From the Research
Degludec starts acting within 1 hour after injection, but takes 3-4 days to reach a steady state in the body. Unlike faster-acting insulins, degludec is an ultra-long-acting basal insulin that provides stable blood glucose control for over 42 hours 1. Patients should not expect immediate blood sugar reductions as with rapid-acting insulins. The medication works by forming soluble multi-hexamers after subcutaneous injection, creating a depot that slowly releases insulin into circulation. This gradual release provides consistent background insulin with less risk of overnight hypoglycemia compared to other long-acting insulins.
Key Points to Consider
- Degludec has a flat, stable glucose-lowering profile with a duration of action of >42 hours, and less within-patient day-to-day variability in glucose-lowering effect than the long-acting insulin analogue insulin glargine 2.
- Patients should continue taking degludec at the same time each day, even if they don't notice immediate effects, and should monitor blood glucose regularly during the initial days of treatment to track its effectiveness.
- Dose adjustments typically shouldn't be made more frequently than every 3-4 days to allow the medication to reach steady state.
- The most recent and highest quality study available, which compared degludec to insulin glargine, found that degludec was noninferior to glargine with respect to the incidence of major cardiovascular events, and had a lower risk of severe hypoglycemia 3.
Clinical Implications
- Degludec may be a suitable option for patients with type 1 or 2 diabetes who require a basal insulin with a long duration of action and a low risk of hypoglycemia.
- The flexibility in dosing time offered by degludec may be beneficial for patients who have difficulty adhering to a strict dosing schedule.
- However, patients should be aware that degludec may take several days to reach its full effect, and should not expect immediate blood sugar reductions.