the body does not produce enough insulin or it produces insulin that does not work properly.  

Usually, treatment of diabetes involves a combination of prescription drugs, exercise and dietary changes to make the condition manageable. Fortunately, due to advances in diabetes research and drug development, there are many safe and effective drugs on the market that are used to treat diabetes. One of the major ways diabetes is treated is with synthetic insulin. By giving the body external insulin, blood sugar can be processed and moved into cells where it is converted into energy. Although the first versions of synthetic insulin were exactly similar to natural human insulin, today there are several types of synthetic insulin that have been modified from the original structure of human insulin to give them better therapeutic effects. Let’s take a look at some of these types of insulin. 

Types of insulin analogs 

Insulin analogs are slightly modified from the natural human insulin structure to give them additional therapeutic benefits. The three main groups of synthetic insulin are short or rapid-acting, intermediate-acting, or long-acting insulin. 

Short or rapid-acting insulin is absorbed very quickly after injection and is used for fast processing of blood sugar after a snack or meal. This type of insulin takes between 5 to 15 minutes to start working, peaks at 1 to 2 hours, and its effects last for 4 to 6 hours. 

Intermediate-acting insulin is used to control blood sugar overnight or in between meals and during fasting. It takes about 1 to 2 hours to start working, peaks at about 4 to 6 hours, and its effects last for a total about 12 hours. 
Long-acting insulin is used to control blood sugar overnight, in between meals and during fasting. It takes 1 to 2 hours to start working, and their effects last for up to 24 hours. They do not peak in action but instead have a relatively even duration of action.  

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What is Tresiba?

Tresiba Flextouch is an ultra long-acting insulin and is the longest acting insulin that is currently on the market. Tresiba is manufactured by Novo Nordisk.  The effects of Tresiba last for an impressive 42 hours post-administration. Compared to other long-acting insulins, like insulin glargine and insulin detemir that have a maximum duration of 24 hours post-injection, Tresiba works for much longer. It also has a reduced risk of hypoglycemia compared to insulin glargine. Unlike other long-acting insulin formulations on the market, Tresiba can also be used in combination with short-acting insulin and other diabetes medication such as metformin. It is used to treat both type 1 and type 2 diabetes and it is safe for use in children over the age of 1 year. 

How does Tresiba work?

Tresiba is a synthetic insulin analog that has a slight modification made to the B-chain of its natural structure. It has an addition of hexadecanedioic acid to the amino acid lysine that is normally present at the 29th position in the B-chain of natural human insulin. This keeps Tresiba in a multihexamer form that after injection is released very slowly and evenly into active insulin monomers within the body. Tresiba is also active at physiological pH, which is another advantageous feature. 

When should you take Tresiba?

Since Tresiba is active for 42 hours post-injection, it does not have the same limitations as other long-acting insulin for when you take it. According to the manufacturer instructions that come with the medication, adults can take Tresiba at any time of the day. The medication can be scheduled according to the convenience of the patient. For example, if you take Tresiba on Monday at 8 am, you can take it again on Tuesday at 2 pm. Since the duration of its effects last for 42 hours, it does not have to be spaced out exactly at 24 hours. 

However, children must take Tresiba at the same time every day. If a child misses a dose of Tresiba, it must be reported immediately to their doctor and blood glucose levels should be monitored. 

Adults who miss a dose of Tresiba should take it as soon as they remember and continue taking it according to their regular schedule. Never take a double dose of Tresiba and there should always be 8 hours between each dose. 

How to take Tresiba

Tresiba is administered by subcutaneous injection on a daily basis. Tresiba is available as multiple-dose vials or as single use FlexTouch pens. These are disposable, pre-filled pens that are available in two strengths. One contains 100 units/mL of insulin and the other formulation contains 200 units/mL of insulin. The prefilled pens should not be shared with anyone else and are for use by a single patient only. The injection pen has a counter that displays the dose units. Tresiba should not be used in an insulin pump. 

The usual initial dosage for Type 2 diabetes is 10 subcutaneous units per day. For patients that are already on another form of long-acting or intermediate-acting insulin, Tresiba should be started at the same dosage level. After the initial use, the dosage may be adjusted according to how your body responds.

For type 1 diabetes, the usual initial dose is one third to one half of the total daily requirement of insulin per day.  For patients with type 1 diabetes, Tresiba is combined with rapid-acting insulin. 

What happens if you overdose on Tresiba?

Insulin overdose can be potentially life threatening as it leads to severe hypoglycemia. Symptoms of hypoglycemia include dizziness, drowsiness, blurry vision, confusion, muscle weakness and hunger. If you think you have overdosed on Tresiba, seek emergency medical attention immediately. 

What are the side effects of Tresiba?

Use of Tresiba can cause some unwanted side effects. Some of these side effects are not serious and may resolve once your body has adjusted to the medication. If you are concerned about any of these side effects caused by the medication, be sure to talk to your doctor for ways in which you can reduce them. 

The most commonly reported side effects of Tresiba are weight gain, hypoglycemia, reactions at the injection site, rash, nasal congestion and stomach pain to name a few. The most commonly reported side effect in clinical trials was hypoglycemia. This is not an exhaustive list of side effects and more information can be found here

Does Tresiba interact with other drugs?

Tresiba can be safely used with rapid-acting insulin or certain diabetes medication like metformin. It should never be mixed with other types of insulin and should be taken with other diabetes medications according to the schedule recommended by your doctor. 

You should inform your doctor if you are taking any other medications with Thiazolidinedione (TZD) like pioglitazone or rosiglitazone, which are also diabetes medications. Combining Tresiba with TZDs can increase the risk of severe heart problems and lead to heart failure. If you have a history of heart failure, then combining Tresiba with TZDs can worsen the condition, but individuals without a prior history of heart problems are also at risk.   Symptoms of heart failure include shortness of breath, swelling of ankles or feet and feeling excessively tired. 

Certain medications and health supplements like vitamins and herbs may also interfere with how well Tresiba both works. This includes even over-the-counter medications, so if you are regularly taking any other medications or supplements, be sure to inform your doctor or pharmacist.

How to buy Tresiba 

If you are prescribed Tresiba for type 1 or type 2 diabetes, you can pick it up with a valid prescription from your preferred pharmacy. The cost of Tresiba can be quite high, especially without an insurance plan that covers it. You can find ways to save on the cost of Tresiba through patient assistance programs available through Novo Nordisk, manufacturer of Tresiba. You can also look into drug coupons available from USA Rx that can get you Tresiba at a lower price than the list cash value. A prescription discount card, like this one, can also help you save on Tresiba and other medications you may be taking. 

Always keep insulin on hand to make sure that you are able to take your dose on time and according to schedule. Since Tresiba has some flexibility in when you take it during the day, there is an added convenience to using it compared to other types of insulin. However, taking your medication around the same time every day can help you remember to take it according to schedule.

Published August 6th, 2020 by Chris Riley
Fact Checked by Chris Riley

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