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Tresiba vs. Lantus: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Diabetes mellitus is a disease that affects over 10% of the United States population, with 1.5 million newly diagnosed cases each year. Diabetes mellitus presents in two forms: Type 1 and Type 2. With Type 1 diabetes, the body does not produce the insulin needed to adequately control blood glucose levels, sometimes called blood sugar. In this instance, insulin injections are the first-line treatment. The body of a Type 2 diabetic makes some insulin but does not utilize it properly. Type 2 is much more prevalent in the United States. In some cases, diet, exercise, and/or oral diabetic medications may adequately control blood sugar. In many cases, however, insulin injections may be necessary to control blood glucose levels for Type 2 diabetics as well.

Tresiba and Lantus are two examples of basal insulin, sometimes called “background” or long-acting insulin. This type of insulin ensures consistent blood sugar levels throughout the day.

What are the main differences between Tresiba and Lantus?

Tresiba (insulin degludec) is a prescription-only injectable basal insulin used in the treatment of both Type 1 and Type 2 diabetes mellitus and is manufactured by Novo Nordisk, Inc. Tresiba facilitates the reuptake of glucose into muscle and adipose (fat) tissues. Insulin also plays a role in regulating fat and protein metabolism. Biosynthetic insulins act as a replacement therapy to help diabetic patients restore their fat, protein, and carbohydrate utilization.

Tresiba’s half-life is 25 hours and has no obvious peak. Tresiba’s long duration of action provides fairly consistent blood sugar control throughout the day while only being dosed once daily. There is no generic version of Tresiba available.

Lantus (insulin glargine) is also a prescription-only injectable basal insulin used in the treatment of both Type 1 and Type 2 diabetes mellitus. Lantus is manufactured by Sanofi. Lantus and Tresiba work in a similar manner to promote the proper utilization of fat, protein, and carbohydrates in diabetic patients. The half-life of Lantus is about 12 hours and typically dosed once per day. Lantus is delivered subcutaneously and is available as an injectable solution in a 10 ml vial in a concentration of 100 units/ml. It is also available in a Lantus Solostar pen delivery device in the same concentration.

There is no FDA approved generic for Lantus. Basaglar, also insulin glargine, is a biosimilar insulin to Lantus and may be more affordable in some cases. Toujeo, also insulin glargine, is a new product that is more concentrated at 300 units/ml. This product may be useful in patients on higher doses to limit injection volume.

Main differences between Tresiba and Lantus
Tresiba Lantus
Drug class Biosynthetic insulin (insulin analog) Biosynthetic insulin (insulin analog)
Brand/generic status Brand Brand
What is the generic name?
Insulin degludec Insulin glargine
What form(s) does the drug come in? Injectable solution in a FlexPen delivery device Injectable solution in a vial or Solostar pen delivery device
What is the standard dosage? Dependent on blood glucose levels Dependent on blood glucose levels
How long is the typical treatment? Indefinite Indefinite
Who typically uses the medication? Children and adults Children 6 and older, adults

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Conditions treated by Tresiba and Lantus

Tresiba and Lantus are each indicated in the treatment of Type 1 and Type 2 diabetes mellitus. People with Type 1 diabetes are deficient in insulin, and injectable biosynthetic insulins such as Tresiba and Lantus act as replacement therapy. People with Type 2 may be somewhat deficient in insulin, but are also insulin resistant, meaning their body does not utilize the insulin it makes properly. Tresiba and Lantus act as insulin replacement and supplementation in this type of disease.

Condition Tresiba Lantus
Diabetes mellitus Type 1 Yes Yes
Diabetes mellitus Type 2 Yes Yes

Is Tresiba or Lantus more effective?

A meta-analysis of 15 clinical studies published in 2019 looked at data from more than 16,000 participants combined. Tresiba produced a larger decrease in blood sugar levels, but overall, the effects of Tresiba and Lantus on hemoglobin A1C (HbA1C) were similar. Tresiba did have a statistically significant less chance of causing hypoglycemia. Researchers concluded that while overall glycemic control was similar, Tresiba may be preferred due to the decreased chance of hypoglycemia.

