Tresiba (Insulin Degludec) Dosing Regimen for Diabetes Mellitus
Insulin degludec (Tresiba) should be initiated at 10 units once daily or 0.1-0.2 units/kg of body weight in insulin-naïve patients with type 2 diabetes, and at approximately one-third to one-half of the total daily insulin dose in patients with type 1 diabetes. 1
Dosing Recommendations by Diabetes Type
Type 1 Diabetes
- Initial dose: One-third to one-half of total daily insulin dose as insulin degludec
- Remaining insulin: Administer as short-acting insulin divided between meals 1
- For insulin-naïve patients: Calculate initial total daily dose as 0.2-0.4 units/kg body weight 1
- Must be used with prandial insulin 1
- For pediatric patients switching from other basal insulins: Start at 80% of previous total daily long/intermediate-acting insulin dose 1
Type 2 Diabetes
- Initial dose: 10 units once daily in insulin-naïve patients 1
- For patients switching from other basal insulins: Start at same unit dose as previous total daily long/intermediate-acting insulin 1
- Can be used alone or in combination with:
Administration Guidelines
- Administer subcutaneously once daily
- Adults: Can inject at any time of day 1
- Pediatric patients: Administer at the same time every day 1
- Available in two concentrations:
- U-100 (100 units/mL): Available as FlexTouch pen (delivers in 1-unit increments, up to 80 units per injection) and multiple-dose vial
- U-200 (200 units/mL): Available as FlexTouch pen (delivers in 2-unit increments, up to 160 units per injection) 1
- Do NOT:
- Administer intravenously
- Use in insulin infusion pumps
- Dilute or mix with other insulins
- Transfer from pen to syringe 1
Dose Titration and Adjustment
- Recommended interval between dose adjustments: 3-4 days 1
- Adjust dose based on:
- Blood glucose monitoring results
- Metabolic needs
- Glycemic control goals 1
- Consider dose adjustments with changes in:
- Physical activity
- Meal patterns
- Renal/hepatic function
- During acute illness 1
Missed Dose Management
- Adults: Inject daily dose upon discovery of missed dose, ensuring at least 8 hours between consecutive injections 1
- Pediatric patients: Contact healthcare provider for guidance and monitor blood glucose more frequently until next scheduled dose 1
Special Considerations
Hypoglycemia Risk Management
- Lower risk of nocturnal hypoglycemia compared to insulin glargine 4, 3, 5
- When switching from other basal insulins, consider:
Flexible Dosing Option
- Ultra-long duration of action (>42 hours) allows for flexible dosing in adults 4, 3
- Studies show potential for adjusting injection time without compromising glycemic control or safety 4
Hospitalized Patients
- For hospitalized patients with persistent hyperglycemia (>180 mg/dL), consider intravenous insulin infusion initially, targeting 140-180 mg/dL 2
- When transitioning from IV to subcutaneous insulin:
- Give first subcutaneous dose 1-2 hours before discontinuing IV drip
- Calculate total daily insulin requirement based on average hourly rate over previous 6-8 hours 2
Clinical Advantages
- Ultra-long-acting profile with duration >42 hours 4, 3
- Less within-patient day-to-day variability in glucose-lowering effect compared to insulin glargine 4
- Lower rates of overall, nocturnal, and severe hypoglycemia when switching from other basal insulins 5
- Improved treatment satisfaction reported by patients 5
Cautions and Contraindications
- Contraindicated during episodes of hypoglycemia 1
- Contraindicated in patients with hypersensitivity to insulin degludec or excipients 1
- Never share pens, needles, or syringes between patients 1
- Use with caution in patients with visual impairment who rely on audible clicks to dial their dose 1
- For pediatric patients requiring less than 5 units daily, use the U-100 vial 1
By following these evidence-based recommendations for insulin degludec initiation and titration, clinicians can effectively manage hyperglycemia while minimizing the risk of hypoglycemia in patients with type 1 and type 2 diabetes.