From the Guidelines
Switching from Lantus (insulin glargine) to Tresiba (insulin degludec) can be done with a 1:1 unit conversion, but should be done under medical supervision, taking into account individual patient factors and blood glucose monitoring results 1. When considering the switch, it's essential to note that Tresiba has a longer duration of action compared to Lantus, which can provide more stable blood glucose levels and less day-to-day variability.
- Key considerations for switching include:
- Monitoring blood glucose levels more frequently during the first week of transition to adjust for individual responses
- Allowing 2-3 days to reach steady state with Tresiba due to its longer half-life
- Making dose adjustments no more frequently than every 3-4 days
- Being aware of the potential for fewer episodes of hypoglycemia with Tresiba
- Considering the flexibility in dosing times with Tresiba, which can be taken at different times each day as long as there's at least 8 hours between doses. The decision to switch should prioritize the patient's overall glycemic control, risk of hypoglycemia, and quality of life, with the goal of achieving optimal blood glucose management and minimizing adverse effects 1.
From the FDA Drug Label
• Dosage adjustments are recommended to lower the risk of hypoglycemia when switching patients to Insulin Degludec from another insulin therapy [see Warnings and Precautions (5. 3)]. Adults withType 1 or Type 2 Diabetes Mellitus: Start Insulin Degludec at the same unit dose as the total daily long or intermediate-acting insulin unit dose Pediatric Patients 1 Year of Age and Older with Type 1 or Type 2 Diabetes Mellitus: Start Insulin Degludec at 80% of the total daily long or intermediate-acting insulin unit dose to minimize the risk of hypoglycemia [see Warnings and Precautions (5.2)].
When switching from Lantus (insulin glargine) to Tresiba (insulin degludec), dosage adjustments are recommended to lower the risk of hypoglycemia.
- For adults, start Insulin Degludec at the same unit dose as the total daily long or intermediate-acting insulin unit dose.
- For pediatric patients 1 year of age and older, start Insulin Degludec at 80% of the total daily long or intermediate-acting insulin unit dose to minimize the risk of hypoglycemia 2.
From the Research
Considerations for Switching from Lantus to Tresiba
- The decision to switch from Lantus (insulin glargine) to Tresiba (insulin degludec) should be based on individual patient needs and characteristics, as both insulins have similar efficacy in achieving glycemic control 3.
- Insulin degludec has been shown to have a lower risk of hypoglycemia, particularly nocturnal hypoglycemia, compared to insulin glargine 3.
- Patients who may benefit from switching to insulin degludec include those who experience hypoglycemia, particularly at night, while on insulin glargine 3.
- The switch from premixed insulin to insulin glargine plus oral antidiabetic drugs has been shown to be beneficial for patients with type 2 diabetes who are younger, have a shorter duration of diabetes, and lower baseline HbA1c and FPG levels 4.
- When switching between basal insulin analogues, the dosing may not be unit-per-unit, and a higher dose of one insulin may be required to achieve the same glycemic control as another 5.
- The safety and efficacy of insulin glargine have been shown to be similar in patients with type 2 diabetes aged 65 years and older compared to those under 65 years 6.