Initial Dosing of Insulin Degludec for Hyperglycemia
The recommended starting dose of insulin degludec for insulin-naïve patients with type 2 diabetes is 10 units once daily. 1
Dosing Guidelines for Insulin Degludec
Initial Dosing
- For insulin-naïve patients with type 2 diabetes, start with 10 units once daily 1
- For patients with type 1 diabetes, the starting dose should be approximately one-third to one-half of the total daily insulin dose, with the remainder administered as short-acting insulin divided between meals 1
- For patients with type 1 diabetes who are insulin-naïve, a general calculation of 0.2 to 0.4 units per kilogram of body weight can be used to determine the initial total daily insulin dose 1
Switching from Other Insulin Therapies
- For adults switching from other long or intermediate-acting insulin: start insulin degludec at the same unit dose as the previous total daily long or intermediate-acting insulin 1
- For pediatric patients (1 year and older): start at 80% of the previous total daily long or intermediate-acting insulin dose to minimize hypoglycemia risk 1
Administration and Titration
- Insulin degludec can be administered once daily at any time of day for adults 1
- For pediatric patients, it should be administered at the same time every day 1
- Dose adjustments should be made based on individual metabolic needs, blood glucose monitoring results, and glycemic control goals 2
- The recommended interval between dose increases is 3-4 days 1
- Insulin degludec has a half-life exceeding 25 hours and duration of action >42 hours, providing stable blood glucose-lowering effect 3, 4
Special Considerations
- Dose adjustments may be needed with changes in physical activity, meal patterns, renal or hepatic function, or during acute illness 1
- For patients requiring high doses of insulin (>0.5 units/kg/day) with A1C still above target, consider advancing to combination injectable therapy with GLP-1 receptor agonists or multiple insulin doses 2
- The FlexTouch pen delivers doses in 2-unit increments and can deliver up to 160 units in a single injection 1
- A concentrated formulation (200 units/mL) is available for patients requiring larger doses, providing the same dose in half the injection volume 4, 5
Monitoring and Adjustment
- Close blood glucose monitoring is essential when initiating insulin therapy 2
- Titrate the dose based on fasting plasma glucose levels, targeting individualized goals 6
- If a patient misses a dose, they should inject their daily dose upon discovering the missed dose, ensuring at least 8 hours between consecutive injections 1
Advantages of Insulin Degludec
- Insulin degludec has a very long duration of action with a near-constant effect and little variation between injections 3
- It carries a lower risk of nocturnal hypoglycemia compared to insulin glargine 3, 4
- The stable profile allows for some flexibility in dosing time when needed 4
- In clinical trials, insulin degludec 200 units/mL improved glycemic control similarly to insulin glargine with a low risk of hypoglycemia 7
By following these guidelines for insulin degludec initiation and titration, clinicians can effectively manage hyperglycemia while minimizing the risk of hypoglycemia in patients requiring basal insulin therapy.