From the Guidelines
When transitioning from Victoza to insulin therapy, insulin glargine (Lantus, Toujeo, Basaglar) or insulin degludec are good options to consider as they are long-acting basal insulins that provide steady coverage throughout the day, with a lower risk of nocturnal hypoglycemia compared to NPH insulin 1.
Key Considerations
- A typical starting dose would be 10 units once daily, preferably at the same time each day, with dose adjustments of 2-4 units every 3-5 days based on fasting blood glucose readings.
- It's essential to continue monitoring blood glucose levels regularly during this transition, aiming for fasting glucose between 80-130 mg/dL.
- The transition should be managed by gradually starting insulin while continuing Victoza for a short overlap period (typically 1-2 weeks) before discontinuing Victoza completely.
- When switching from one basal insulin to another, doses can often be converted unit for unit and subsequently adjusted based on glucose monitoring, with an initial dose reduction of 10-20% considered for individuals at high risk for hypoglycemia 1.
Benefits and Risks
- Insulin glargine and insulin degludec have been shown to reduce the risk of level 2 hypoglycemia and nocturnal hypoglycemia compared to NPH insulin 1.
- The combination of basal insulin and GLP-1 RA has potent glucose-lowering actions and less weight gain and hypoglycemia compared to intensified insulin regimens 1.
- Side effects to watch for include hypoglycemia, which may require keeping fast-acting carbohydrates on hand.
Clinical Decision-Making
- Clinicians should be aware of the potential for overbasalization with insulin therapy and evaluate for clinical signals such as high bedtime-to-morning or preprandial-to-postprandial glucose differential, hypoglycemia, and high glucose variability 1.
- Evidence of overbasalization should prompt reevaluation of the glucose-lowering treatment plan to better address postprandial hyperglycemia 1.
From the FDA Drug Label
Regulation of glucose metabolism is the primary activity of insulin. Insulin lowers blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat, and by inhibiting hepatic glucose production. Humulin R U-100 is human insulin with a short duration of action.
The FDA drug label does not answer the question.
From the Research
Insulin Options
When converting from Victoza, a glucagon-like peptide-1 (GLP-1) receptor agonist, to insulin, several options are available. The choice of insulin depends on various factors, including the patient's diabetes type, lifestyle, and individual needs.
Basal Insulins
- Insulin glargine: a long-acting basal insulin that can help regulate blood sugar levels throughout the day 2, 3
- Insulin detemir: a long-acting basal insulin that can help regulate blood sugar levels throughout the day 2, 3
- Insulin lispro protamine: a long-acting basal insulin that can help regulate blood sugar levels throughout the day 2
Rapid-Acting Insulins
- Insulin lispro: a rapid-acting insulin that can help regulate blood sugar levels after meals 4, 3
- Insulin aspart: a rapid-acting insulin that can help regulate blood sugar levels after meals 4, 3
- Insulin glulisine: a rapid-acting insulin that can help regulate blood sugar levels after meals 5
Considerations
When switching from Victoza to insulin, it's essential to consider the patient's individual needs and lifestyle. Factors such as diet, physical activity, and other medications should be taken into account when selecting an insulin regimen. Additionally, the patient's ability to administer insulin injections and monitor blood sugar levels should be assessed.
Efficacy and Safety
Studies have shown that basal-bolus insulin therapy can be effective and safe in patients with type 2 diabetes who are inadequately controlled with other insulin regimens 6. However, the choice of insulin and dosing regimen should be individualized to minimize the risk of hypoglycemia and other adverse events.