Tresiba FlexTouch 200 Units / mL - 3x3ml
Tresiba FlexTouch 200
Insulin degludec
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Prescription Required.

Product of Canada.

Express Ships from Canada.

Prescription Required.
Product of Canada.
Express Ships from Canada.

What is the Tresiba 200 units/mL Pre-filled Pen (FlexTouch)?

Tresiba (insulin degludec) is a long-acting basal insulin that is administered once-daily to control blood glucose levels.

It is used to treat type 1 and type 2 diabetes mellitus in adults, adolescents and children (over the age of 1).

It is available in the form of prefilled insulin pens known also as Tresiba FlexTouch Pens.

Tresiba can be used in combination with rapid-acting insulin, oral medications for diabetes and antidiabetic medications, other than insulin.


Tresiba is injected subcutaneously (under the skin) once daily, at any time of the day.

Adult patients who notice they’ve missed a dose should inject their daily-dose during waking hours then continue their regular dosing schedule.

For pediatric patients, Tresiba should be taken at the same time daily. If they miss a dose they should contact their doctor and monitor blood sugar levels closely until their next dose.

Adult patients should ensure that at least 8 hours have elapsed between consecutive injections. Dose increases should be made within 3-4 days from last injection.

It’s important to note that Tresiba contains less than 1 mmol sodium (23 mg) per dose which means its essentially sodium-free.

How to store Tresiba FlexTouch U-200

Keep medication away from children and pets.

Do not use medication after the expiry date on the label or carton.

Before first use:

Store Tresiba FelxTouch pens in refrigerator between 36°F to 46°F. Keep the pen on to protect from direct light and away from freezing element.

After first use or if carried as spare:

You can carry your Tresiba FlexTouch pens with you and keep at away from light or within room temperature (not above 86°F). It can be refrigerated between 36°F to 46°F for up to 8 weeks (56 days).

Be sure to keep the cap on the pen at all times when not in use to protect it from direct light.

Do not dispose of medication in household trash or in wastewater (toilet, sink). Speak to your pharmacist about how to properly dispose of medication no longer used in order to protect the environment.

How to use Tresiba

Use medication exactly as instructed by your doctor or pharmacist. Let them know if you are unsure how to take insulin or have any questions.

  • Your doctor will instruct you on:-your Tresiba dosage per day
  • how and when to monitor your blood glucose levels
  • flexibility in dosing schedule

Always follow your doctors instructions for dosage and timing. Use Tresiba once daily at the same time.

If you cannot take it at your scheduled time, make sure you take it within 8 hours between doses.

Let your doctor or pharmacist know if you decide to make dietary changes as this can impact your blood sugar level.

Always check medication labels before using medication. Your Tresiba® pre-filled pen should have the words “Tresiba® 200 units/mL” marked on the pen label and packaging. Tresiba® 200 units/mL packaging and labels are designed with a dark green to identify it compared to the Tresiba® 100 units/mL packaging and label which is light green.

If you suffer from poor eye sight or blind, get help from another person who is trained to administer the FlexTouch pre-filled pen. Use a magnifying glass if it helps you read the dose counter.

The strength of your Tresiba pre-filled pen dose is dialed in units and dose counter shows the number of units left to be injected. The pre-filled pen 200 units/mL can provide a dose of 2–160 units in one injection in steps of 2 units.

For patients > 65 years of age

Tresiba can be used in seniors however it’s recommended to monitor blood sugar levels frequently.

If you have liver or kidney problems

You may need to check your blood sugar levels frequently if you have existing liver or kidney problems. Let your doctor know of any existing issues such as kidney or liver issues as they may need to adjust your treatment.

Injecting Tresiba

Your doctor, pharmacist or nurse should show you how to administer your Tresiba pre-filled pen.

Do not use Tresiba:

  • in insulin pumps
  • if the pen was not stored correctly
  • if the pen is damaged
  • if the insulin is not colorless and clear

How to inject Tresiba

  • Tresiba is administered by injection under the skin (subcutaneously). Do not inject into a muscle or vein.
  • The best places to inject are the upper arm, thighs or front of waist (abdomen).
  • Always use a new needle before every injection. Re-used needles may result in blocked dosing. Dispose of needles after every injection.
  • Do not try to extract insulin using a syringe from a pen as this may result in a potential dosing error or overdose.
  • Rotate injection sites to avoid skin complications such as developing skin pitting or lumps.

If you use more Tresiba then required this may result in low blood sugar or hypoglycemia.

If you forget to use Tresiba, inject at the earliest convenience. Do not inject a double dose if you discover you missed your previous dose. If you find out you’ve missed a dose, make sure that at least 8 hours separates doses.

