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Key takeaways
Tresiba (insulin degludec) is an ultra long-acting insulin, while Toujeo (insulin glargine) is a long-acting insulin. They are used for managing blood sugar levels in patients with diabetes.
Both Tresiba and Toujeo can cause similar side effects such as hypoglycemia and injection site reactions, but Tresiba may lead to less hypoglycemia and has a unique side effect profile including potential headache and diarrhea.
Insurance coverage for Tresiba and Toujeo varies, with both being generally covered by insurance plans and Medicare, and costs can be reduced using specific discount cards, with Tresiba potentially being more expensive.
Despite differences in onset and duration of action, both Tresiba and Toujeo are effective in improving blood sugar and HbA1c levels, with the choice between them depending on individual patient needs and healthcare provider recommendations.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Tresiba and Toujeo are two different insulins used to manage blood sugar levels in those with diabetes. Tresiba is an ultra long-acting insulin and Toujeo is a long-acting insulin. Either insulin may be prescribed in adults or children for effective sugar control throughout the day.
Compared to short-acting insulins, Tresiba (insulin degludec) and Toujeo (insulin glargine) are designed to release insulin over a longer period of time. Because of their long duration of effect, these insulins can help provide more stable blood sugar levels while lowering the risk of hypoglycemia (dangerously low blood sugar levels). Despite their similarities in effect and use, Tresiba and Toujeo have several differences.
What are the main differences between Tresiba and Toujeo?
Tresiba is the brand name for insulin degludec. It is an ultra long-acting insulin that is administered daily as an injection under the skin (subcutaneous). Tresiba is available as a prefilled FlexTouch pen in strengths of 100 units/mL and 200 units/mL. It is also available as a 10 mL multiple-dose vial.
After Tresiba is administered, its glucose-lowering effects can last for 42 hours or more. Tresiba starts working within one hour and has a half-life of 25 hours on average. It takes three to four days of daily use for Tresiba to reach consistent levels in the blood (steady-state).
Toujeo is the brand name for insulin glargine. It is a long-acting insulin that is administered as a daily subcutaneous injection. Toujeo is available as a 1.5 mL SoloStar pen or a 3 mL Max SoloStar pen.
The effects of Toujeo usually last for between 24 and 36 hours after administration. Toujeo starts working within six hours after using it. Therefore, it’s a much slower releasing insulin than Tresiba. It has a half-life of around 19 hours and takes five days of daily use to reach consistent levels in the blood.
Both Tresiba and Toujeo can be stored at room temperature for 56 days or eight weeks.
| Main differences between Tresiba and Toujeo | ||
|---|---|---|
| Tresiba | Toujeo | |
| Drug class | Insulin Ultra long-acting |
Insulin Long-acting |
| Brand/generic status | Brand name only | Brand name only |
| What is the generic name? | Insulin degludec | Insulin glargine |
| What form(s) does the drug come in? | Solution for injection | Solution for injection |
| What is the standard dosage? | Starting dose and maintenance dose depends on the type of diabetes, current blood sugar levels, and goals of treatment | Starting dose and maintenance dose depends on the type of diabetes, current blood sugar levels, and goals of treatment |
| How long is the typical treatment? | Long-term for continued control of blood sugar levels | Long-term for continued control of blood sugar levels |
| Who typically uses the medication? | Adults and children aged 1 year and older | Adults and children aged 6 years and older |
Conditions treated by Tresiba and Toujeo
Tresiba and Toujeo are second-generation basal insulins used to improve blood sugar control in those with diabetes. Either insulin can be prescribed to treat Type 1 or Type 2 diabetes. As basal insulins, they are administered once daily for consistent glucose control throughout the day. Some people with diabetes may need short-acting insulin for meals.
These insulins can help normalize glucose levels while lowering overall HbA1c levels. HbA1c is defined by average glucose levels over two to three months.
| Condition | Tresiba | Toujeo |
| Diabetes mellitus Type 1 | Yes | Yes |
| Diabetes mellitus Type 2 | Yes | Yes |
Is Tresiba or Toujeo more effective?
Tresiba and Toujeo are two effective basal insulins for lowering blood sugar levels and improving HbA1c levels. Compared to rapid-acting and short-acting insulins, these insulins are used once daily for consistent glycemic control. The most effective insulin is the one that works best for you based on your doctor’s recommendation.
According to a systematic review published by Diabetes Therapy, insulin degludec and insulin glargine are similarly effective for managing blood glucose levels. A total of 15 different clinical trials comparing the two insulins were evaluated. There was no statistically significant difference in either insulin’s ability to improve glucose levels. However, insulin degludec was found to cause less hypoglycemia, or dangerously low blood sugar levels.
