What is the typical starting dose and titration schedule for Tresiba (insulin degludec)?

Tresiba (Insulin Degludec) Dosing and Titration

The recommended starting dose of Tresiba (insulin degludec) for insulin-naïve patients with type 2 diabetes is 10 units once daily, with dose adjustments recommended every 3-4 days based on blood glucose monitoring. 1

Starting Dose Recommendations

For Type 2 Diabetes:

• Insulin-naïve patients: 10 units once daily 1
• Switching from other basal insulins (adults): Start at the same unit dose as the previous total daily long or intermediate-acting insulin 1
• Switching from other basal insulins (pediatric patients): Start at 80% of the previous total daily long or intermediate-acting insulin dose to minimize hypoglycemia risk 1

For Type 1 Diabetes:

• Insulin-naïve patients: Approximately one-third to one-half of the total daily insulin dose, with the remainder administered as short-acting insulin divided between meals 1
• As a general rule, 0.2 to 0.4 units of insulin per kilogram of body weight can be used to calculate the initial total daily insulin dose 1

Administration Guidelines

• Inject subcutaneously into the thigh, upper arm, or abdomen 1
• Can be administered at any time of day in adults, but should be given at the same time every day in pediatric patients 1
• Rotate injection sites within the same region to reduce the risk of lipodystrophy 1
• Available in two concentrations:
  • U-100 (delivers doses in 1-unit increments, up to 80 units per injection)
  • U-200 (delivers doses in 2-unit increments, up to 160 units per injection) 1

Dose Titration Schedule

The recommended titration schedule for Tresiba is to adjust doses every 3-4 days based on blood glucose monitoring results 1. A practical approach to dose adjustment:

• Fasting glucose ≥180 mg/dL: Increase by 6-8 units
• Fasting glucose 140-179 mg/dL: Increase by 4 units
• Fasting glucose 120-139 mg/dL: Increase by 2 units
• Fasting glucose 100-119 mg/dL: Maintain or increase by 0-2 units
• Fasting glucose <100 mg/dL: Decrease by 2-4 units
• Any hypoglycemia (<70 mg/dL): Decrease by 10-20% 2

Special Considerations

• Insulin degludec has an ultra-long duration of action (>42 hours) and a stable glucose-lowering profile 3
• Due to its long half-life (17-21 hours), Tresiba offers flexibility in dosing time for adult patients 4
• For adult patients who miss a dose, instruct them to inject their daily dose during waking hours upon discovering the missed dose, ensuring at least 8 hours between consecutive injections 1
• For pediatric patients who miss a dose, they should contact their healthcare provider for guidance and monitor blood glucose levels more frequently until the next scheduled dose 1
• Dose adjustments may be needed with changes in physical activity, meal patterns, renal or hepatic function, or during acute illness 1

Monitoring and Safety

• Increase frequency of blood glucose monitoring during dose adjustments or changes to insulin regimen 1
• Tresiba has shown similar glycemic control to insulin glargine but with potentially lower risk of nocturnal hypoglycemia in clinical trials 5
• In patients with type 1 diabetes, Tresiba must always be used concomitantly with short-acting insulin 1

Important Precautions

• Do not administer intravenously or in an insulin infusion pump
• Do not dilute or mix with any other insulin or solution
• Do not transfer from the FlexTouch pen into a syringe for administration 1
• For pediatric patients requiring less than 5 units daily, use the U-100 vial 1

Tresiba's ultra-long action profile and stable glucose-lowering effect make it a valuable option for basal insulin therapy, with the potential benefit of reduced nocturnal hypoglycemia compared to other basal insulins 3, 5.