From the Guidelines
When switching from Humalog 50:50 to Ryzodeg 70/30, a unit-for-unit conversion at the same total daily dose is recommended, typically given once or twice daily, with close monitoring of blood glucose levels for 3-7 days after transitioning. This approach is based on the pharmacologic properties of the insulins and the need to adjust for the longer-acting component in Ryzodeg, as discussed in the context of insulin therapy adjustments 1.
Key Considerations
- The switch should ideally be supervised by a healthcare provider to facilitate dose titration based on blood glucose patterns.
- Patients should be educated about the different pharmacokinetic profile of Ryzodeg, particularly its longer duration of action compared to Humalog 50:50.
- Ryzodeg offers potential advantages including fewer injections, more stable glucose control, and reduced risk of nocturnal hypoglycemia compared to Humalog 50:50.
Monitoring and Adjustments
- Monitor blood glucose closely for signs of hypoglycemia or hyperglycemia.
- Adjust doses as necessary based on blood glucose monitoring results.
- Consider the timing of meals and the activity level of the patient when adjusting insulin doses.
Evidence Basis
The recommendation for a unit-for-unit conversion is based on the principles of insulin therapy adjustment outlined in the American Diabetes Association standards of medical care in diabetes 1, which emphasize the importance of regimen flexibility and consideration of the pharmacodynamic profiles of different insulins.
From the Research
Strategy for Switching from Humalog 50:50 to Ryzodec (70/30)
- The strategy for switching from Humalog 50:50 to Ryzodec (70/30) is not directly addressed in the provided studies, but some insights can be gained from the studies on insulin degludec/insulin aspart (IDegAsp) and biphasic insulin aspart 30 (BIAsp 30) 2, 3, 4, 5, 6.
- IDegAsp is a fixed-ratio co-formulation of insulin degludec and insulin aspart, similar to Ryzodec, which is a co-formulation of insulin degludec and insulin aspart in a 70/30 ratio 2.
- The recommended starting dose of IDegAsp is 10 units with the most carbohydrate-rich meal(s), followed by individualized dose adjustments 2.
- When switching from basal insulin or premixed insulins to IDegAsp, the dose should be adjusted based on the patient's individual needs and glucose control goals 2.
- Studies have shown that IDegAsp is effective in improving glycemic control and reducing hypoglycemia rates compared to conventional premixed insulins and basal insulins 3, 4, 5, 6.
- The safety and efficacy profile of IDegAsp is consistent across different patient populations, including those with different baseline glycated hemoglobin levels, disease duration, and body mass index 6.
Key Considerations for Switching
- The dose of Ryzodec should be individualized based on the patient's glucose control goals and needs 2.
- The patient's glucose monitoring data and hypoglycemia history should be taken into account when adjusting the dose of Ryzodec 2.
- The patient should be educated on the proper use of Ryzodec, including the timing of injections and the importance of glucose monitoring 2.
- Regular follow-up appointments should be scheduled to monitor the patient's glucose control and adjust the dose of Ryzodec as needed 2.