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Tresiba® (insulin degludec injection) 100 U/mL, 200 U/mL: How it Works with Dr Gavin

Hello, I’m Dr. James Gavin. I’m here to talk about the basal insulin, Tresiba®. Tresiba® has a long duration of action. You may already be familiar with this aspect. I’d like to walk through the molecular design of Tresiba® to see how that duration of action was created. I’ll also touch on why it was created this way and what it could mean for your patients with diabetes. Let’s get started and see how it works at the molecular level. Tresiba® was designed to be different, and we can see that in its mechanism of protraction. This protraction allows Tresiba® a slow and consistent rate of absorption into circulation. In the pen, Tresiba® exists as stable and soluble insulin dihexamers bonded together by zinc. Once Tresiba® is injected, the phenol diffuses and the insulin dihexamers form chains referred to as multihexamers. Since the rate of insulin absorption is tied closely to molecular size, these large multihexamers stay in place, creating a subcutaneous depot of insulin. As the zinc bonding the multihexamers diffuses, individual monomers slowly and continuously disassociate from both ends of each chain. These monomers are now the correct molecular size for absorption into the bloodstream. As a result of this mechanism of protraction, Tresiba® has a duration of action of at least 42 hours that won’t taper off at the end of the day. For adults, Tresiba® can be dosed once daily at any time of the day. Adult patients who miss a dose of Tresiba® should inject their daily dose during waking hours upon discovering the missed dose, and then continue with their regular dosing schedule, ensuring that at least 8 hours have elapsed between Tresiba® injections. When I prescribe a basal insulin, I take a close look at how it works and consider why it works the way it does. This helps me make treatment decisions. For patients who could benefit from a long duration of action, I would prescribe Tresiba®.

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