Insulin Degludec (Tresiba)
Insulin degludec (Tresiba) is an ultra-long-acting basal analogue with an action duration exceeding 42 hours, forming soluble multihexamer depots after injection. Its extreme duration makes it the least reversible insulin and correspondingly hazardous if hypoglycaemia occurs.
01 Overview
Degludec self-associates into long multihexamer chains at the injection site that slowly release monomers, giving a flat profile lasting more than 42 hours and low glucose variability. It is an approved basal insulin with good hypoglycaemia data in supervised diabetic use.
Any non-diabetic use is especially dangerous: because degludec persists for days, a hypoglycaemic episode cannot be shortened by stopping it, and its long tail complicates dose titration. It offers no advantage that justifies the risk for physique use.
02 Mechanism
Binds the insulin receptor to promote glucose uptake and anabolic signalling; multihexamer self-assembly at the depot produces ultra-slow, flat absorption lasting over 42 hours.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Diabetic basal | 10–40 IU/day | SubQ | Once daily; individualised; medical use only |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Flat continuous insulin coverageUltra-stable basal levels give steady nutrient-partitioning signalling. | Clinical | ||
| Low glucose variabilityVery flat profile reduces day-to-day swings in supervised use. | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Weight gainFat accrual from chronic insulin exposure. | Mild | Common | Clinical | |
| Multi-day hypoglycaemia riskBecause action lasts over 42 hours, any low is prolonged and irreversible, gravely increasing danger of seizure, coma or death. | Life-threatening | Common in misuse | Clinical |