A meta-analysis published in 2018 had similar findings. Tresiba was significantly less likely to cause hypoglycemia events. For this reason, Tresiba may be preferred over Lantus.

This article is not intended to provide medical advice. Your healthcare provider will decide which types of insulin options are best for you.

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Coverage and cost comparison of Tresiba vs. Lantus

Tresiba is a prescription insulin that is typically covered by commercial insurances and Medicare drug plans. With some plans, there may be formulary restrictions, and you may want to check your coverage with your plan or pharmacy. The average cost of one 3 ml pen of Tresiba Flextouch 100 unit/ml is about $400 without insurance. You could pay a discounted price of about $350 with a coupon from SingleCare.

Lantus is a prescription insulin that is typically covered by commercial insurances as well as many Medicare drug plans. Formulary restrictions may also affect Lantus coverage. The average cost of one 3 ml pen is about $100, but with a coupon from SingleCare, you could pay about $70.

It is important to note that one pen of each type of insulin will not last the same amount of time for each patient. This is dependent upon the insulin dose prescribed for each patient.

Tresiba Lantus
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Standard dosage 1, 3 ml Flextouch 100 unit/ml pen 1, 3 ml Solostar 100 unit/ml pen
Typical Medicare copay Varies depending on plan factors Varies depending on plan factors
SingleCare cost $350+ $70+

Common side effects of Tresiba vs. Lantus

Tresiba and Lantus both have the ability to cause hypoglycemia, or low blood sugar. This tendency tends to vary based on factors such as whether the patient is a Type 1 or Type 2 diabetic, what other insulin or diabetic therapies the patient may be using, and diet. When using Tresiba or Lantus with short-acting or rapid-acting insulins, this risk increases.

Patients must have the ability to monitor their blood glucose levels with either a traditional meter or a continuous glucose monitoring system (CGMS). Patients should also be taught the signs and symptoms of severe hypoglycemia, as it can be life-threatening. These include shakiness, lightheadedness, mental confusion, nausea, blurred vision, and headache. Hypoglycemia can be reversed with the ingestion of glucose or administration of injectable Glucagon.

Injection site reactions may be bothersome to the patient. These can include redness, itching, or bruising. Rotating injection sites can help reduce or alleviate these symptoms.

This list is not intended to be a comprehensive list of potential side effects. Please consult your healthcare provider for a complete list.

Tresiba Lantus
Side effect Applicable? Frequency Applicable? Frequency
Allergic reactions Yes 0.9% Yes Not defined
Itching Yes Not defined Yes Not defined
Rash Yes Not defined Yes Not defined
Injection site reaction Yes 3.8% Yes Not defined
Skin thickening or pitting at the injection site (lipodystrophy) Yes 0.3% Yes Not defined
Headache Yes 12% Yes 5-10%
Weight gain Yes Not defined Yes Not defined
Hypoglycemia (low blood sugar) Yes 10-12% Yes 6-10%
Swelling of hands and feet (peripheral edema) Yes 0.9-3% Yes 20%

Source: Tresiba (DailyMed) Lantus (DailyMed)

Drug interactions of Tresiba vs. Lantus

There are many classes of antidiabetic drugs, and oftentimes, people with Type 2 diabetes may need a combination of different antidiabetics to prevent hyperglycemia (elevated blood sugar). Unfortunately, the combination of multiple drugs intended to lower blood sugar may decrease the glucose levels too much, resulting in hypoglycemia. Patients should be monitored closely when using Tresiba and Lantus in combination with other antidiabetic medications such as metformin and glyburide. Thiazolidinediones, such as pioglitazone, may make patients especially prone to hypoglycemia. Your dose of Tresiba or Lantus may need to be adjusted frequently.

A common class of antihypertensive drugs known as angiotensin-converting enzyme (ACE) inhibitors have been shown to increase insulin sensitivity. When using these drugs to treat high blood pressure in diabetic patients also taking Tresiba or Lantus, the risk of hypoglycemia is increased. Patients should be monitored for signs of hypoglycemia if this combination is deemed necessary.