In a systematic review published by the Diabetes, Obesity and Metabolism journal, a total of 70 studies compared the effects and safety of insulin degludec, insulin glargine, and insulin detemir. Insulin detemir is the active insulin analog in Levemir. Results found that all three insulins were similar in effectiveness, although insulin degludec caused less hypoglycemia. Diabetic patients taking insulin detemir experienced less weight gain than the other basal insulins.
Consult your healthcare provider on the best insulin treatment for you. One type of insulin may work better depending on your overall condition. Other medications may be needed to fully control blood sugar levels.
Coverage and cost comparison of Tresiba vs. Toujeo
Tresiba is covered by most insurance plans, including Medicare. For a 10 mL 100 unit/mL vial, the average cash price can be as high as $406.99. Using a discount card can help save money on prescription insulins even with insurance. A SingleCare Tresiba coupon can lower the price to $343 depending on the participating pharmacy.
Like Tresiba, Toujeo is covered by many insurance plans although there may be a copay. The average cash price of Toujeo can range from $341 to $565 depending on if you’re prescribed the Toujeo Max Solostar or Toujeo Solostar. The cost with a SingleCare discount card is $217 and $301, respectively.
RELATED: How much is Toujeo Max Solostar without insurance?
| Tresiba | Toujeo | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Standard dosage | Dosage depends on glucose levels and treatment goals | Dosage depends on glucose levels and treatment goals |
| Typical Medicare copay | $5–$585 | $13–$447 |
| SingleCare cost | $343+ | $217-$301 |
Common side effects of Tresiba vs. Toujeo
Low blood sugar, or hypoglycemia, is one of the most common side effects of Tresiba and Toujeo. The symptoms of hypoglycemia may be mild or severe depending on the person’s response to insulin, how much insulin is administered, and diet and exercise habits. Symptoms of hypoglycemia include hunger, lightheadedness, irritability, confusion, and increased sweating.
Tresiba and Toujeo can also cause injection site reactions, such as redness, swelling, or itching around the area of injection. However, these side effects are usually mild and go away on their own. Other side effects include upper respiratory tract infections or a cold (nasopharyngitis), swelling in the hands or feet (edema), and weight gain.
Tresiba has also been reported to cause headache and diarrhea.
| Tresiba | Toujeo | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Injection site reactions | Yes | 4% | Yes | * |
| Hypoglycemia | Yes | 12% | Yes | * |
| Headache | Yes | 12% | No | – |
| Upper respiratory tract infection | Yes | 12% | Yes | 10% |
| Nasopharyngitis | Yes | 24% | Yes | 13% |
| Diarrhea | Yes | 6% | No | – |
| Edema | Yes | 1% | Yes | * |
| Weight gain | Yes | * | Yes | * |
*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Tresiba), DailyMed (Toujeo)
Drug interactions of Tresiba vs. Toujeo
Like other insulins, Tresiba and Toujeo can interact with much of the same drugs. Certain antihypertensives, like ACE inhibitors and angiotensin II receptor blocking agents, can increase the risk of hypoglycemia when used with Tresiba or Toujeo. Antidiabetic agents, like dulaglutide, glyburide, and pioglitazone, can also increase the risk of hypoglycemia with Tresiba or Toujeo.
Drugs such as corticosteroids and oral contraceptives can decrease the effectiveness of Tresiba or Toujeo. This is because these drugs can impair the body’s ability to use glucose for energy. Antiadrenergic drugs, such as beta-blockers, clonidine, and reserpine, can mask the signs and symptoms of hypoglycemia.
Glucose monitoring may be needed when Tresiba or Toujeo is used along with other drugs that can affect glucose tolerance and insulin levels.
| Drug | Drug class | Tresiba | Toujeo |
| Enalapril Lisinopril Ramipril |
ACE inhibitors | Yes | Yes |
| Losartan Olmesartan Irbesartan Valsartan |
Angiotensin II receptor blocking agents | Yes | Yes |
| Dulaglutide Exenatide Glyburide Pioglitazone Rosiglitazone |
Antidiabetic agents | Yes | Yes |
| Hydrocortisone Prednisone Prednisolone |
Corticosteroids | Yes | Yes |
| Estradiol Ethinyl estradiol Drospirenone Norethindrone |
Oral contraceptives | Yes | Yes |
| Atenolol Propranolol Metoprolol Clonidine Guanethidine Reserpine |
Antiadrenergic agents | Yes | Yes |
Consult a healthcare professional for other possible drug interactions.
