Tresiba Shortage: What Providers and Prescribers Need to Know in 2026

The ongoing shortage of Tresiba (insulin degludec) is creating clinical challenges for practices managing patients with type 1 and type 2 diabetes. As of early 2026, intermittent stockouts persist across retail pharmacy chains — particularly for the U-200 FlexTouch formulation. This guide provides actionable clinical guidance for prescribers navigating the shortage: which alternatives to consider, how to convert doses, how to document medical necessity, and how to connect patients with resources.

Current Shortage Status (Early 2026)

Tresiba (insulin degludec) remains in intermittent short supply nationally. Novo Nordisk — the sole manufacturer — has acknowledged supply constraints caused by a combination of demand surges (following the IRA's $35 Medicare insulin cap), formulary shifts by major payers, the discontinuation of Levemir redirecting patients to alternative basal insulins, and inherent limitations in scaling biologic manufacturing. The U-200 formulation is more severely affected than U-100. Supply is expected to improve gradually through 2026 but no firm timeline has been provided.

Clinical Alternatives to Tresiba: What to Prescribe

When Tresiba is unavailable, the following alternatives should be considered based on clinical profile and patient preference:

Insulin Glargine U-300 (Toujeo): The closest pharmacokinetic equivalent to Tresiba. Lasts up to 36 hours with a very flat profile. Best choice for patients who specifically benefit from Tresiba's ultra-long duration and low nocturnal hypoglycemia risk. Dose conversion: start at the same number of units as Tresiba; may need 10-15% upward titration due to differences in absorption kinetics. Monitor closely.

Insulin Glargine U-100 (Lantus, Basaglar, Rezvoglar): Most widely available and affordable option. Duration ~24 hours, relatively flat profile. Dose conversion from Tresiba is typically 1:1 unit-for-unit, but consider a ~20% dose reduction initially to reduce hypoglycemia risk, then titrate up as needed. The DEVOTE trial showed Tresiba reduced severe hypoglycemia risk by 40% vs. glargine; patients switching back to glargine may experience a modest increase in hypoglycemia risk.

NPH Insulin: Intermediate-acting insulin, typically requiring twice-daily dosing. Substantially different pharmacokinetic profile from Tresiba — pronounced peak, shorter duration (~18-20 hours), greater variability. Reserve for true shortage emergencies when no long-acting analog is available. If prescribed, split the total Tresiba dose into two NPH doses: ~2/3 at bedtime and ~1/3 in the morning.

Dose Conversion Summary Table

Tresiba → Toujeo: Start same units; may titrate up 10-15%. Once daily dosing maintained.

Tresiba → Lantus/Basaglar (U-100): Start at same units or reduce by 20% if hypoglycemia risk is high. Once daily dosing maintained. Titrate based on fasting BG.

Tresiba → NPH: Reduce total dose by ~20%. Split into twice daily: approximately 2/3 bedtime, 1/3 morning. Significant monitoring required.

Proactive Prescription Writing During a Shortage

To reduce downstream friction for patients during the Tresiba shortage, consider these prescription writing strategies:

Write for both concentrations: Prescribe "Insulin Degludec (Tresiba) U-100 OR U-200" when both concentrations are clinically appropriate. This gives the pharmacist flexibility to dispense whichever is available.

Add an alternative: Include a standing alternative prescription for Toujeo or Lantus with the note "Dispense if Tresiba is unavailable" to avoid a delay if the patient can't find Tresiba.

90-day supplies: When feasible and appropriate, prescribe a 90-day supply to reduce how frequently patients need to navigate the shortage landscape.

Documenting Medical Necessity and Prior Authorization

If your patient has failed or is contraindicated for insulin glargine — or if there is documented clinical justification for Tresiba's specific pharmacokinetic profile (e.g., recurrent nocturnal hypoglycemia, high hypoglycemia unawareness) — document this clearly in the chart. This supports prior authorization requests and appeals. Include:

History of recurrent nocturnal hypoglycemia on insulin glargine

Hypoglycemia unawareness that makes a longer-acting, peakless insulin clinically preferable

Prior trial and failure of step-therapy requirements

Patient-specific factors (e.g., shift work or variable schedules that benefit from flexible dosing timing)

Patient Resources to Share

Direct your patients to the following resources to help them navigate the shortage: medfinder for Providers helps patients locate pharmacies with Tresiba in stock. NovoCare (1-888-668-6444) can assist with stock location and savings programs. The Novo Nordisk Insulin Value Program provides Tresiba for $35/month for eligible patients.

See also our detailed provider guide: How to Help Your Patients Find Tresiba in Stock.