Insulin Degludec Shortage: A Provider's Briefing for 2026

The ongoing intermittent shortage of Insulin Degludec (Tresiba) continues to affect patients and clinicians across the United States. As a prescriber, you're likely fielding questions from patients who can't fill their prescriptions — and you need practical, evidence-based guidance to manage this situation. This article summarizes the current shortage status, switching protocols, and resources available to your practice.

For a patient-facing version of this update, see: Insulin Degludec Shortage Update: What Patients Need to Know in 2026.

Current Shortage Status

As of February 2026, Insulin Degludec (Tresiba) is in intermittent short supply nationally. Key points:

• The U-200 formulation is more affected than U-100
• Novo Nordisk remains the sole manufacturer — no biosimilar or generic is available
• Supply is gradually improving but regional variability persists
• The FDA Drug Shortages database tracks current status at accessdata.fda.gov

Root Causes

Understanding the drivers helps inform your patient conversations:

• Demand surge: The Inflation Reduction Act's $35/month insulin cap for Medicare Part D dramatically increased Insulin Degludec utilization. Many commercial insurers followed with similar caps.
• Single-source dependency: No biosimilar insulin degludec exists. Unlike insulin glargine (with Lantus, Basaglar, Semglee, and others), the entire supply depends on Novo Nordisk.
• Manufacturing lead times: Biologic insulin manufacturing expansion requires 2-3 years from planning to production. Novo Nordisk is investing in new capacity but it's not yet fully online.
• Formulary-driven demand shifts: PBM formulary changes that add Tresiba as preferred can create sudden regional demand spikes.

Clinical Considerations for Switching

When Insulin Degludec is unavailable for a patient, a switch to an alternative basal insulin may be necessary. Here are evidence-based switching protocols:

Insulin Degludec → Insulin Glargine U-100 (Lantus/Basaglar/Semglee)

• Conversion: Unit-for-unit (1:1)
• Timing: Once daily at the same time each day (less dosing flexibility than degludec)
• Monitoring: Increase SMBG frequency for 1-2 weeks; watch for nocturnal hypoglycemia
• Notes: Glargine U-100 has slightly more day-to-day variability and a more pronounced tail effect. Patients stable on degludec may notice more glucose fluctuations initially.

Insulin Degludec → Insulin Glargine U-300 (Toujeo)

• Conversion: May require 10-15% dose increase (Toujeo typically requires higher unit doses)
• Timing: Once daily
• Monitoring: Standard titration protocol; watch for hyperglycemia during transition if dose is not appropriately increased
• Notes: Closest pharmacokinetic match to degludec — flat profile, duration ~36 hours. Good option for patients who need ultra-long-acting coverage.

Insulin Degludec → Insulin Detemir (Levemir)

• Conversion: Unit-for-unit, but often requires twice-daily dosing
• Timing: Once or twice daily
• Monitoring: Increase monitoring frequency; shorter duration means more potential for gaps in coverage
• Notes: May cause less weight gain. Shorter and less stable profile than degludec. Consider only if glargine options are also unavailable.

Key Principles for All Switches

• Insulin degludec has a half-life of ~25 hours and steady-state duration >42 hours. After the last dose, residual degludec activity will persist for 2-3 days.
• Start the new basal insulin at the time the next degludec dose would have been due.
• Counsel patients on the different dosing flexibility — degludec allows variable dosing times (minimum 8 hours apart), while glargine U-100 should be given at the same time daily.
• CGM data, if available, is invaluable during transitions. Review time-in-range and overnight patterns within the first week.

Helping Patients Locate Insulin Degludec

Before switching, it may be worth attempting to locate Insulin Degludec at alternative pharmacies. Resources include:

• MedFinder for Providers — helps clinicians and staff locate medications in short supply for patients
• NovoCare: 1-888-668-6444 — Novo Nordisk's patient support line can assist with locating stock
• Specialty and mail-order pharmacies often maintain better supply than retail chains

For a detailed guide you can share with patients, see: How to Find Insulin Degludec in Stock Near You.

Patient Assistance and Cost Considerations

Patients forced to switch pharmacies may face different pricing. Key programs to be aware of:

• Novo Nordisk Insulin Value Program: $35 cap for up to 3 months' supply for cash-paying patients
• Tresiba Savings Card: Commercially insured patients may pay as little as $0-$25/month
• NovoCare Patient Assistance Program: Free insulin for qualifying uninsured/underinsured patients
• Inflation Reduction Act: Medicare Part D enrollees pay no more than $35/month for any covered insulin

For a comprehensive guide you can share with patients: How to Save Money on Insulin Degludec in 2026. For provider-specific savings guidance, see How to Help Patients Save Money on Insulin Degludec.

Practice Management Tips

• Proactive communication: Consider reaching out to patients on Insulin Degludec before they run out. Your EHR can identify these patients.
• Pre-authorize alternatives: If your practice frequently sees Insulin Degludec patients, consider having standing alternative protocols ready so staff can respond quickly.
• Sample stock: Maintain samples of Insulin Degludec when available to bridge patients during stockouts.
• Document the shortage: Note the shortage-driven switch in the patient's chart to facilitate switching back when supply normalizes.

Looking Ahead

Novo Nordisk's manufacturing expansion plans suggest supply will gradually improve through 2026. However, given the single-source nature of Insulin Degludec, intermittent disruptions may continue until biosimilar competition enters the market. Staying informed and having switching protocols ready will help your practice navigate this period smoothly.

For a complementary guide on helping patients locate this medication, see: How to Help Your Patients Find Insulin Degludec in Stock.