What is the recommended dosage and administration of Tresiba (insulin degludec) 100 units/mL injection for diabetes management?

Tresiba (Insulin Degludec) 100 units/mL Dosing and Administration

For insulin-naïve patients with type 2 diabetes, start Tresiba at 10 units once daily, administered at the same time each day, and titrate by 2-4 units every 3 days until fasting glucose reaches 80-130 mg/dL. 1

Starting Doses by Patient Type

Type 2 Diabetes (Insulin-Naïve)

• Initial dose: 10 units once daily 1
• Administer at the same time each day 1
• Continue metformin and consider one additional non-insulin agent 2

Type 1 Diabetes (Insulin-Naïve)

• Initial dose: One-third to one-half of total daily insulin requirement 1
• Total daily insulin typically 0.2-0.4 units/kg body weight 1
• Remainder given as short-acting insulin divided among meals 1
• Must be used with short-acting insulin 1

Switching from Other Basal Insulins

Adults (Type 1 or Type 2):

• Start at the same unit dose as previous long/intermediate-acting insulin 1

Pediatric Patients (≥1 year):

• Start at 80% of previous long/intermediate-acting insulin dose to minimize hypoglycemia risk 1

Dose Titration Protocol

Standard titration algorithm: 2

• Increase by 2 units every 3 days if fasting glucose 140-179 mg/dL 2
• Increase by 4 units every 3 days if fasting glucose ≥180 mg/dL 2
• Target fasting glucose: 80-130 mg/dL 2
• Decrease by 2 units if >2 fasting values/week <80 mg/dL 2

Alternative approach: Increase by 10-15% or 2-4 units once or twice weekly until target reached 3, 2

Administration Guidelines

Injection Technique

• Subcutaneous injection only in thighs, upper arms, or abdomen 1
• Rotate injection sites with each dose 1
• Do not inject into areas with lipodystrophy, pits, lumps, or damaged skin 1
• Administer at consistent time daily for optimal effect 1

Unique Flexibility Feature

Adults who miss a dose: Inject during waking hours upon discovery, ensuring at least 8 hours between consecutive doses 1

Pediatric patients who miss a dose: Contact healthcare provider for guidance and increase glucose monitoring 1

Product Specifications

• 100 units/mL (U-100): Available as 3 mL FlexTouch pen or 10 mL vial 1
• 200 units/mL (U-200): Available as 3 mL FlexTouch pen 1
• Must appear clear and colorless—do not use if cloudy, thick, or colored 1
• Do not shake or roll the vial 1
• Do not dilute or mix with other insulins 3

When to Intensify Beyond Basal Insulin

Critical threshold: When basal insulin exceeds 0.5 units/kg/day and A1C remains above target despite controlled fasting glucose, add prandial insulin or GLP-1 receptor agonist rather than continuing to escalate basal insulin alone 3, 2

Signs of overbasalization requiring prandial insulin addition: 2

• Basal dose >0.5 units/kg/day
• Bedtime-to-morning glucose differential ≥50 mg/dL
• Recurrent hypoglycemia
• High glucose variability

Pharmacokinetic Advantages

Insulin degludec forms soluble multihexamer chains after injection, creating a subcutaneous depot with: 4, 5, 6

• Duration of action: >42 hours 7
• Half-life: 17-21 hours (approximately double that of glargine) 5
• Peakless, flat profile with minimal day-to-day variability 4, 7, 6
• Reaches steady state with consistent once-daily dosing 6

Clinical Efficacy

Glycemic control: Noninferior to insulin glargine for achieving A1C <7% in both type 1 and type 2 diabetes 4, 7

Hypoglycemia advantage: Significantly lower nocturnal hypoglycemia rates compared to glargine 4, 7, 6

Critical Safety Warnings

Hypoglycemia Risk Factors 1

• Never use during hypoglycemic episodes 1
• Long-acting effect may delay recovery from hypoglycemia compared to shorter-acting insulins 1
• Risk increases with intensity of glycemic control 1
• Monitor closely when changing regimens, injection sites, or during illness 1

Contraindications 1

• Active hypoglycemia
• Hypersensitivity to insulin degludec or excipients

Sharing Prohibition 1

Never share pens, needles, or syringes between patients—risk of blood-borne pathogen transmission 1

Common Pitfalls to Avoid

• Delaying insulin initiation in patients not achieving glycemic goals with oral agents 2
• Continuing to escalate basal insulin beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia 2
• Not adjusting for lipodystrophy: Repeated injections into affected areas cause hyperglycemia; sudden site change to unaffected area can cause hypoglycemia 1
• Inadequate dose titration: Failing to systematically increase doses based on glucose monitoring 2