How to treat hypoglycemia with Insulin Icodec (insulin icodec)?

Treatment of Hypoglycemia with Insulin Icodec

For patients experiencing hypoglycemia while on insulin icodec, the standard treatment approach should be followed with 15-20g of fast-acting carbohydrates, preferably pure glucose, followed by blood glucose rechecking after 15 minutes. 1, 2

Immediate Management of Hypoglycemia

• Treat hypoglycemia (blood glucose ≤70 mg/dL or 3.9 mmol/L) with 15-20g of fast-acting carbohydrates, preferably pure glucose 1, 3
• Recheck blood glucose 15 minutes after treatment; if hypoglycemia persists, repeat the treatment 1, 2
• Once blood glucose normalizes, the patient should consume a meal or snack to prevent recurrence of hypoglycemia 1
• Pure glucose is the preferred treatment as it raises blood glucose more effectively than equivalent amounts of other carbohydrates 1, 4

Special Considerations for Insulin Icodec

• For patients using automated insulin delivery systems, a smaller amount (5-10g) of carbohydrates may be appropriate unless hypoglycemia is associated with exercise or significant meal bolus overestimation 1, 3
• Due to the ultra-long-acting nature of insulin icodec, patients may be at higher risk for recurrent hypoglycemia and should be monitored more closely after initial treatment 2
• After initial treatment and normalization of blood glucose, consider consuming additional carbohydrates to prevent recurrent hypoglycemia due to the continued action of insulin icodec 1, 2

Treatment Options by Effectiveness

• Glucose tablets or solution are the most effective treatment options 3, 5
• Any carbohydrate-containing food that contains glucose can be used, but the glycemic response correlates better with glucose content than with total carbohydrate content 1, 4
• Avoid carbohydrate sources high in protein as they may increase insulin secretion without adequately raising glucose 1, 2
• Adding fat may slow and then prolong the acute glycemic response, which may be beneficial in the context of long-acting insulin icodec 1

Severe Hypoglycemia Management

• For severe hypoglycemia (altered mental status, unconsciousness, or inability to consume oral carbohydrates), administer glucagon 1, 2
• Intranasal and ready-to-inject glucagon preparations are preferred due to ease of administration and faster correction of hypoglycemia 1, 2
• All individuals treated with insulin icodec should be prescribed glucagon, and those in close contact should be instructed on its use 1
• After severe hypoglycemia, evaluate the need for medication adjustments to prevent future episodes 2, 6

Prevention of Recurrent Hypoglycemia

• Identify and address risk factors for hypoglycemia through regular assessment 2, 7
• For patients with recurrent hypoglycemia or hypoglycemia unawareness, consider temporarily raising glycemic targets 1, 2
• Ensure patients have access to glucose-containing foods or glucose tablets at all times 2, 3
• Consider more frequent blood glucose monitoring or continuous glucose monitoring for patients on insulin icodec to detect and prevent hypoglycemic episodes 2, 6

Follow-up After Hypoglycemic Episodes

• Document all hypoglycemic episodes and review patterns to adjust insulin icodec dosing if needed 2, 7
• Provide structured education on hypoglycemia prevention, recognition, and treatment 1, 2
• For patients with impaired hypoglycemia awareness, more vigilant monitoring and preventive strategies are essential 1, 2
• If hypoglycemia occurs frequently with insulin icodec, consider alternative insulin regimens with shorter duration of action 7, 6