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Tresiba vs Levemir – Which Is The Best Long-Acting Insulin?

Tresiba vs Levemir - Which Is The Best Long-Acting Insulin

About 23 million Americans are diagnosed with diabetes. The CDC also estimates that another 84.1 million adults 18 years and older have prediabetes.

If you have diabetes, either your cells can’t use insulin efficiently or your pancreas can’t produce sufficient insulin. To control your blood glucose levels, you need to replace the normal function of your pancreas with regular insulin injections.

Long-acting insulins are insulin analogs which are steadily released and can last in the body for up to 42 hours. They lower blood sugar levels when rapid-acting insulins stop working.

By controlling the level of blood glucose, the complications and symptoms of diabetes are reduced. This is important since uncontrolled diabetes can lead to serious complications by damaging organs and blood vessels. For instance, it can increase the risk of:

  • eye disease;
  • heart disease;
  • nerve damage;
  • kidney disease;
  • stroke.

Here is a comparison between Tresiba and Levemir, two brand names of long-acting insulin:

Tresiba

Tresiba (insulin degludec) is a long-acting insulin which is used to control high blood sugar in adults and children who are 1 year of age and older with diabetes. It lasts for up to 42 hours and this allows doses to be taken at different times of the day.

This ultra-long-acting insulin is produced by Novo Nordisk. It cannot be delivered in pill form as it would be broken down in the stomach, instead, it is injected once a day under the skin, in the upper arm, thigh, or abdomen.

It is available in two different strengths:

  • double strength 200 units/mL;
  • standard strength 100 units/mL.

Levemir

Image credit – https://commons.wikimedia.org/wiki/File:Insulin_analog_100_IU-1ml_penfill_levemir_yellow_background.jpg

Levemir (insulin detemir) is a type of long-acting insulin which is used to treat people with diabetes by keeping blood glucose levels under control.

It is manufactured by Novo Nordisk.

Uses

Tresiba is a once-daily basal insulin which provides a duration of action of about 42 hours with a stable and flat glucose-lowering effect. According to the data from the EU-TREAT study, in patients with type 1 diabetes, a 16 percent lower rate of hypoglycemia was observed over 180 days. In patients with type 2 diabetes, results showed a 67 percent reduction in the rate of hypoglycemic events over 180 days.

Levemir is used to improve blood sugar control in children and adults with diabetes mellitus. It is typically injected once per day at the same time each day and should be injected into the fatty tissue beneath the skin. A single injection works for up to 24 hours to keep blood glucose levels stable.

Mechanism of Action

Insulin degludec stops the production of glucose by the liver, and stimulates the absorption of glucose, especially by fat and muscle cells.

Insulin detemir can help keep your blood glucose levels within a normal range by preventing the liver from producing more glucose and moving glucose from the bloodstream into the cells.

Side Effects

Possible side effects of Tresiba can include:

  • thickening or hollowing of the skin where the medicine was injected;
  • mild skin rash;
  • low blood sugar;
  • muscle weakness or limp feeling;
  • feeling short of breath;
  • numbness or tingling;
  • increased thirst or urination;
  • fluttering in your chest;
  • irregular heartbeats;
  • constipation;
  • leg cramps;
  • swelling in your hands or feet;
  • weight gain.

Possible side effects of Levemir can include:

  • blurry vision;
  • low blood sugar level;
  • muscle weakness;
  • low blood potassium level;
  • nausea;
  • increased heart rate;
  • hunger;
  • confusion;
  • headache;
  • tiredness.

Dosage

Tresiba

The initial total daily insulin requirement is 0.2 to 0.4 units of insulin per kilogram of body weight. The dosage should be adjusted according to blood glucose measurements, metabolic needs, and glycemic goals.

Levemir

The initial total daily insulin requirement is 1/3 the total daily insulin requirement subcutaneously once a day or in divided doses two times per day. The dose should be adjusted according to blood glucose measurements, metabolic needs, and glycemic goals.

Warnings & Precautions

Tresiba

To make sure this medication is safe for you, tell your healthcare professional if you have:

  • diabetic ketoacidosis;
  • kidney disease;
  • low levels of potassium in your blood;
  • liver disease.

Insulin degludec may not be suitable for individuals who experience reactions to metacresol, glycerol, zinc acetate, or phenol. Also, it is not approved for use by anyone younger than 18 years old.

Levemir

It should not be given to a child younger than 2 years old or if you have signs of low potassium levels in the blood.

Drug Interactions

Tresiba may interact in a negative way with the following medications:

  • aspirin;
  • Victoza (liraglutide);
  • furosemide (a medication which is used to treat fluid build-up due to liver scarring, heart failure, or kidney disease);
  • Trulicity (dulaglutide);
  • levothyroxine;
  • metoprolol;
  • lisinopril;
  • metformin;
  • losartan.

Levemir may interact in a negative way with the following medications:

  • Victoza (liraglutide);
  • aspirin;
  • metoprolol;
  • hydrochlorothiazide;
  • metformin;
  • Zyrtec;
  • carvedilol;
  • losartan;
  • furosemide;
  • lisinopril;
  • levothyroxine.

Alcohol

Alcohol may affect blood glucose levels in people with diabetes. It is best to completely avoid or limit the intake of alcoholic drinks while taking these medications.

Is It Safe During Pregnancy or Breastfeeding?

There isn’t enough information about the safety of using insulin degludec during pregnancy and breastfeeding. Consult with your doctor to weigh the potential benefits and risks before taking this type of insulin.

The U.S. FDA has approved Levemir during in pregnancy. However, there are no human data available regarding the use of insulin detemir by breastfeeding women.

Tresiba vs Levemir – Cost & Effectiveness

Tresiba is an ultra-long-acting insulin that contains insulin degludec. It is used to improve glycemic control in people with diabetes, and it has a duration of more than 42 hours.

Levemir is a long-acting, basal insulin which contains insulin detemir. It is used to improve blood glucose control in adults with type 2 diabetes. Once injected, it has a long duration of about 24 hours.

A 2016 study done at the Diabetes Research Centre, Leicester General Hospital, Leicester, the United Kingdom, that analyzed the long-term tolerability and safety of insulin detemir and insulin degludec as a basal treatment in people with type 1 diabetes mellitus, established that insulin degludec provides a lower risk of nocturnal confirmed hypoglycemia than insulin detemir.

Another 2013 study conducted at the Division of Diabetes, Endocrinology, and Metabolism, Hyogo College of Medicine, Japan, concluded that it is possible to achieve similar glycemic control with once-daily injection and lower doses of insulin degludec in people with type 1 diabetes mellitus who have been treated with insulin detemir.

The cost for Tresiba (100 units/mL) is approximately $514 for a supply of 15 milliliters, whereas the cost for Levemir (100 units/mL) is approximately $315 for a supply of 10 milliliters.

Sources

https://www.ncbi.nlm.nih.gov/pubmed/23371395
https://www.cochrane.org/CD006383/ENDOC_insulin-detemir-versus-insulin-glargine-for-type-2-diabetes-mellitus
http://www.jomrjournal.org/article.asp?issn=2347-9906;year=2014;volume=1;issue=4;spage=209;epage=213;aulast=Bhosle
https://www.ncbi.nlm.nih.gov/pubmed/29106039
http://care.diabetesjournals.org/content/35/12/2464
 

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