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More than 38 million Americans live with diabetes, making it the 7th leading cause of death in 2023. It remains the top cause of kidney failure, amputations, and adult blindness. Roughly 1 in 4 US health-care dollars is spent caring for people with diabetes.

Managing this disease takes more than willpower. It requires medication, lifestyle adjustments, and consistent monitoring. Newer long-acting insulins like Toujeo and Tresiba have become essential medications for people working to keep blood sugar under control.

This guide breaks down the differences between Toujeo and Tresiba, explaining how they work, how effective they are, their side effects, and what factors matter when choosing between them.

Key Differences Between Toujeo and Tresiba

Parameters Toujeo SoloStar Tresiba
US Average Retail Price $514 $620
Pharma Giant Price $150 $149
Active Ingredient Insulin glargine Insulin degludec
FDA-approved Ages 6 years and older (T1D & T2D) 1 year and older (T1D & T2D)
Pen Options & Dose Steps
  • SoloStar: 1-unit steps, up to 80 U, 450 U (1.5 mL) total units per pen
  • Max SoloStar: 2-unit steps, up to 160 U, 900 U (3 mL) total units per pen
  • FlexTouch U-100: 1-unit steps, up to 80 U, 300 U (3 mL) total units per pen
  • FlexTouch U-200: 2-unit steps, up to 160 U, 600 U (3 mL) total units per pen
Route of Administration Subcutaneous injection Subcutaneous injection
Side Effects Hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain Hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain
Dosage Frequency Once daily at the same time of day Once daily. May be injected at any time of day (keep 8 hours or more between doses)
Duration of Action Long-acting insulin (up to 36 hours) Ultra-long-acting insulin (up to 42 hours)

Effectiveness and Safety

Across randomized trials, including head-to-head and real-world studies, Toujeo and Tresiba deliver very similar glycemic efficacy.

In some settings, Toujeo tends to show fewer early titration lows, while Tresiba provides slightly lower fasting glucose and fewer nocturnal or severe hypoglycemia events. Overall, A1C reduction is essentially the same, and the differences are small and depend on the setting.

Tresiba vs. Toujeo for Type 1 Diabetes (T1D)

There aren’t direct head-to-head trials of Toujeo vs. Tresiba in children, but both have strong pediatric data:

Toujeo (EDITION JUNIOR trial, ages 6-17, vs. Lantus U100):

  • A1C dropped by ~0.40% in both groups
  • Ketosis events were 46% lower with Toujeo

Tresiba (BEGIN YOUNG trial, ages 1-17, vs. Levemir):

  • A1C control was similar between groups
  • Tresiba lowered morning blood sugars by about 29 mg/dL more than Levemir
  • Kids needed 30% less basal insulin (0.38 vs. 0.55 U/kg)
  • Ketosis events were 59% lower with Tresiba

So, both are safe and effective in kids with T1D, but Tresiba may reduce ketosis more.

On the other hand, a few studies have compared Toujeo and Tresiba directly in adults with type 1 diabetes:

  • CGM trial: Time-in-range was almost identical (53% Toujeo vs. 55% Tresiba). Average glucose variability was 39.9% with Toujeo and 41.2% with Tresiba, which indicates comparable stability with a small edge toward Toujeo.
  • Real-world study: Both reduced A1C about the same (0.2% for Toujeo, 0.14% for Tresiba). Hypoglycemia overall went down in both groups, but Toujeo had no severe events, while 7 were reported with Tresiba.
  • Glucose stability study: Both provided stable control. When doses are matched unit-for-unit, Tresiba may lower glucose a bit more, leading to fewer highs but a bit more lows compared with Toujeo.

Both control glucose equally well. Toujeo has real-world evidence of fewer severe lows, while Tresiba may push glucose a bit lower (fewer highs, but sometimes more lows).

Tresiba vs. Toujeo for Type 2 Diabetes (T2D)

Similarly, both insulins are highly effective for T2D.

Head-to-head trial (24 weeks, T2D who have never used insulin before)

In about 930 adults with uncontrolled T2D starting basal insulin, both Toujeo and Tresiba lowered A1C from 8.7% to 7.0%. During the first 12 weeks of titration, Toujeo caused fewer hypoglycemia events. By week 24, hypoglycemia rates were similar between the two insulins.

Long-term safety trial (88 weeks, high-risk T2D)

In 1,600 adults already on basal insulin and at increased risk for hypoglycemia, both Toujeo and Tresiba controlled blood sugar equally well. However, Tresiba reduced night-time lows by 37% and severe lows by 80% compared with Toujeo, making it potentially safer in patients more vulnerable to dangerous lows.

Real-world switching study (from Lantus U100 or Levemir to Toujeo or Tresiba)

Among 3,184 adults switching from older basal insulins, A1C improvement was similar with Toujeo and Tresiba.