Do not stop using Tresiba without speaking to your doctor first. Stopping your insulin medication can result in elevated blood sugar levels and potentially ketoacidosis (too much acid in blood).


As with all medication, side effects can occur when taking insulin in regular dosages. Side effects can range from mild to severe. Typically most side effects last go away within a few days or weeks.


Hypoglycemia (low blood sugar) is the most common side effect when taking insulin. It usually affects 1 in 10 people however if not treated can become serious.

If you experience low blood sugar be sure to consume a glucose tablet, sugar snack (such as hard candy, raisins, jelly beans, sugar packet) or beverage (fruit juice or non-diet soda).

If blood sugar levels drop too low, patients can lose consciousness and require a glucagon injection since they cannot take sugar orally. Inform family and friends that you have diabetes and educate them on what to do if you lose consciousness due to hypoglycemia.

If you lose consciousness they should:

  • turn you on your side
  • get medical assistance immediately
  • not give you anything orally (food or drink)

Once you regain consciousness you should consume a sugary snack or beverage.

If you do not regain consciousness, you should be taken to the hospital or contact emergency response.

If severe low blood sugar is not treated promptly it may result in severe complications such as brain damage or even death.

Low blood sugar can result if:

  • you drink alcohol
  • exercise too much
  • eat too little
  • skip a meal

Warning signs of low blood sugar common on suddenly. These include:

  • headache
  • fast heartbeat
  • cold sweats
  • cool pale skin
  • feeling sick
  • tiredness
  • weakness
  • confusion
  • anxiety
  • difficulty concentrating
  • tremors
  • feeling hungry
  • blurred vision

Measure blood sugar levels often and get rest. Wait until blood sugar levels have settled.

Let your doctor know if:

  • you have lost consciousness due to low blood sugar
  • have have used/received a glucagon injection
  • you’ve experienced frequent episodes of low blood sugar

This may be the result of your insulin schedule/timing, diet and exercise.

Hyperglycemia (high blood sugar levels)

High blood sugar levels may result from:

  • eating more and exercising less than usual
  • drinking alcohol
  • an infection or fever
  • rationing insulin or not using enough
  • skipping insulin doses
  • stop using insulin without speaking ot your doctor

Symptoms of hyperglycemia may include:

  • flushed skin
  • feeling sleepy or tired
  • thirst
  • loss of appetite
  • nausea or vomiting
  • increased urination
  • dry mouth
  • fruity or acetone breath
  • dry skin

These symptoms can lead to a very serious condition called ketoacidosis which is a build of acid in the blood. This happens as a result of the body breaking down fat instead of sugar. If not treated it can potentially lead to diabetic coma or even death.

If patients experience hyperglycemia thy should:

  • test blood sugar levels
  • test blood for ketones and urine
  • get medical assistance immediately

If you experience any side effects not listed above, report them to your doctor or pharmacist. By reporting side effects you can help improve safety measures and information on this medication.

Allergic Reaction

If you are allergic to insulin or any ingredients in Tresiba, you may experience allergic reactions. Common signs of an allergic reaction include:

  • suddenly feeling unwell and sweating
  • rapid heartbeat and feeling dizzy
  • local reactions spread to other parts of body
  • difficulty breathing
  • feeling sick (vomiting)

Skin changes at injection sites

If you inject repeatedly in the same area it may result in the fatty tissue shrinking (lipoatrophy) or thickening (lipohypertrophy). This usually affects 1 in 100 people. Signs of this may be lumps under the skin caused by a protein build-up called amyloidosis. Do not inject into skin that is lumpy or shrunken as this may affect the effectiveness of insulin delivery. Rotate injection sites to avoid this and to help further prevent skin changes.

Other side effects include:

Common (may affect 1 in 10 patients):

Local site reactions. Symptoms may include redness, hives, swelling and itching at the site of injection. Typically these skin changes go away after a few days. Consult your doctor if you find these skin complications persist and do not disappear after a few weeks.

Uncommon (may affect up to 1 in 100 patients)

When you first start using Tresiba your body may keep more water than usual and result in swelling around the joints. This is usually temporary.

Rare (may affect up to 1 in 1000 patients)

Tresiba can cause allergic reactions such as diarrhea, nausea, tiredness, swelling of the lips & tongue and hives.


Consult your doctor before using Tresiba and be aware of the following:

  • Hypoglycemia (low blood glucose levels) – if your blood sugar levels drop too low be sure to follow your doctors instructions
  • Hyperglycemia (high blood glucose levels) – follow your doctors instructions if your blood sugar levels are too high
  • Switching between insulin medications – your insulin dose may need to be adjusted if you switch brands or another type of insulin
  • Ensure you are using the right type of insulin – always check the label before administering medication
  • Eye disorders – fast improvements in blood sugar control may lead to potential eye disorders such as diabetic retinopathy. Consult with your doctor if you have any vision problems.

