Comprehensive medication guide to Tresiba including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$35/month maximum for Medicare Part D enrollees under the Inflation Reduction Act cap; $35/month for commercially insured patients via Novo Nordisk savings card. Tier 2–3 on most formularies; some plans require step therapy.
Estimated Cash Pricing
$300–$500 per box of Tresiba FlexTouch pens without insurance; vials from ~$100 with discount programs. With GoodRx or SingleCare coupons, prices can drop to $87–$122 for a 30-day supply.
Medfinder Findability Score
45/100
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Tresiba is the brand name for insulin degludec, an ultra-long-acting basal insulin analog manufactured by Novo Nordisk. It was FDA-approved on September 25, 2015, and became commercially available in the United States in January 2016. Tresiba is indicated to improve glycemic control in adults and children aged 1 year and older with type 1 or type 2 diabetes mellitus.
Tresiba is a "basal" or "background" insulin — it provides a steady, continuous level of insulin throughout the day and night to keep blood sugar stable between meals and during sleep. Unlike fast-acting insulins, Tresiba is not meant to cover mealtime blood sugar spikes. Many patients with type 1 diabetes use Tresiba as their basal insulin alongside a rapid-acting mealtime insulin.
Tresiba is unique among basal insulins for its ultra-long duration of action — over 42 hours — and its remarkably flat pharmacokinetic profile with no pronounced activity peak. The DEVOTE clinical trial demonstrated that Tresiba reduces the risk of severe hypoglycemia by 40% compared to insulin glargine (Lantus) in type 2 diabetes patients.
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Tresiba (insulin degludec) is a modified form of human insulin. Scientists at Novo Nordisk engineered it by removing one amino acid from the insulin molecule and attaching a long fatty acid chain at the B29 position. When injected subcutaneously, the fatty acid chains cause insulin degludec molecules to link together into long chains called multi-hexamers.
These multi-hexamer chains cluster into a stable depot under the skin at the injection site. Individual insulin monomers then slowly and steadily break off from this depot and enter the bloodstream over 42+ hours. This slow, constant release produces Tresiba's characteristic flat, peakless action profile. Once in circulation, insulin degludec binds to insulin receptors on cells throughout the body, stimulating glucose uptake and suppressing hepatic glucose production — lowering blood sugar.
Tresiba reaches steady-state concentration in the blood after 3-4 days of once-daily injections. Its half-life at steady state is approximately 25 hours, independent of dose. The insulin is degraded similarly to human insulin, with all metabolites inactive.
100 units/mL (U-100) — FlexTouch pen (3 mL, box of 5)
Doses from 1-80 units in 1-unit increments
200 units/mL (U-200) — FlexTouch pen (3 mL, box of 3)
Doses from 2-160 units in 2-unit increments; higher-dose patients
100 units/mL (U-100) — Vial (10 mL)
For use with U-100 syringe; suitable for pediatric patients needing less than 5 units/day
Tresiba has experienced intermittent supply constraints throughout 2025 and into 2026. Novo Nordisk is the sole manufacturer — there are no biosimilars or generics available in the US — which means any supply disruption has immediate and wide-ranging effects. Increased demand following the $35 Medicare insulin cap, formulary shifts by major payers, and the discontinuation of Levemir have all contributed to elevated demand that manufacturing has struggled to fully meet.
The shortage primarily affects the Tresiba FlexTouch U-200 formulation, though U-100 pens and vials have also experienced periodic stockouts. Supply is regionally uneven — patients in some areas report no difficulty finding Tresiba, while others are turned away at multiple pharmacies. Mail-order pharmacies and independent pharmacies often have better stock than chain retail pharmacies.
If you are having difficulty finding Tresiba at your pharmacy, medfinder can help. Simply enter your medication, dosage, and zip code — medfinder calls pharmacies on your behalf to find which ones can fill your prescription, then texts you the results.
Tresiba (insulin degludec) is not a controlled substance, so it does not require special DEA scheduling or prescriber registration beyond a standard state prescribing license. Any licensed healthcare provider with prescribing authority can write a prescription for Tresiba.
Endocrinologists: Specialists in diabetes and hormone disorders; recommended for type 1 diabetes and complex cases
Primary Care Physicians (PCPs): Family medicine and internal medicine doctors; commonly prescribe basal insulin for type 2 diabetes
Pediatricians and Pediatric Endocrinologists: For children aged 1 year and older with type 1 or type 2 diabetes
Nurse Practitioners (NPs) and Physician Assistants (PAs): Advanced practice providers with prescribing authority in all 50 states
Telehealth platforms such as Teladoc, MDLive, and Amazon Clinic can also prescribe Tresiba for established diabetes patients. This is a convenient option for patients who have difficulty accessing in-person care or who need a prescription quickly.