    • Toujeo patients saw fewer overall hypoglycemia events, from 15.6% down to 12.7%
    • ER/hospital hypoglycemia visits dropped from 5.3% to 3.5%
    • Tresiba patients did not show a significant change

Overall, both insulins are highly effective for patients with T2D, but Tresiba may provide strong protection against night-time and severe hypoglycemia in high-risk patients.

Duration of Action of Toujeo and Tresiba

Woman injecting a Toujeo SoloStar pen into arm

At a dose of 0.4 units/kg, Toujeo lasts about 24 hours. At 0.6 units/kg or higher, its action can last even longer, up to 36 hours. Steady state takes about 5 days of daily use for blood levels to stabilize.

On the other hand, Tresiba is unique because it provides ultra-long, steady coverage. Both U-100 and U-200 Tresiba last at least 42 hours. It takes only about 2-3 days of daily use to reach steady state.

Researchers actually examined whether Toujeo and Tresiba U100, when titrated to each person’s needs, would work about the same in people with T1D. Patients first optimized their insulin doses for 3 months, then received their individualized daily doses of either Toujeo (~0.34 U/kg) or Tresiba (~0.26 U/kg) at night.

Results are as follows:

  • Both kept blood glucose steady for 24 hours, with equivalent effects.
  • Toujeo suppressed fat and ketone breakdown a bit more than Tresiba (free fatty acids -14%, glycerol -14%, ketones -18%). Glucagon effects were the same.
  • Within the same day, Toujeo showed 23% less variability in effect compared to Tresiba, so it may deliver a slightly more even glucose-lowering profile.
  • Tresiba achieved the same control at lower doses.

In short, Toujeo is slightly steadier, Tresiba requires less insulin, and both are equally effective for blood sugar control.

Side Effects of Tresiba vs. Toujeo

The side-effect profiles of Toujeo and Tresiba are very similar because they belong to the same class of long-acting basal insulins. According to their prescribing information, the most common side effects include:

    • Hypoglycemia (low blood sugar)
    • Allergic reactions
    • Injection site reactions
    • Lipodystrophy (changes in fat tissue under the skin, such as lumps or dents)
    • Pruritus (itching)
    • Rash
    • Edema (swelling)
    • Weight gain

Hypoglycemia

Hypoglycemia is the main risk with both insulins, and overall rates are similar.

    • Toujeo: Fewer hypoglycemia events during the early titration phase in one trial.
    • Tresiba: Fewer nighttime and severe episodes in another study.

These differences were small and may depend on factors like dose timing, lifestyle, and individual hypoglycemia history.

Hypoglycemia often starts with shakiness, sweating, hunger, and rapid heartbeat, and can progress to confusion, blurred vision, poor coordination, and, if untreated, seizures or unconsciousness.

Weight Changes

If weight gain is a concern, evidence suggests that the two insulins may differ slightly. In the CONCLUDE trial, which followed patients for 88 weeks, those using Tresiba U200 gained an average of 2.9 kg (about 6.4 lbs). In comparison, patients on Toujeo gained an average of 1.7 kg (about 3.7 lbs) over the same period.

Another analysis looked at people who switched from Tresiba U100 to Toujeo. In this group, the switch was associated with a small weight loss of about 3 lbs.

While these changes are relatively small, the data suggest that Toujeo may be associated with less weight gain, or even slight weight reduction in some cases, compared with Tresiba.

Dosing and Administration

Toujeo and Tresiba look almost identical in how they’re prescribed because both drugs serve the same basal insulin role. Both are once-daily basal insulins, started at similar doses, and titrated in nearly the same way.

The only difference in administration is that Tresiba can be taken at different times of day without losing effectiveness, as long as you keep at least 8 hours between doses.

For example, if you normally take it at 9 PM but forget, you could take it at 7 AM the next morning and then return to your regular schedule the following evening. As long as you maintain that 8-hour minimum gap, you won’t lose effectiveness. This flexibility is especially useful for people with irregular schedules.

Toujeo Tresiba
Strength 300 units per mL 100 units per mL and 200 units per mL
Forms
  • Toujeo SoloStar pen: Contains 1.5 mL (450 units total). Each pen delivers doses in 1-unit increments, up to 80 units per injection.
  • Toujeo Max SoloStar pen: Contains 3 mL (900 units total). Each pen delivers doses in 2-unit increments, up to 160 units per injection.
  • Tresiba FlexTouch U-100 pen: Contains 3 mL (300 units total). Each pen delivers doses in 1-unit increments, up to 80 units per injection.
  • Tresiba FlexTouch U-200 pen: Contains 3 mL (600 units total). Each pen delivers doses in 2-unit increments, up to 160 units per injection.
Frequency Once per day, same time each day Once per day, flexible time
Dosage for type 1 diabetes (starting dose) Approximately one-third to one-half of the total daily insulin dose. Approximately one-third to one-half of the total daily insulin dose.
Dosage for type 2 diabetes (starting dose) 0.2 units/kg, up to 10 units per day 0.2 units/kg, up to 10 units per day

Important Note!

