What are the guidelines for increasing the dose of Tresiba (insulin degludec)?

Guidelines for Increasing Tresiba (Insulin Degludec) Dose

The recommended approach for titrating Tresiba (insulin degludec) is to increase the dose by 2 units every 3-4 days until target fasting glucose levels are achieved, while monitoring for hypoglycemia. 1

Initial Dosing Considerations

• For insulin-naïve patients with type 2 diabetes: Start with 10 units once daily 2
• For insulin-naïve patients with type 1 diabetes: Start with approximately one-third to one-half of the total daily insulin dose 2
• For patients switching from other long-acting insulins:
  • Adults: Start at the same unit dose as the previous long/intermediate-acting insulin 2
  • Pediatric patients: Start at 80% of the previous long/intermediate-acting insulin dose 2

Dose Titration Protocol

Standard Titration Approach

• Adjust dose every 3-4 days based on fasting blood glucose (FBG) patterns 1
• Target fasting glucose range: 90-150 mg/dL (or individualized target) 1
• Dose adjustment algorithm:
  • If 50% of FBG readings are above target: Increase by 2 units 1
  • If FBG is consistently <80 mg/dL or any hypoglycemia occurs: Decrease by 2 units or 10-20% 1

More Detailed Titration Based on Glucose Patterns

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

Important Clinical Considerations

Monitoring

• Check blood glucose regularly, particularly during dose adjustments
• Assess adequacy of insulin dose at every visit 1
• Watch for clinical signs of overbasalization:
  • Elevated bedtime-to-morning glucose differential
  • Hypoglycemia (aware or unaware)
  • High glucose variability 1

Safety Precautions

• Never transfer Tresiba from the FlexTouch pen into a syringe 2
• Be aware that Tresiba comes in two concentrations (U-100 and U-200) 2
• Rotate injection sites within the same region to reduce risk of lipodystrophy 2
• For adults, missed doses can be taken upon discovery, ensuring at least 8 hours between consecutive injections 2
• For pediatric patients who miss a dose, contact healthcare provider for guidance 2

Special Populations

• For older adults, consider simplifying insulin regimens:
  • If on complex insulin therapy, consider changing timing from bedtime to morning 1
  • For premixed insulin, consider using 70% of total dose as basal only in the morning 1

Hypoglycemia Management

• If hypoglycemia occurs, determine the cause
• If no clear reason is identified, reduce the dose by 10-20% 1
• For severe hypoglycemia, stop insulin and administer glucose immediately

Practical Tips

• Tresiba has an ultra-long duration of action (>42 hours) with less day-to-day variability compared to other long-acting insulins 3, 4
• Due to its stable profile, Tresiba allows for some flexibility in dosing time, though maintaining consistency is still recommended 3
• Dose adjustments may be needed with changes in physical activity, meal patterns, renal/hepatic function, or during acute illness 2

By following this systematic approach to Tresiba dose titration, you can effectively optimize glycemic control while minimizing the risk of hypoglycemia.