Limitations of Use

Tresiba® is not recommended for treating diabetic ketoacidosis.

Do not use Tresiba if you are allergic to insulin degludec or any of the ingredients in this medication.

Skin Changes at Injection Sites

Rotate injection sites regularly in order to avoid skin complications such as skin shrinking, thickening or developing lumps under the skin.

Injecting insulin into lumpy skin, shrunken or thickened skin may affect the effectiveness of Tresiba. Inform your doctor if you are injecting into affected areas as they may choose to recommend closely monitoring you blood glucose levels, adjust your insulin dosage and other antidiabetic medications.

Children & Adolescents

Tresiba can be used in children over the age of 1 and adolescents.

Other Medications & Tresiba

Inform your doctor if you are currently taking any other prescription medications, over-the-counter drugs, herbal supplements or vitamins. These may affect glycemic levels which will require your doctor to adjust your insulin treatment.

The list below are common medications which can affect your insulin treatment.

The following may cause hypoglycemia:

  • other diabetes medications (oral or injectable)
  • sulfonamides, for infections
  • anabolic steroids (such as testosterone)
  • beta-blockers (used for high blood pressure)
  • mild fever
  • monoamine oxidase (MAO) inhibitors
  • angiotensin converting enzyme (ACE) inhibitors
  • acetylsalicylic acid (and other salicylates)

Blood glucose may rise due to the following drug interactions:

  • anazol (endometriosis)
  • oral contraceptives (birth control pills)
  • thyroid hormones (thyroid problems)
  • growth hormone (growth hormone deficiency)
  • glucocorticoids (ie ‘cortisone’ for inflammation)
  • sympathomimetics (ie epinephrine, salbutamol or terbutaline)
  • thiazides (used for high blood pressure or water retention)
  • octreotide and lanreotide (treats acromegaly) and may increase or decrease blood sugar levels.
  • pioglitazone (often used to treat type 2 diabetes)

Consult your doctor immediately if you are experiencing symptoms of heart failure such as rapid weight gain, unusual shortness of breath or localized swelling (edema).

Tresiba & Alcohol Consumption

If you are consuming alcohol, you may require adjusting your insulin treatment since alcohol can cause rapid increase and decrease in blood sugar levels. It’s important to monitor blood sugar levels if you consume alcohol.

Pregnancy & Breast Feeding

It is unknown whether Tresiba affects a baby during pregnancy or breast feeding. Inform your doctor if you are pregnant, considering pregnancy, breast feeding or about to breast feed. Your doctor may choose to adjust your insulin treatment depending on the patients needs. Monitoring blood sugar levels (hypoglycemia) is extremely important as it may affect the health of both mother and baby.

Driving or operating heavy machinery

Having low blood sugar levels can affect a patients ability to concentrate. This could be dangerous if a patient driving or operating machinery. Consult with your doctor if it is safe for you to perform these activities if:

  • you experience low blood sugar levels often
  • you find it difficult to identify low blood sugar

Frequently Asked Questions: Tresiba Insulin FlexTouch U-200

Tresiba U-200 is a once-daily injection of basal insulin manufactured by Novo Nordisk. This comes in a pre-filled pen, made for patients with type1 or type 2 diabetes. The pen itself comes with pre-filled vials, a visible dosing window, and a click-to-administer button, allowing the easiest method possible for administering insulin. The U-200 differs from its counterpart, the U-100 by its level of dosing (200 units/1ml). Tresiba FlexTouch pens are also delivered via subcutaneous injection, meaning it is injected into the skin rather than directly through the veins. Injecting Tresiba intravenously can result in severe episodes of hypoglycemia and should be avoided. It is also not made for people with diabetic ketoacidosis and can cause life-threatening side effects. The Tresiba U-200 pen delivers anywhere from 2-160 units of insulin per injection.

When Tresiba is prescribed, the most important thing to do is speak with your doctor about other medications, supplements or vitamins you are taking. There are various interactions that can occur between Tresiba and other common medications. Drugs which can decrease blood glucose levels may lead to interactions. These include antipsychotics, corticosteroids, thyroid hormones, beta blockers, alcohol and oral contraceptives. Not all of these medications will cause serious interactions but it’s important to let your doctor know what you are currently taking. Drugs that also stop the blunt signs of hypoglycemia such as beta blockers or clonidine should also be avoided or swapped out for another medication.

