Can a patient increase Tresiba (insulin degludec) by 2 units if blood glucose levels are elevated for 3-4 days?

Adjusting Tresiba (Insulin Degludec) Based on Blood Glucose Readings

Yes, patients can increase their Tresiba dose by 2 units if blood glucose levels remain elevated for 3-4 consecutive days, following evidence-based titration guidelines. 1

Proper Titration of Tresiba

Standard Titration Protocol

• Initial starting dose for insulin-naïve patients with Type 2 diabetes: 10 units once daily 2
• Titration algorithm: Increase by 2 units every 3-4 days until fasting glucose target is reached 1
• Adjust doses based on blood glucose patterns, with 3-4 days between increases to allow for steady state 1

Important Considerations When Adjusting Tresiba

1. Pharmacokinetic Profile:

   • Ultra-long-acting insulin with duration >42 hours 3
   • Requires at least 3-4 days to reach steady state 1
   • More stable glucose-lowering profile compared to other basal insulins 3

2. Safety Precautions:

   • If hypoglycemia occurs with no clear reason, reduce dose by 10-20% 1
   • Monitor for signs of overbasalization (basal dose >0.5 units/kg/day, hypoglycemia, high variability) 1
   • Increase frequency of blood glucose monitoring during dose adjustments 2

Patient Self-Titration Guidelines

When to Increase Dose

• If fasting blood glucose remains above target for 3-4 consecutive days 1
• No hypoglycemic episodes during this period
• Patient should ensure at least 8 hours between consecutive Tresiba injections 2

When to Decrease or Hold Dose

• If any hypoglycemia occurs (blood glucose <70 mg/dL or 3.9 mmol/L) 1
• If experiencing symptoms of hypoglycemia even with normal readings
• If significant changes in physical activity, meal patterns, or during acute illness 2

Documentation and Monitoring

• Patients should keep a log of:
  • Daily blood glucose readings
  • Insulin doses administered
  • Any hypoglycemic episodes
  • Changes in diet or activity

Special Situations

For Elderly Patients

• More cautious titration may be needed
• Consider alert strategy: call provider immediately for blood glucose <70 mg/dL 1

For Patients on Multiple Daily Injections

• When adding prandial insulin, consider reducing the basal insulin dose by 4 units or 10% 1
• Total daily insulin dose typically ranges from 0.5-1.0 units/kg/day 4

Common Pitfalls to Avoid

1. Adjusting too quickly: Tresiba has a longer half-life than other insulins and requires 3-4 days to reach steady state 1

2. Ignoring patterns: Decisions should be based on multiple days of readings, not single high values

3. Failure to consider other factors: Changes in diet, exercise, stress, or illness can affect insulin requirements 2

4. Dose stacking: Due to Tresiba's long duration of action, frequent dose increases can lead to accumulation and delayed hypoglycemia

By following these structured guidelines for self-titration of Tresiba, patients can safely adjust their insulin doses to achieve optimal glycemic control while minimizing the risk of hypoglycemia.