Ryzodeg 2/3 and 1/3 Split Dosing Calculation
The 2/3 and 1/3 split dosing guideline you're referencing applies to twice-daily premixed NPH insulin regimens, NOT to Ryzodeg (insulin degludec/liraglutide). Ryzodeg is dosed once daily as a single injection, typically starting at 10-16 units and titrated based on fasting glucose targets 1.
Critical Clarification
The evidence provided shows that the 2/3 before breakfast and 1/3 before dinner split is specifically for twice-daily premixed insulin or NPH-based regimens when intensifying from basal insulin 1. This is NOT the dosing strategy for Ryzodeg.
Correct Ryzodeg Dosing Approach
Ryzodeg should be administered once daily at any time of day, with or without food:
- Starting dose: 10-16 units once daily (or 16 units if switching from basal insulin)
- Titration: Increase by 2 units every 3-4 days based on fasting plasma glucose readings
- Target: Fasting glucose 80-130 mg/dL (4.4-7.2 mmol/L)
- Flexibility: Can be given at different times each day if needed (though consistent timing is preferred)
Common Pitfall to Avoid
Do not apply NPH/premixed insulin dosing rules to Ryzodeg. The 2/3 and 1/3 split is for older insulin regimens that require twice-daily dosing. Ryzodeg combines ultra-long-acting basal insulin (degludec) with a GLP-1 receptor agonist (liraglutide) in a fixed ratio, designed specifically for once-daily administration 2, 3.
If You Need Twice-Daily Insulin Coverage
If your patient requires more intensive insulin therapy beyond what once-daily Ryzodeg provides:
- Add prandial insulin to the largest meal (start 4 units or 10% of basal dose) 1
- Consider switching to a basal-bolus regimen with separate basal and prandial insulins
- The 2/3 and 1/3 split would only apply if switching to a twice-daily NPH or premixed insulin regimen