From the Guidelines
To calculate the Tresiba insulin dose based on subcutaneous insulin scale doses, you should total the daily insulin requirements from your sliding scale and convert 80-90% of this amount to Tresiba, then adjust gradually based on blood glucose monitoring, increasing the dose by 1–2 units or 10–15% twice weekly as needed 1. When transitioning from a sliding scale to Tresiba, it's essential to start conservatively and adjust gradually to avoid hypoglycemia. Tresiba is a long-acting basal insulin that works for over 42 hours with a steady, peakless profile, making it ideal for providing background insulin coverage. Some key points to consider when calculating the Tresiba dose include:
- Total daily insulin requirements from the sliding scale
- Converting 80-90% of this amount to Tresiba
- Adjusting the dose based on blood glucose monitoring
- Increasing the dose by 1–2 units or 10–15% twice weekly as needed 1
- Continuing some rapid-acting insulin for mealtime coverage and correction doses as needed Regular monitoring is essential during this transition period to avoid hypoglycemia, as Tresiba's effects last significantly longer than rapid-acting insulins used in sliding scales. It's also important to note that the sole use of sliding-scale insulin in the inpatient hospital setting is strongly discouraged, and a basal-plus-correction insulin regimen is preferred for patients with poor oral intake or those who are receiving nothing by mouth 1.
From the Research
Calculating the Dose of Tresiba (Insulin Degludec)
To calculate the dose of Tresiba (insulin degludec) based on the doses received via a subcutaneous insulin scale, consider the following points:
- Insulin degludec has a flat, stable glucose-lowering profile with a duration of action of >42 hours 2.
- The dose of insulin degludec can be adjusted based on the patient's glucose levels and insulin requirements 3, 4.
- A 200 U/mL formulation of insulin degludec is available for use in patients who require large volumes of basal insulin 2.
- Clinical trials have shown that insulin degludec can be administered once daily, with a broad dosing window, allowing for flexible dose administration if required 4.
Factors to Consider When Calculating the Dose
When calculating the dose of insulin degludec, consider the following factors:
- The patient's current glucose levels and insulin requirements 5, 6.
- The patient's previous response to insulin therapy 5.
- The presence of any factors that may affect insulin absorption or glucose levels, such as meal times or physical activity 3, 4.
Dosing Regimens
Different dosing regimens for insulin degludec have been studied, including: