Basal Insulin Analogs

Mechanism of Action and Pharmacokinetics

Both Tresiba and Lantus are basal insulin analogs designed to provide relatively constant, peakless insulin levels to control blood glucose between meals and overnight, as recommended by the American Diabetes Association 1, 2
Both medications work primarily by restraining hepatic glucose production and limiting hyperglycemia overnight and between meals, with a moderate strength of evidence 2, 3
Both are recombinant DNA-derived insulin analogs that have been modified from human insulin to change their onset and duration of action, according to the European Association for the Study of Diabetes 4

Tresiba comes in U-100 and U-200 formulations, while Lantus comes in U-100 and U-300 (Toujeo) formulations, as reported by the American Association of Clinical Endocrinologists 2, 3, 5, 6

When switching between these insulins, doses can often be converted unit-for-unit, but an initial dose reduction of 10-20% may be needed for patients at high risk of hypoglycemia, as suggested by the Endocrine Society 6
Both insulins can be used in combination with mealtime insulin in type 1 diabetes or with oral medications in type 2 diabetes, with a high strength of evidence 3, 4

The American Diabetes Association classifies insulin degludec (Tresiba) as a long‑acting basal insulin analog, grouping it with insulin glargine and insulin detemir as basal insulin options. 7

According to the American Diabetes Association, insulin degludec lowers glucose primarily by suppressing hepatic glucose production and reducing overnight and inter‑meal hyperglycemia, which is the core mechanism shared by all basal insulins. 7

The American Diabetes Association’s 2021 guidelines list insulin degludec among the recommended basal insulin choices for both type 1 and type 2 diabetes management. 7