What is the recommended usage and dosing of Tresiba (insulin degludec) for patients with type 1 or type 2 diabetes?

Tresiba (Insulin Degludec) Usage and Dosing for Diabetes

Tresiba (insulin degludec) is recommended as a once-daily basal insulin for patients with type 1 or type 2 diabetes, with dosing based on patient-specific factors and titrated according to blood glucose monitoring results. 1

Dosing Recommendations

Type 1 Diabetes

• Starting dose: Approximately one-third to one-half of the total daily insulin dose
• Remainder should be administered as short-acting insulin divided between meals
• Initial calculation: 0.2 to 0.4 units/kg/day of total insulin 1
• Must be used with prandial insulin 1

Type 2 Diabetes

• Starting dose for insulin-naïve patients: 10 units once daily 1
• For patients switching from other basal insulins:
  • Adults: Same unit dose as previous total daily long/intermediate-acting insulin 1
  • Children (≥1 year): 80% of previous total daily long/intermediate-acting insulin dose 1

Administration Guidelines

• Administer subcutaneously once daily
• Adults: Can be administered at any time of day 1
• Children: Should be administered at the same time every day 1
• Available in two concentrations:
  • U-100: FlexTouch pen (delivers up to 80 units per injection in 1-unit increments) and vial
  • U-200: FlexTouch pen (delivers up to 160 units per injection in 2-unit increments) 1
• For pediatric patients requiring <5 units daily, use U-100 vial 1

Dose Titration

• Individualize and titrate based on:
  • Metabolic needs
  • Blood glucose monitoring results
  • Glycemic control goals 1
• Recommended interval between dose increases: 3-4 days 1
• Dose adjustments may be needed with changes in:
  • Physical activity
  • Meal patterns
  • Renal or hepatic function
  • During acute illness 1

Missed Dose Management

• Adults: Inject during waking hours upon discovering the missed dose, ensuring at least 8 hours between consecutive injections 1
• Children: Contact healthcare provider for guidance and monitor blood glucose more frequently 1

Clinical Advantages

Insulin degludec offers several advantages over other basal insulins:

• Ultra-long duration of action (>42 hours) 2
• Lower risk of nocturnal hypoglycemia compared to insulin glargine 3, 4
• Less day-to-day variability in glucose-lowering effect 2
• Potential for flexible dosing schedule when necessary 5

Safety Considerations

• Never share pens, needles, or syringes between patients 1
• Do not administer intravenously or in an insulin infusion pump 1
• Do not dilute or mix with other insulins or solutions 1
• Do not transfer from FlexTouch pen into a syringe 1
• Contraindicated during episodes of hypoglycemia 1
• Use with caution in patients with visual impairment 1

Special Populations

• In patients with frequent severe hypoglycemia on human insulin, long-acting insulin analogs like degludec may be beneficial 6
• The World Health Organization recommends human insulin as first-line insulin therapy due to cost considerations, but acknowledges the benefit of long-acting analogs like degludec for patients with frequent severe hypoglycemia 6

Common Pitfalls to Avoid

1. Overbasalization: Watch for clinical signals such as:

   • Basal dose >0.5 units/kg
   • High bedtime-morning glucose differential
   • Hypoglycemia
   • High glucose variability 6, 7

2. Injection technique issues: Ensure proper rotation of injection sites to prevent lipohypertrophy, which can lead to erratic insulin absorption 7

3. Medication confusion: Be aware that the U-200 concentration delivers in 2-unit increments, which differs from most other insulins 1

4. Inadequate monitoring: Regular blood glucose monitoring is essential during dose titration 7

By following these recommendations, Tresiba can be effectively used to manage blood glucose levels in patients with type 1 or type 2 diabetes while minimizing the risk of hypoglycemia.