Tresiba (Insulin Degludec) Dosing Frequency
Tresiba (insulin degludec) is designed for once-daily administration, not twice-daily (BID) dosing for most patients. 1
Pharmacokinetic Profile Supporting Once-Daily Dosing
Insulin degludec (Tresiba) has unique pharmacokinetic properties that distinguish it from other basal insulins:
- Ultra-long duration of action with a half-life exceeding 25 hours 2
- Steady-state profile characterized by near-constant effect 2
- Continuous and highly predictable slow dissociation of insulin monomers from subcutaneous depot 3
- Duration of action approximately double that of insulin glargine 3
Clinical Guidelines on Tresiba Administration
The American Diabetes Association and Endocrine Society guidelines support once-daily dosing of Tresiba:
- Tresiba provides relatively constant insulin levels over approximately 24 hours 1
- Primary action is to restrain hepatic glucose production and limit hyperglycemia between meals and overnight 1
- Morning administration results in steady basal insulin levels throughout the day and night 1
Special Circumstances for Twice-Daily Dosing
While once-daily dosing is standard, there are specific situations where twice-daily dosing might be considered:
- For patients with type 1 diabetes, insulin glargine and potentially degludec may require twice-daily dosing in some cases 1
- If 24-hour coverage isn't achieved with once-daily dosing, splitting the total daily dose may be considered 1
Adjusting Tresiba Dosage
When adjusting Tresiba dosage:
- Make small incremental changes (1-2 units or 5-10% of current dose) 1
- Monitor overnight patterns by checking blood glucose at bedtime, 3 AM, and upon waking 1
- Reduce the dose if any hypoglycemia occurs 1
- Be cautious with doses exceeding 0.5 units/kg/day due to increased risk of nocturnal hypoglycemia 1
Insulin Degludec/Insulin Aspart (IDegAsp) Formulation
It's important to note that there is a separate formulation called IDegAsp (insulin degludec/insulin aspart), which combines degludec with rapid-acting insulin aspart:
- IDegAsp is administered once or twice daily with main meal(s) 4
- This is different from Tresiba alone, which is the pure degludec formulation
Common Pitfalls to Avoid
- Don't confuse Tresiba (insulin degludec) with IDegAsp (insulin degludec/insulin aspart combination)
- Avoid overbasalization with insulin therapy (doses >0.5 units/kg/day) which can lead to hypoglycemia 5
- Don't make large dose adjustments; incremental changes are safer 1
- Remember that irregular timing of injections has relatively little pharmacodynamic influence with Tresiba due to its consistent steady-state profile 2
In summary, Tresiba (insulin degludec) should be administered once daily for most patients, with twice-daily dosing reserved for specific situations where 24-hour coverage cannot be achieved with a single dose.