While Tresiba is similar to other insulin pens on the market, patients have reported a higher rate of symptom suppression than other popular brands such as Lantus. Tresiba works longer in the blood for up to 42 hours, while other injections often only last 24 hours. Tresiba may also be better at preventing episodes of low blood sugar throughout the night, which can cause patients to wake up negatively and impact their sleep.

In most cases, adult patients who miss a dose are instructed to make up their dose the next morning or as soon as they remember. You can then return to your regular dosing schedule. For pediatric patients under the age of 12, doses must be given at the same time each day. For both adult and pediatric patients, at least 8 hours must elapse between consecutive doses. The FlexTouch U-200 pen will show the number of units to be delivered. It is not recommended to double your dose if you miss a day.

Besides other drug interactions that should be discussed with your doctor prior to starting Tresiba, one should also avoid herbal supplements or drinking alcohol which can both influence blood sugar levels. Tresiba should NEVER be taken DURING an episode of low blood sugar or during an episode of diabetic ketoacidosis. Never mix insulin brands with each other and speak with your doctor about any other diabetic medications or insulins you are on prior to starting Tresiba. As with any insulin or diabetic regimen, one should also avoid overconsuming high levels of sugar, processed and fried foods.

Currently there are no studies examining the dangers of Tresiba with pregnant women or any evidence of it causing birth defects or miscarriages. It is not known whether Tresiba is safe, but based on other clinical insulin studies, doctors will prescribe Tresiba to pregnant women on a case by case basis. Insulin is generally recommended by the American Diabetes Association as the primary treatment for managing blood sugar during pregnancy and breastfeeding women.

Tresiba comes in a pre-filled pen, made for easy administering, although it is important to read and follow directions carefully. Make sure the correct type and dose of insulin is in your dosing window of the pen, which shows how many units of insulin will be injected. Never take more than prescribed and do not convert dosing from previous prescriptions. Your doctor will be able to convert this and provide you proper instructions for your individual dose. To avoid lumps on the skin consider alternating injection sites. Never inject Tresiba into skin that is pitted, thickened, bruised or contains open custs as this can lead to potential infections.



How do I administer a Tresiba U-200 injection?

The Tresiba U-200 flex touch was made with the hope of giving patients an easy way of administering their daily insulin injections. The pre-filled pen itself comes with a pen cap, needles, a cap to hold the needle in place, as well as a scale and dosing window. This allows patients to see the exact amount of units that will be administered in their dose. This is very important to double check to make sure you are always giving yourself the correct dose.

The dosing window in the center of the pre-filled pen allows patients to select their exact dosage amount for each injection. Patients are directed to pull the cap to expose the needle, but do not throw the cap away. Select your correct amount of units to be dosed and hold the pen upside down, lightly tapping to get rid of any air bubbles. A one-click administer button makes it easy to inject the needle into your skin to receive a full dose of the insulin. For more details on how to administer including a step by step video you can continue here to Tresiba’s official website.


Can I throw out my Tresiba injections after use?

For safety it is important to immediately dispose of your needles and in a sharps disposal container. You should also dispose of pens, vials, cartridges, and any other empty parts of your prescription into a proper container or drug collection program.  The Novo Nordisk Drug Disposal Program that manufactures Tresiba pens makes disposal of insulin needles easy and stress free. It is important to remember to never throw used syringes or needles in a trash or recycling bin and always keep it out of reach of children and pets. Local laws may guide different patients how to properly dispose of their injections in their community. For more information on proper disposal of needles as well as where you can find a Sharps Disposable Medical container you can visit



What is the difference between basal insulin and short acting insulin?

It is important to not mix up your insulin regimens as this can cause dangerous interactions. Botus insulin or short acting insulin is often taken before mealtimes. Basal insulin, which is what is found in Tresiba Flextouch U-200, is a longer-acting insulin. Patients usually will take this between mealtimes and before bed to keep their sugar levels consistent throughout the day and night.



I am already taking insulin but want to switch to Tresiba Flextouch U-200, can I do that?

Yes, after speaking with your doctor and any risks about possibly switching it is easy to swap out your current prescription and immediately begin using Tresiba. For those already on insulin Tresiba is a 1:1 conversion. Meaning you can start the same unit dose of Tresibas basal insulin as you were already taking.


How long does Tresiba last until expiration?

Refrigerated, Tresiba can last until its expiration date making it easy to store for future uses. Tresiba can also be kept under room temperature for up to 8 weeks or 56 days. This includes both unopened and opened vials of Tresiba. For proper storing make sure pens and packages are undamaged and the pen cap is tightly screwed on.



What is the dosage in a Tresiba U200 insulin injection?

