What is the recommended usage and dosage of Tresiba (insulin degludec) for patients with diabetes mellitus type 1 or 2?

Tresiba (Insulin Degludec) Dosing and Administration

Recommended Starting Doses

For insulin-naïve patients with type 2 diabetes, start Tresiba at 10 units once daily; for type 1 diabetes, start at approximately one-third to one-half of the total daily insulin requirement (with the remainder as rapid-acting insulin at meals), using 0.2-0.4 units/kg/day as the initial total daily dose calculation. 1

Type 2 Diabetes Mellitus

• Initial dose: 10 units subcutaneously once daily 1
• Administer at any time of day in adults, though consistency is preferred 1
• Typically combined with metformin and possibly one additional non-insulin agent 2
• Titrate by 10-15% or 2-4 units once or twice weekly based on fasting glucose targets 2

Type 1 Diabetes Mellitus

• Initial dose: One-third to one-half of total daily insulin requirement 1
• Calculate total daily insulin as 0.2-0.4 units/kg/day for insulin-naïve patients 1
• The remainder must be given as rapid-acting (prandial) insulin divided among meals 1
• Pediatric patients (≥1 year) should inject at the same time daily (unlike adults who have flexibility) 1

Switching from Other Insulins

When switching adults from other basal insulins, start Tresiba at the same unit dose as the previous long- or intermediate-acting insulin; for pediatric patients, reduce to 80% of the previous basal dose to minimize hypoglycemia risk. 1

• Adults: Use equivalent unit-for-unit conversion 1
• Pediatric patients (≥1 year): Start at 80% of previous basal insulin dose 1
• Close glucose monitoring required during transition period 1
• Dose adjustments recommended every 3-4 days 1

Unique Dosing Flexibility

Tresiba offers flexible once-daily dosing in adults, allowing administration at varying times with at least 8 hours between injections, though pediatric patients must maintain consistent timing. 1

• Adults can adjust injection time day-to-day if needed 1
• Minimum 8-hour interval required between consecutive doses in adults 1
• Pediatric patients require same-time daily administration 1
• If dose missed in adults: inject during waking hours upon discovery 1
• If dose missed in pediatrics: contact provider for guidance and increase monitoring 1

Available Formulations and Administration

Tresiba is available as U-100 (100 units/mL) in vials and pens, and U-200 (200 units/mL) in pens only; no dose conversion is needed when using the pens as the dose window displays actual units to be delivered. 1

U-100 Formulation

• Available as 3 mL FlexTouch pen (delivers 1-80 units per injection) 1
• Available as 10 mL vial for patients requiring <5 units daily 1
• Delivers doses in 1-unit increments 1

U-200 Formulation

• Available as 3 mL FlexTouch pen (delivers 2-160 units per injection) 1
• Delivers doses in 2-unit increments 1
• Intended for patients requiring higher basal insulin volumes 1, 3
• No dose conversion required—the pen displays actual units 1

Critical Safety Warnings

Never dilute, mix, transfer to syringes, administer intravenously, or share Tresiba pens/needles between patients. 1

• Do NOT mix with any other insulin or solution 1
• Do NOT transfer from pen to syringe 1
• Do NOT use in insulin pumps or give intravenously 1
• Never share pens or needles due to bloodborne pathogen transmission risk 1
• Contraindicated during hypoglycemic episodes 1

Dose Titration and Intensification

If basal insulin dose exceeds 0.5 units/kg/day and HbA1c remains above target, advance to combination injectable therapy rather than continuing to escalate Tresiba alone. 2

• Titrate every 3-4 days based on fasting glucose 1
• For type 2 diabetes requiring intensification: add GLP-1 receptor agonist or prandial insulin 2
• Fixed-ratio combination of liraglutide plus insulin degludec is FDA-approved 2
• For type 1 diabetes: ensure adequate prandial insulin coverage before increasing basal dose 4
• Typical total daily requirements: 0.4-1.0 units/kg/day, with type 2 diabetes often requiring ≥1 unit/kg due to insulin resistance 2, 5

Clinical Advantages

Tresiba provides ultra-long duration of action (>42 hours) with a flat, peakless profile and significantly lower day-to-day variability compared to insulin glargine, resulting in reduced nocturnal hypoglycemia risk. 3, 6, 7

• Duration of action exceeds 42 hours 3, 7
• 20% within-subject day-to-day variability versus higher with glargine 1
• Steady-state achieved after 3-4 days of administration 1
• Half-life approximately 25 hours at steady state 1
• Noninferior glycemic control (HbA1c) compared to glargine with lower nocturnal hypoglycemia rates 3, 6, 8
• Onset of appearance approximately 1 hour after first dose 1

Special Populations and Considerations

• Pregnancy: Very limited clinical experience; avoid use pending safety data 9
• Pediatric patients <1 year: Not approved 1
• Renal/hepatic impairment: Dose adjustments may be needed 1
• Acute illness: Monitor closely and adjust doses to prevent hypo/hyperglycemia 1
• Higher insulin requirements: U-200 formulation allows reduced injection volume 3, 6