What is the appropriate dosage and administration frequency for 40 units of insulin?

Insulin Therapy for Tresiba 40 Units

For patients requiring 40 units of Tresiba (insulin degludec), the appropriate dosage is 40 units administered once daily at the same time each day by subcutaneous injection.

Dosage and Administration Guidelines

Administration Schedule

• Tresiba 40 units should be administered once daily at the same time each day
• The timing can be flexible if needed, but should maintain at least 8 hours between doses
• Injection sites should be rotated within the same region (thigh, abdominal wall, or upper arm) to prevent lipodystrophy 1

Dose Adjustment

• The initial dose for insulin-naïve patients with type 2 diabetes is typically 10 units once daily or 0.1-0.2 units/kg/day 1, 2
• For patients already on insulin therapy, switching to Tresiba can often be done on a unit-to-unit basis 2
• Dose should be adjusted every 3-4 days based on fasting blood glucose readings:
  • Increase by 2 units if fasting glucose is 120-139 mg/dL
  • Increase by 4 units if fasting glucose is 140-179 mg/dL
  • Increase by 6-8 units if fasting glucose is ≥180 mg/dL 1
  • Reduce dose by 10-20% if hypoglycemia occurs 1

Monitoring and Follow-up

Blood Glucose Monitoring

• Regular self-monitoring of blood glucose is essential for patients on 40 units of Tresiba
• Target fasting blood glucose range: 80-130 mg/dL 1
• HbA1c should be evaluated every 3 months to assess overall glycemic control 1
• Signs of "overbasalization" should be monitored, including hypoglycemia (especially nocturnal) or high glucose variability 1

Hypoglycemia Prevention

• Patients should be educated on hypoglycemia recognition and management
• Hypoglycemia risk is highest between midnight and 6:00 A.M. 3
• Patients should always carry a source of quick-acting carbohydrates 1
• Exercise may increase hypoglycemia risk and require dose adjustments 1

Special Considerations

Meal Planning and Nutrition

• Consistent carbohydrate meal plans are preferred to facilitate matching insulin to carbohydrate intake 3
• Coordination between meal delivery and insulin administration is critical to prevent hyperglycemic and hypoglycemic events 3

Combination Therapy

• For patients with type 2 diabetes on 40 units of Tresiba:
  • Continue oral antidiabetic medications, particularly metformin 1
  • Consider adding GLP-1 receptor agonist before initiating prandial insulin if HbA1c remains above target 1
  • Consider SGLT2 inhibitors as complementary therapy to improve glucose control and reduce insulin requirements 1

Prandial Insulin Addition

• If HbA1c remains above target despite optimization of basal insulin at 40 units:
  • Start prandial insulin at the largest meal with an initial dose of 4 units or 10% of the basal dose 1
  • Increase prandial insulin by 1-2 units or 10-15% every 3-4 days as needed 1
  • Progress to multiple daily injections if needed for better glycemic control 1

Common Pitfalls to Avoid

1. Inappropriate Dose Timing: Administering Tresiba at inconsistent times can lead to unpredictable glycemic control
2. Failure to Rotate Injection Sites: Can lead to lipodystrophy and variable insulin absorption
3. Inadequate Monitoring: Not adjusting doses based on blood glucose patterns
4. Ignoring Hypoglycemia: Not reducing dose after hypoglycemic episodes
5. Overbasalization: Continuing to increase basal insulin beyond 0.5 units/kg/day without considering prandial coverage 1

By following these guidelines for administering 40 units of Tresiba, patients can achieve optimal glycemic control while minimizing the risk of adverse events.