Insulin doses are highly individualized. The numbers shown here (such as starting doses or titration amounts) are examples taken from clinical guidelines and studies. They do not necessarily reflect the dose you will need. Your insulin dose depends on many personal factors, including your blood sugar levels, weight, other medications, and overall health.

Only your doctor or diabetes care team can decide the right dose and adjust it safely. Never change your insulin on your own without medical guidance.

Cost of Toujeo vs. Tresiba

The prices below show the manufacturer costs of Toujeo and Tresiba. In most cases, pharmacy retail prices are higher and will vary depending on your location, pharmacy, and insurance coverage.

Tresiba (insulin degludec), according to Novo Nordisk’s pricing:

  • U-100 FlexTouch, 5 pens × 3 mL (15 mL total; 1,500 units): $508.43 per carton
  • U-200 FlexTouch, 3 pens × 3 mL (9 mL total; 1,800 units): $610.11 per carton
  • U-100 10 mL vial (1,000 units): $338.95 per vial

Toujeo (insulin glargine U-300), according to Sanofi’s pricing:

  • Toujeo SoloStar, 3 pens × 1.5 mL (4.5 mL total; 1,350 units): $428.57 per carton
  • Toujeo Max SoloStar, 2 pens × 3 mL (6 mL total; 1,800 units): $571.43 per carton

You can access Toujeo and Tresiba at much lower prices through Pharma Giant, a trusted Canadian pharmacy partner. Thanks to Canada’s strict drug pricing regulations, you can save up to 90% compared with US retail costs.

Current Pharma Giant prices:

  • Tresiba U-100 FlexTouch 5-pen pack – $149
  • Tresiba U-100 FlexTouch 10-pen pack – $294
  • Tresiba U-100 FlexTouch 15-pen pack – $435
  • Tresiba U-200 FlexTouch 3-pen pack – $179
  • Tresiba U-200 FlexTouch 6-pen pack – $354
  • Tresiba U-200 FlexTouch 9-pen pack – $525
Toujeo SoloStar pen coupon and discount
Toujeo DoubleStar pen coupon and discount
Tresiba FlexTouch coupons and discounts
Tresiba FlexTouch coupons and discounts

Plus, you can enjoy additional discounts when ordering larger quantities and offers from Toujeo coupons and Tresiba coupons. To save more, use the coupon code PGSAVE10 for a 10% discount on your first order. Pharma Giant promises expedited delivery, with medications typically arriving within 3-5 business days.

Summary

Toujeo and Tresiba are both highly effective long-acting basal insulins. Tresiba lasts over 42 hours and allows flexible dosing times, while Toujeo lasts up to 36 hours and may provide slightly steadier daily control. Side effects are similar, though Toujeo may cause less weight gain than Tresiba.

Both are strong options, which means the choice between them can reasonably hinge on other factors like personal preference, cost, insurance coverage, or pen features, rather than expecting a big difference in day-to-day glucose profiles from one versus the other.

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Frequently Asked Questions

The US FDA does not officially approve Tresiba for use in pregnancy. Current guidelines usually recommend insulins with more safety data, like NPH or insulin detemir (Levemir), for pregnant women. Doctors may prescribe Tresiba if the potential benefit outweighs the risks, but it’s generally not the first choice. Always consult your care team before using it during pregnancy.

Toujeo is a concentrated form of insulin glargine (U-300). Its closest equivalent is Lantus (insulin glargine U-100), though the two differ in concentration, duration, and dosing needs. Another alternative is Basaglar, a biosimilar version of insulin glargine U-100.

No, using both at the same time is not recommended. They are both long-acting basal insulins, and combining them would increase the risk of hypoglycemia. Patients should be on one basal insulin at a time, guided by their doctor.

The high cost of Toujeo in the US is largely due to manufacturer pricing, lack of generic competition, and the way insurance and pharmacy benefit managers handle rebates. These factors keep US insulin prices higher than in countries with stricter pricing regulations. Canadian pharmacies often sell it at much lower costs.

Yes, you can switch between the two under medical supervision. Doctors usually adjust the dose since Tresiba may require fewer units than Toujeo. Monitoring blood glucose closely during the transition is important to avoid highs or lows.

Hair loss is not listed as a common or known side effect of Tresiba. Reports of hair changes are rare and may be linked to diabetes itself, other medications, or health conditions. If hair loss occurs, it should be discussed with a healthcare provider to find the cause.

Tresiba (insulin degludec) is an ultra-long-acting basal insulin. Its closest alternatives are Toujeo (insulin glargine U-300) and Lantus (insulin glargine U-100), which provide once-daily basal coverage but with shorter duration. Insulin detemir (Levemir) is another option, though it often requires twice-daily dosing.

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