Blood Glucose Threshold for Ryzodeg Administration
The blood glucose level should be at least 70 mg/dL (3.9 mmol/L) before administering Ryzodeg (insulin degludec). This threshold is based on established guidelines for hypoglycemia management and insulin administration.
Rationale for the 70 mg/dL (3.9 mmol/L) Threshold
- Hypoglycemia is clinically defined as any blood glucose level <70 mg/dL (3.9 mmol/L), which represents the initial threshold for counterregulatory hormone release 1
- Level 1 hypoglycemia is classified as glucose <70 mg/dL (3.9 mmol/L) and ≥54 mg/dL (3.0 mmol/L) 1
- Administering insulin when blood glucose is below this threshold increases the risk of severe hypoglycemia 1
Hypoglycemia Risk Considerations
- Insulin administration at blood glucose levels <70 mg/dL (3.9 mmol/L) significantly increases the risk of developing more severe hypoglycemia 1
- Level 2 hypoglycemia (<54 mg/dL or 3.0 mmol/L) is the threshold at which neuroglycopenic symptoms begin to occur 1
- Level 3 hypoglycemia is characterized by altered mental and/or physical status requiring assistance 1
- Severe hypoglycemia can lead to significant morbidity including cognitive impairment, seizures, coma, and in rare cases, mortality 1
Blood Glucose Monitoring Before Insulin Administration
- Before administering Ryzodeg, blood glucose should be checked to ensure it is ≥70 mg/dL (3.9 mmol/L) 1
- If blood glucose is <70 mg/dL (3.9 mmol/L), hypoglycemia should be treated first before insulin administration 1
- For patients with blood glucose <70 mg/dL (3.9 mmol/L), treatment with 15-20g of glucose is recommended, followed by reassessment in 15 minutes 1
Special Considerations
- For hospitalized patients, insulin regimens should be reassessed if blood glucose falls below 100 mg/dL (5.6 mmol/L) to prevent hypoglycemia 1
- Modification of insulin regimen is required when blood glucose values are <70 mg/dL (3.9 mmol/L) unless the event is easily explained by other factors (such as a missed meal) 1
- Patients with a history of hypoglycemia unawareness may require higher glucose thresholds before insulin administration 1
Clinical Pitfalls to Avoid
- Never administer insulin when blood glucose is already in the hypoglycemic range (<70 mg/dL or 3.9 mmol/L) 1
- Avoid relying solely on symptoms to determine if a patient is hypoglycemic; always confirm with blood glucose measurement 1
- Be aware that insulin degludec (component of Ryzodeg) has a long duration of action, so hypoglycemia may be prolonged if it occurs 2
- Remember that the risk of hypoglycemia is higher in patients with renal impairment, liver disease, and the elderly 1