Insulin Degludec

Insulin Degludec Brand Name– Tresiba

What is Insulin Degludec

Insulin degludec is a long-acting, once-daily basal insulin analog used in adult and pediatric patients 1 year and older with diabetes mellitus (DM).

Insulin degludec forms multi-hexamers upon injection into subcutaneous tissue, which allows for a delay in the onset of action and a constant release of insulin over 24 hours.

In adult participants with type 1 and 2 DM who had inadequate blood sugar control at trial entry, treatment provided A1C reductions in line with reductions achieved with other, previously approved long-acting basal-type insulins.

No insulin has been shown to reduce the risk for cardiovascular disease (CVD), but data suggest that insulin glargine U-100 and insulin degludec do not increase the risk for major cardiovascular events (MACE).

When targeting intensive glycemic control in patients with long-standing type 2 diabetes at a high risk of CVD, insulin degludec is associated with a lower risk of severe hypoglycemia compared with insulin glargine U-100; absolute incidence difference of 1.7% over 2 years (RR 0.60; p = 0.001 for superiority; OR 0.73; p = 0.001 for superiority).

In the treatment of type 1 DM, insulin therapy may be initiated with a basal-bolus regimen of insulin glargine and then further individualized to achieve treatment goals. In the treatment of type 2 DM, insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.

In patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists (GLP-1 RA) are the preferred choice to insulin. Evidence from trials comparing GLP-1 RAs and insulin (basal, premixed, or basal-bolus) shows similar or even better efficacy in A1C reduction; GLP-1 RAs have a lower risk of hypoglycemia and are associated with reductions in body weight compared to weight gain with insulin.

In patients who cannot tolerate a GLP-1 RA, or who fail to meet glycemic targets with dual/triple therapy, insulin therapy with basal insulin, such as insulin degludec should be initiated and titrated to target.

If A1C remains above the target, prandial insulin should be added. Consider an initial injectable combination (i.e., GLP-1 RA plus basal insulin or prandial/basal insulin) if A1C is greater than 10% and 2% above target.

Consider the early introduction of insulin if there is evidence of ongoing catabolism, if symptoms of hyperglycemia are present, or when A1C levels (greater than 10%) or blood glucose levels (300 mg/dL or more) are very high.

In patients who are starting on insulin therapy and are taking a thiazolidinedione or sulfonylurea, discontinue or reduce the dose of the oral medication

Indications

• type 1 diabetes mellitus
• type 2 diabetes mellitus

Side Effects

1. anaphylactoid reactions
2. angioedema
3. antibody formation
4. bronchospasm
5. cutaneous amyloidosis
6. diarrhea
7. headache
8. hyperinsulinemia
9. hypertension
10. hypoglycemia
11. hypokalemia
12. hypotension
13. infection
14. injection site reaction
15. insulin resistance
16. insulin shock
17. lipodystrophy
18. peripheral edema
19. pharyngitis
20. rash
21. sinusitis
22. Somogyi effect
23. urticaria
24. weight gain
25. wheezing

Monitoring Parameters

• blood glucose
• glycosylated hemoglobin A1c (HbA1c)

Contraindications

• breast-feeding
• coma
• continuous subcutaneous insulin infusion (CSII) administration
• diabetic ketoacidosis
• diarrhea
• fever
• geriatric
• hepatic disease
• hyperosmolar hyperglycemic state (HHS)
• hypoglycemia
• hypokalemia
• infection
• intravenous administration
• neonates
• pregnancy
• renal failure
• renal impairment
• surgery
• thyroid disease
• tobacco smoking
• trauma
• visual impairment
• vomiting

Interactions

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