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Administrating Insulin and Insulin Analogues

Insulin Degludec (Tresiba)

What is Tresiba (degludec)?

Insulin degludec is a new ultra long-acting insulin which has become available in the UK since January 2013. It has a duration of action for over 40 hours. It is manufactured by NovoNordisk and is available under the trade name Tresiba®.

How is it different from other basal insulins?

There are two significant differences between Tresiba and other basal insulins such as Detemir or Glargine. Firstly, it has a significantly longer duration of action and secondly, it is available in a higher strength formulation. Tresiba is the first basal insulin to be available in a higher strength formulation of 200 units/ml.

Why the 200 units per ml formulation?

Insulin conventionally has been available in a strength of 100 units per ml so as to avoid dosing errors. The risk of making an error in dose is minimised by making Tresiba available in a pen device which dials up the required dose in units, regardless of the concentration of the insulin. The advantage of the higher strength insulin will be in patients who require higher than average daily doses of insulin, where the insulin is less effective due to insulin resistance. The volume of injection will be halved for patients who use the higher strength formula.

What are the advantages of using degludec over other basal insulins?

insulin degludec has more stable concentrations with less variability when compared to other insulins such as insulin glargine and detemir. Studies have shown that patients receiving degludec have significantly less night-time hypoglycaemia. More widespread clinical use is required before it’s place in treatment can be determined.

Is insulin degludec more effective in terms of controlling diabetes?

No. The studies showed no significant difference between insulin degludec and insulin glargine in terms of blood glucose lowering, measured by HbA1c and fasting plasma glucose.

What are the disadvantages of this new insulin?

It is significantly more expensive than other basal insulins which are currently available. The annual cost of using 40 units of degludec will be in the region of £700 compared with around £400 for either glargine or detemir. However, use of this product in selected patients may prove to be cost-effective if it helps avoid hypoglycaemia.

What preparations will be available?

Insulin degludec (Tresiba) is available in pre-filled pen devices (known as FlexTouch) in two strengths: 100 units/mL and 200 units/mL.

The 100 units/mL strength is also available in cartridge form (called Penfill). The 200 units/ml strength will not be available in cartridge form so as to avoid dosing errors.

Would I need to change dose when changing from the lower strength to the higher strength preparation?

No, you would simply continue to take the same number of units prescribed. The dose-counter window of the Tresiba FlexTouch pen device shows the number of units that will be injected, irrespective of strength.

What precautions will be taken to avoid dosing errors?

Patients should be provided with a patient booklet and Insulin Passport (or safety card), and should be trained on the correct use of Tresiba, before the product is prescribed or dispensed.

 

© Dr Nishan Wijenaike
Consultant Physician
July 2013