From the Guidelines
To transition from Tresiba (insulin degludec) to Lantus (insulin glargine), it is recommended to start Lantus the day after the last Tresiba dose and begin with a similar dose, potentially reduced by 10-20% to avoid hypoglycemia, while closely monitoring blood glucose levels. When transitioning between different insulin regimens, it's crucial to consider the pharmacokinetic profiles of the insulins involved, as noted in the context of transitioning intravenous to subcutaneous insulin 1. Although the provided evidence primarily discusses transitioning from intravenous to subcutaneous insulin, the principle of careful dose calculation and monitoring applies broadly.
The key considerations in transitioning from Tresiba to Lantus include:
- The duration of action of Tresiba, which is up to 42 hours, necessitating a gap after the last dose before starting Lantus.
- The potential need to adjust the dose of Lantus downward from the Tresiba dose to prevent hypoglycemia, given Lantus's shorter duration of action of about 24 hours.
- The importance of monitoring blood glucose levels frequently during the transition period to catch and manage any fluctuations promptly.
- Ensuring the patient has fast-acting carbohydrates available to treat hypoglycemia, should it occur.
Given the information from 1 about the importance of meticulous supervision and protocols for preventing and managing hypoglycemia, especially in settings involving transitions between different insulin formulations, it's clear that a careful and supervised approach to transitioning from Tresiba to Lantus is essential for minimizing risks and ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Adult patients treated with Insulin Degludec achieved levels of glycemic control similar to those achieved with LANTUS (insulin glargine 100 units/mL) and LEVEMIR (insulin detemir) and achieved statistically significant improvements compared to sitagliptin.
The FDA drug label does not provide a specific protocol for transitioning from Tresiba (insulin degludec) to Lantus (insulin glargine) [ 2 ].
From the Research
Transitioning from Tresiba to Lantus
- The provided studies do not directly address the protocol for transitioning from Tresiba (insulin degludec) to Lantus (insulin glargine) 3, 4, 5, 6, 7.
- However, studies have compared the efficacy and safety of insulin degludec and insulin glargine in patients with type 1 and type 2 diabetes 4, 6.
- One study found that insulin degludec resulted in a reduced rate of overall symptomatic hypoglycemic episodes compared to insulin glargine U100 in patients with type 2 diabetes 4.
- Another study found that insulin degludec resulted in a reduced rate of overall symptomatic hypoglycemic episodes compared to insulin glargine U100 in patients with type 1 diabetes 6.
- A study comparing Basalin (another name for insulin glargine) and Lantus found that Lantus showed lower 24h mean blood glucose, 24h mean amplitude of glycemic excursion, and lower 24h standard deviation of blood glucose than Basalin in patients with well-controlled type 2 diabetes mellitus 7.
Key Considerations
- When transitioning from one insulin regimen to another, it is essential to monitor blood glucose levels closely and adjust the dose as needed 5.
- The dose of insulin glargine should be adjusted according to the blood glucose level as part of an aggressive regimen to achieve near normoglycaemia without incurring episodes of hypoglycaemia 3.
- Insulin treatment needs to be individualized, and the choice of insulin regimen should be based on the patient's specific needs and medical history 3, 5.