No. Tresiba (insulin degludec) is not a controlled substance and is not scheduled by the DEA. It does not require any special DEA licensing to prescribe, and there are no restrictions on the number of refills per prescription beyond standard pharmacy practice.
Because Tresiba is not controlled, it can be prescribed by any licensed healthcare provider — including primary care physicians, endocrinologists, nurse practitioners, physician assistants, and telehealth providers. Prescriptions can be sent electronically or on paper, and can include refills. Insulin prescriptions are subject to standard state pharmacy laws but have no controlled substance-specific requirements.
The most common side effects include:
Hypoglycemia (low blood sugar) — most common and clinically important
Injection site reactions (redness, swelling, itching, bruising)
Weight gain
Peripheral edema (swelling in hands and feet)
Lipodystrophy (skin thickening or pitting at injection sites)
Upper respiratory symptoms (cold-like symptoms, headache)
Serious side effects requiring immediate medical attention:
Severe hypoglycemia (seizures, loss of consciousness) — call 911
Hypokalemia (dangerously low potassium) — irregular heartbeat, muscle weakness
Anaphylaxis (severe allergic reaction) — difficulty breathing, facial swelling — call 911
Heart failure — when used with thiazolidinediones (TZDs) like pioglitazone
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Insulin Glargine U-300 (Toujeo)
Closest alternative to Tresiba — lasts up to 36 hours with a very flat profile. Better suited for patients who value Tresiba's long duration. Not 1:1 dose conversion; may need 10-15% upward titration.
Insulin Glargine U-100 (Lantus, Basaglar, Rezvoglar)
Most widely available and affordable basal insulin. Duration ~24 hours, relatively flat. Biosimilars significantly less expensive than Tresiba. Dose conversion from Tresiba is typically 1:1 or with ~20% reduction.
NPH Insulin
Intermediate-acting insulin available at some pharmacies without a prescription. Requires twice-daily dosing, has a pronounced peak, and greater variability. Emergency use only as a Tresiba substitute.
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Sulfonylureas (glipizide, glimepiride, glyburide)
majorIncreases risk of hypoglycemia when combined with Tresiba. Dose reduction may be needed.
GLP-1 Agonists (semaglutide, liraglutide, dulaglutide)
moderateCan increase blood-sugar-lowering effect of Tresiba. Monitor blood sugar closely; dose adjustment may be needed.
Corticosteroids (prednisone, dexamethasone)
majorSignificantly reduce Tresiba's effectiveness. Blood sugar rises; substantial insulin dose increase may be needed during steroid treatment.
Beta-blockers (metoprolol, atenolol, propranolol)
moderateCan mask symptoms of hypoglycemia (rapid heartbeat, shakiness). May also affect blood sugar levels in unpredictable ways.
Alcohol
majorCan unpredictably raise or lower blood sugar. Blocks hepatic glucose recovery from hypoglycemia. Avoid or use with great caution.
Thiazolidinediones (pioglitazone/Actos, rosiglitazone)
majorCombination with any insulin can cause or worsen heart failure. Monitor for shortness of breath, weight gain, edema.
ACE Inhibitors/ARBs (lisinopril, losartan, enalapril)
moderateMay enhance the blood-sugar-lowering effect of Tresiba. Monitor glucose levels when starting or stopping these medications.
Atypical Antipsychotics (olanzapine, clozapine, aripiprazole)
moderateCan cause hyperglycemia and reduce Tresiba effectiveness. Dose adjustment and increased monitoring needed.
Tresiba (insulin degludec) is one of the most advanced basal insulins available — its ultra-long 42+ hour duration, flat peakless profile, and proven reduction in severe hypoglycemia make it a clinically valuable option for both type 1 and type 2 diabetes patients. Its flexible once-daily dosing (at any time of day) is particularly beneficial for patients with variable schedules.
The main challenges in 2026 are availability and cost. Intermittent supply shortages mean patients may need to search across multiple pharmacies to find their medication. The $35 Medicare insulin cap and Novo Nordisk's Insulin Value Program have made Tresiba significantly more affordable for many patients, but those outside these programs may face high out-of-pocket costs without a savings card or discount program.
If you're having trouble finding Tresiba at your pharmacy, medfinder can help you locate pharmacies near you that have it in stock. Simply provide your medication, dosage, and zip code — medfinder calls pharmacies on your behalf and texts you the results, saving you hours of searching on your own.
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