• Improvement of glycemic control in adults with diabetes mellitus.

Contraindicated in:

• Hypersensitivity to insulin degludec
• Hypoglycemia.

Use Cautiously in:

• Stress and infection (may temporarily ↑ insulin requirements)
• Renal impairment (may ↓ insulin requirements)
• Hepatic impairment (may ↓ insulin requirements)
• Obese patients (effects may be ↓)
• Patients with visual impairment who may rely on audible clicks to dial their dose
• OB: Pregnancy may temporarily ↑ insulin requirements
• Lactation: Consider possible effects on infant (lactating females may require adjustments in insulin dose and/or meal plan)
• Pedi: Children <1 yr (safety and effectiveness not established)
• Geri: Older adults may have ↑ risk of hypoglycemia.

Endo: HYPOGLYCEMIA.

F and E: hypokalemia.

Local: cutaneous amyloidosis, erythema, lipodystrophy, pruritus, swelling.
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.
• Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin may ↑ insulin requirements.
• Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates may ↓ insulin requirements.
• Concurrent use with pioglitazone may ↑ risk of fluid retention and worsening HF.

Drug-Natural Products:

• Glucosamine may worsen blood glucose control.
• Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

• Solution for injection: 100 units/mL (prefilled pens and vials); 200 units/mL (prefilled pens);
• In combination with: liraglutide (Xultophy). See Appendix [not included in this PDA edition]

• SC (Adults): Type 1 diabetes (insulin naive): 1/3–½ of the total daily insulin dose given once daily, then adjust on the basis of patient's needs (remainder of insulin dose should be given as a short-acting insulin and divided between each daily meal) (usual starting total daily insulin dose = 0.2–0.4 units/kg); Type 2 diabetes (insulin naive): 10 units once daily, then adjust on the basis of patient's needs; Type 1 or 2 diabetes (and already on insulin): Give the same dose as the total daily dose of the long-acting or intermediate-acting insulin once daily, then adjust on the basis of patient's needs.
• SC (Children 1 yr): Type 1 or 2 diabetes (and already on insulin): Give 80% of the total daily dose of the long-acting or intermediate-acting insulin once daily, then adjust on the basis of patient's needs.

Tresiba, Tresiba FlexTouch

• Lowers blood glucose by:
  • stimulating glucose uptake in skeletal muscle and fat,
  • inhibiting hepatic glucose production.
• Other actions:
  • inhibition of lipolysis and proteolysis,
  • enhanced protein synthesis.

• Control of hyperglycemia in diabetic patients.

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Absorption: Absorption is slow and delayed following SUBQ administration.

Distribution: Widely distributed to tissues.

Protein Binding: >99%.

Metabolism/Excretion: Metabolized by liver, spleen, kidney, and muscle.

Half-life: 25 hr.

Tresiba PenFill

(effect on blood sugar)

†Following discontinuation after chronic use.

• Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. If a dose is missed, inject daily dose during waking hr upon discovering missed dose. Ensure that at least 8 hr have elapsed between consecutive injections. Discuss importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
• Caution patient not to share pen device with another person, even if needle is changed; may risk transmission of bloodborne pathogens.
• Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
• Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness, and health care professional notified of significant changes.
• Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, herbal products, or alcohol.
• Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
• Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled.
• Instruct patient and caregiver on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
• Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Emphasize the importance of regular follow-up, especially during first few wk of therapy.

IN-soo-lin DEG-lu-dek