Warnings of Tresiba and Toujeo
Severe hypoglycemia is possible after using insulins like Tresiba or Toujeo. The risk of severe hypoglycemia may be increased in those with renal, or kidney problems, and hepatic, or liver, impairment. Insulins like Tresiba or Toujeo should only be used with a proper prescription and guidance from a healthcare provider. Hypoglycemia may require emergency therapy in the form of carbohydrates or glucagon.
Tresiba and Toujeo may cause hypersensitivity reactions in some people. If you experience a severe rash or trouble breathing, seek medical attention immediately.
Hypokalemia, or low levels of potassium, may occur while using Tresiba or Toujeo. Hypokalemia can be life-threatening and cause symptoms like trouble breathing, abnormal heart rhythms (arrhythmia), or death.
Some people may need to be monitored for signs and symptoms of heart failure if they’re also using thiazolidinedione medications. Using these medications together with Tresiba or Toujeo can cause fluid retention and worsen congestive heart failure.
Consult a doctor or healthcare provider for other possible warnings and precautions.
Frequently asked questions about Tresiba vs. Toujeo
What is Tresiba?
Tresiba is an ultra long-acting insulin manufactured by Novo Nordisk. It is administered once daily to people with diabetes for consistent glucose control. Tresiba is available in multiple-dose vials or FlexTouch pens. The generic name of Tresiba is insulin degludec.
What is Toujeo?
Toujeo is a long-acting insulin manufactured by Sanofi-Aventis. As a long-acting insulin, it only needs to be administered once daily to control blood sugar levels. Toujeo comes as a prefilled SoloStar pen or a Max SoloStar pen. The generic name of Toujeo is insulin glargine.
Are Tresiba and Toujeo the same?
Both Tresiba and Toujeo improve blood sugar levels and HbA1c levels in people with Type 1 diabetes or Type 2 diabetes. They are both injected under the skin (subcutaneously) once daily. However, they are not the same drug; Tresiba contains insulin degludec while Toujeo contains insulin glargine. These insulins have different durations of action, among other differences.
Is Tresiba or Toujeo better?
Tresiba has a longer duration of action than Toujeo; Tresiba works for more than 42 hours while Toujeo works for up to 36 hours. Tresiba also starts working faster than Toujeo; Tresiba starts working within one hour while Toujeo starts working within six hours. Still, both insulins are effective in treating diabetes.
Treatment effectiveness will depend on the insulin dose you use. Dosage may need to be adjusted if the insulin is not improving glucose levels enough. The incidence of hypoglycemia may be lower in those who take Tresiba versus those who take Toujeo.
Can I use Tresiba or Toujeo while pregnant?
Tresiba or Toujeo should only be used during pregnancy if the benefits outweigh the risks. Currently, there are not enough studies to tell whether Tresiba or Toujeo can harm an unborn baby. However, uncontrolled glucose levels during pregnancy (gestational diabetes) is a major condition that can cause complications if left untreated. Consult your healthcare provider if you are pregnant before using Tresiba or Toujeo.
Can I use Tresiba or Toujeo with alcohol?
Alcohol can interfere with how blood sugar is processed in the body. Alcohol may reduce how well insulin works in the body. Excessive alcohol use can also lead to hypoglycemia, or dangerously low blood sugar levels. Alcohol use and hypoglycemia can lead to increased confusion, lightheadedness, and headaches, which may require medical attention.
Is Tresiba the same as NovoLog?
Tresiba is not the same as NovoLog. Although they are both insulins, they work in different ways. Tresiba is an ultra long-acting insulin while NovoLog is a rapid-acting insulin. NovoLog starts working much quicker than Tresiba, but its effects only last for a few hours. Tresiba is administered as a daily basal insulin for consistent glucose levels throughout the day. NovoLog is recommended as a mealtime insulin.
What is the best time to take Tresiba?
Tresiba can be taken at any time of day. For example, it could be taken in the morning or at night depending on your preference and doctor’s recommendation. Tresiba is recommended to be taken once daily in both adults and children. In children, Tresiba should be taken at the same time every day.
Which insulin is best?
The best insulin is the one that works for you and your condition. Different factors play a role in determining the best insulin, including current glucose levels, other conditions you may have, other medications you may be taking, and the cost of the insulin. Multiple insulins may also be needed; for example, a long-acting insulin can be used once daily while a rapid-acting insulin can be used during meals as needed. Tresiba may be the best long-acting insulin currently since it has the longest duration of action. No matter which insulin is used, glucose monitoring is recommended to determine how well the prescribed insulin is working.