The flextouch U-200 contains 200 units of insulin per m/l with 3 mls in each prefilled pen for a total of 600 units of insulin per pen. Packages come in a standard size of three pens or 1800 units per package. Doses each in injection may vary but 160 units is the max dose per injection of the U-200, with about 80 units being the average administered. Doses can vary individually for injections though, which your doctor will discuss with you before use.


What are the potential side effects?

It is important to note that with any medication or insulin injections side effects can always occur. Working with your doctor to monitor how Tresiba is working as well as your glucose levels. If you have an allergic reaction please talk to your doctor immediately as this can cause one to go into anaphylaxis. Possible side effects of taking Tresiba can range from mild to severe and include:

  • Skin rash/hives
  • Itching
  • Wheezing
  • Nausea/Diarrhea
  • Fatigue
  • Weight gain
  • Swelling of face, throat or tongue
  • Low blood sugar
  • Numbness/Tingling in the limbs


How old do you have to be to take Tresiba?

Tresiba is safe for anyone with diabetes meticulitis above the age of 1. Pediatric dosing will look different for adults and doses should never be doubled or taken more than once a day.

To use the Tresiba FlexTouch pen, follow these steps:

  1. Preparation:
    • Ensure you have the correct insulin type and strength. Tresiba FlexTouch is available in U-100 and U-200 concentrations.
    • Wash your hands thoroughly before handling the pen.
    • Inspect the insulin in the pen. Tresiba should be clear and colorless. Do not use if it’s cloudy or discolored.
    • Attach a new needle each time you inject. Remove the paper tab from the needle, twist it onto the pen, then remove the outer needle cap and inner needle cap.
  2. Priming the Pen:
    • If it’s your first time using the pen, prime it by selecting a 2-unit dose and pressing the dose button until the counter shows zero. This ensures the pen is ready for accurate dosing.
  3. Selecting the Dose:
    • Turn the dose selector to the number of units you need to inject. The Tresiba FlexTouch U-200 pen allows dose increments of 2 units at a time, with a maximum dosage of 160 units per injection.
  4. Choosing an Injection Site:
    • You can inject Tresiba into your abdomen, thigh, or upper arm. Avoid injecting near the belly button or into areas where the skin is discolored, bruised, scaly, hard, or has lumps.
  5. Injecting the Insulin:
    • Clean the injection site with an alcohol wipe and let it dry.
    • Insert the needle at a 90-degree angle to your skin.
    • Press the dose button and hold it down until the dose counter returns to zero.
    • Count slowly to six while keeping the needle in place to ensure the full dose is delivered.
  6. After Injection:
    • Carefully remove the needle and dispose of it safely in a sharps container.
    • Do not store the pen with the needle attached. Replace the pen cap.
  7. Storage and Handling:
    • Store unused Tresiba pens in the refrigerator. Once in use, you can keep them at room temperature, away from direct heat and light.
    • Tresiba pens can be used for up to 8 weeks after their first use if stored correctly.

Remember, it’s crucial to follow your healthcare provider’s instructions on insulin dosage and administration. If you’re unsure or it’s your first time, ask your doctor or nurse to demonstrate how to use the Tresiba FlexTouch pen. Do not change your insulin type or dosage without medical advice.

It is important to note that with any medication or insulin injections side effects can always occur. Working with your doctor to monitor how Tresiba is working as well as your glucose levels. If you have an allergic reaction please talk to your doctor immediately as this can cause one to go into anaphylaxis. Possible side effects of taking Tresiba can range from mild to severe and may include, but not limited to:

  • Skin rash/hives
  • Itching
  • Wheezing
  • Nausea/Diarrhea
  • Fatigue
  • Weight gain
  • Swelling of face, throat or tongue
  • Low blood sugar
  • Numbness/Tingling in the limbs

Tresiba is safe for anyone with diabetes mellitus above the age of one. Pediatric dosing will look different for adults and doses should never be doubled or taken more than once a day.

Tresiba (insulin degludec) can last out of the fridge, at room temperature (below 86°F [30°C]), for 56 days (8 weeks). This includes Tresiba that is in-use (opened) and not in-use (unopened). After this time Tresiba should be discarded.

It is important to not mix up your insulin regimens as this can cause dangerous interactions. Bolus insulin or short-acting insulin is often taken before mealtimes. Basal insulin, which is what is found in the Tresiba FlexTouch 200, is a longer-acting insulin. Patients usually will take this between mealtimes and before bed to keep their sugar levels consistent throughout the day and night.

Do not consume alcohol or OTC medication which may contain alochol. Do not drive or operate heavy machinery unless you know how your body reacts to Tresiba.