How to Administer Insulin Degludec
Insulin degludec should be administered once daily by subcutaneous injection, with flexibility in timing that allows for administration at any time of day as long as there is a minimum of 8 hours between doses. 1, 2
Administration Technique
- Insulin degludec is available as a U-100 formulation (100 units/mL) and a U-200 formulation (200 units/mL), with the U-200 formulation only available in prefilled pens to minimize dosing errors 3
- Administer by subcutaneous injection into the thigh, upper arm, or abdomen 1
- Do not shake or roll the vial before use, as this may cause bubbles or foam that can lead to incorrect dosing 1
- Insulin degludec should appear clear and colorless; do not use if it appears cloudy, thick, or colored 1
- Rotate injection sites within the same region to reduce the risk of lipodystrophy (pits in skin or thickened skin) and localized cutaneous amyloidosis (skin with lumps) 1
Dosing Guidelines
- For insulin-naïve patients with type 2 diabetes, consider starting with 10 units once daily 3
- For patients transitioning from other basal insulins, the initial dose can be the same as their previous total daily basal insulin dose 3
- For patients receiving enteral or parenteral nutrition in hospital settings, insulin degludec can be dosed at 10 units daily as basal insulin 3
- Titrate the dose based on fasting blood glucose levels or continuous glucose monitoring results 3
Timing Flexibility
- Unlike other basal insulins, insulin degludec offers flexibility in dosing time due to its ultra-long action profile (terminal half-life of ~25 hours) 4, 2
- Studies have shown that insulin degludec maintains efficacy and safety even when administered at different times from day to day, with intervals between doses ranging from 8 to 40 hours 2, 5
- This flexibility may be particularly beneficial for patients with unpredictable schedules, those who travel frequently, or those who rely on healthcare professionals for insulin administration 4, 2
Special Considerations
- For perioperative management, administer 60-80% of the usual insulin degludec dose the day before surgery 3
- During fasting periods (such as Ramadan), insulin degludec can be taken at the time of the main meal with no need to change timing for longer-acting formulations 3
- When adding prandial insulin to a regimen with insulin degludec, consider starting with 4 units or 10% of the basal insulin dose at the largest meal of the day 3
- If significant additions to prandial insulin doses are made, particularly with the evening meal, consider decreasing the basal insulin degludec dose to reduce hypoglycemia risk 3
Storage and Handling
- Store unopened insulin degludec vials in the refrigerator at 36°F to 46°F (2°C to 8°C) in the original carton to protect from light 1
- Once opened, insulin degludec can be used for up to 56 days (8 weeks) if stored at room temperature or in the refrigerator 1
- Do not dilute or mix insulin degludec with any other type of insulin or solutions 1
Advantages Over Other Basal Insulins
- Insulin degludec has been shown to have a lower risk of nocturnal hypoglycemia compared to insulin glargine 6, 7
- Its ultra-long duration of action allows for once-daily dosing with a more stable glucose-lowering effect 4, 5
- The flexible dosing schedule may improve adherence in patients who find rigid insulin scheduling challenging 2
Common Pitfalls to Avoid
- Do not administer insulin degludec intravenously or intramuscularly; it is designed for subcutaneous use only 1
- Avoid recapping needles after injection to prevent needlestick injuries 1
- Do not use insulin degludec past the expiration date or beyond 56 days after first use 1
- Be aware that U-200 formulations are more concentrated and require specific pens; they are not interchangeable with U-100 syringes 3
By following these guidelines, patients can effectively and safely use insulin degludec to manage their diabetes while potentially benefiting from its unique pharmacokinetic profile that allows for flexible dosing.