This is not intended to be a complete list of drug interactions for Tresiba and Lantus. Please consult your pharmacist or healthcare provider for a complete list.

Drug Drug class Tresiba Lantus
Angiotensin-converting enzyme (ACE) inhibitors Yes Yes
Monoamine oxidase (MAO) inhibitors Yes Yes
Antidiabetic drugs Yes Yes
Sulfamethoxazole Sulfonamide antibiotics Yes Yes
Diuretics Yes Yes
Corticosteroids Yes Yes
Phenothiazine derivatives Yes Yes
Antipsychotics Yes Yes
Ethinyl Estradiol
Oral contraceptives Yes Yes
Beta blockers Yes Yes
Thyroid hormones Yes Yes
Magnesium salicylate
Bismuth subsalicylate
Salicylates Yes Yes
Fluoxetine Selective serotonin reuptake inhibitor (SSRI) Yes Yes

Warnings of Tresiba and Lantus

Tresiba and Lantus carry the risk of hypoglycemia, or low blood glucose levels. Patients on Tresiba or Lantus should know the signs and symptoms of hypoglycemia, which include shakiness, lightheadedness, mental confusion, nausea, blurred vision, and headache.

Hypokalemia, or low potassium levels, is also a possible adverse event related to Tresiba or Lantus use. This is especially important to consider in patients who have impaired renal function or may be on potassium-wasting medications such as furosemide.

Insulin delivery devices, such as Flextouch or Solostar pens, as well as pen needles and syringes, should not be shared between patients. There is a risk of cross-contamination with bloodborne pathogens and diseases. Patients should receive education and counseling on basic diabetes care, including the safe use of needles.

Tresiba and Lantus are intended for subcutaneous dosing only. They should never be administered intramuscularly or intravenously.

Frequently asked questions about Tresiba vs. Lantus

What is Tresiba?

Tresiba (insulin degludec) is a long-acting basal insulin that is typically dosed only once daily. It is available only as a prescription. Tresiba is available in a FlexTouch pen delivery system in concentrations of 100 units/ml and 200 units/ml.

What is Lantus?

Lantus (insulin glargine) is a long-acting basal insulin that is typically dosed only once daily. It is available only as a prescription. Lantus is available in a Solostar pen delivery system in a concentration of 100 units/ml and in a 10 ml vial of the 100 units/ml concentration.

Are Tresiba and Lantus the same?

Tresiba and Lantus are each long-acting, basal insulins, but they are not the same. Tresiba is insulin degludec and has a longer half-life of 25 hours. Lantus is insulin glargine and has a shorter half-life of 12 hours. Both are dosed once daily.

Is Tresiba or Lantus better?

While glycemic control is similar between Tresiba and Lantus, data shows that Tresiba may be less likely to lead to dangerous hypoglycemic events. For this reason, Tresiba may be preferred, especially in patients who are prone to or have a history of hypoglycemia.

Can I use Tresiba or Lantus while pregnant?

Tresiba is classified as pregnancy category C by the Food and Drug Administration (FDA). There are clinical studies to support its use and safety in pregnancy. Lantus is category B due to the fact that studies have shown there is low risk of fetal harm. Lantus is considered generally safe in pregnancy.

Can I use Tresiba or Lantus with alcohol?

The concurrent use of Tresiba or Lantus with alcohol carries the risk of hypoglycemia. Alcohol consumption, especially on an empty stomach, inhibits gluconeogenesis. This leads to a prolonged risk of low blood sugar.

What insulin is comparable to Lantus?

Basaglar is biosimilar to Lantus, though it is not an FDA-approved generic for Lantus and is not substitutable for Lantus. Both Lantus and Basaglar are insulin glargine in a concentration of 100 units/ml.

What is the best time to take Tresiba?

Tresiba can be given at any time of the day without regard to mealtime, but it is important to administer the medication at the same time every day.

What is a good alternative to Tresiba?

Toujeo is a basal insulin available in a higher concentration of 300 units/ml. Higher concentrations in basal insulins allow patients with high necessary doses to inject less volume.