From the Guidelines
When switching from Humalog 50:50 to Ryzodeg, start with a unit-for-unit conversion as a general rule, but consider a 10-20% dose reduction due to the longer duration of insulin degludec compared to the NPH component in Humalog 50:50, as suggested by the most recent guidelines 1. This approach is based on the pharmacodynamic profiles of the insulins involved and the goal of maintaining or improving glycemic control while minimizing the risk of hypoglycemia.
Key Considerations:
- Ryzodeg contains 70% insulin degludec (basal) and 30% insulin aspart (rapid-acting), which should replace Humalog 50:50 at the same total daily dose initially, but divided differently.
- For example, if a patient was taking 30 units of Humalog 50:50 twice daily (60 units total), they would typically start with 60 units of Ryzodeg once daily.
- Blood glucose should be monitored closely during the transition, especially overnight and fasting levels, to adjust the dose as needed and prevent hypoglycemia.
- Ryzodeg is typically administered with the largest meal of the day, but can be given with any meal as long as it's consistent.
- If glycemic control is suboptimal with once-daily dosing, Ryzodeg can be split into twice-daily dosing, as outlined in recent diabetes management guidelines 1.
Benefits of the Transition:
- Insulin degludec provides more stable 24-hour coverage with less risk of nocturnal hypoglycemia compared to the NPH component in Humalog 50:50.
- This can lead to improved glycemic control and reduced risk of diabetes-related complications, as emphasized in the standards of medical care in diabetes 1.
Monitoring and Adjustments:
- Close monitoring of blood glucose levels is crucial during the transition to Ryzodeg to adjust the dose as needed and prevent hypoglycemia.
- Patients should be educated on how to adjust their insulin doses based on their glucose levels, meal plans, and physical activity to achieve optimal glycemic control, as recommended in recent guidelines 1.
From the FDA Drug Label
2.4 Switching to Insulin Degludec from Other Insulin Therapies 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 with Type 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 Humalog 50:50 to Ryzodeg, the patient should start Ryzodeg (which contains insulin degludec) at the same unit dose as the total daily long or intermediate-acting insulin unit dose for adults with Type 1 or Type 2 Diabetes Mellitus, or at 80% of the total daily long or intermediate-acting insulin unit dose for pediatric patients 1 year of age and older with Type 1 or Type 2 Diabetes Mellitus, with close medical supervision and increased frequency of blood glucose monitoring to minimize the risk of hypoglycemia or hyperglycemia 2.
From the Research
Switching Humalog 50:50 to Ryzodeg
- There are no direct studies comparing the effects of switching from Humalog 50:50 to Ryzodeg.
- However, studies have compared the effects of Humalog Mix 50 with human insulin Mix 30 in type 2 diabetes patients during Ramadan, showing that changing to Humalog Mix 50 resulted in improvement in glycaemic control without increasing the incidence of hypoglycaemia 3.
- Ryzodeg, a co-formulation of insulin degludec and insulin aspart, has been shown to provide basal insulin coverage for at least 24 hours with additional mealtime insulin for one or two meals depending on dose frequency 4.
- Insulin degludec, a component of Ryzodeg, has a flat and stable glucose-lowering profile, a duration of action exceeding 30 hours, and less inter-patient variation in glucose-lowering effect than insulin glargine 5, 4.
- The use of analog insulin mix 50:50, similar to Humalog 50:50, has been shown to result in better postprandial glucose control in patients with type 2 diabetes during Ramadan, without affecting HbA1c or increasing the incidence of hypoglycaemia 6.
- A review of human and analogue insulin trials found that rapid-acting analogues, such as insulin aspart, generally reduced hypoglycaemia and postprandial glucose, while basal analogues tended to reduce hypoglycaemia, particularly nocturnal hypoglycaemia 7.