insulin degludec
Brand: Tresiba
ISMP High Alert Prototype: insulin-glargine
Drug Class: insulin
Drug Family: insulin
Subclass: ultra-long-acting basal insulin analog
Organ Systems: endocrine
Mechanism of Action
Ultra-long-acting basal insulin analog in which fatty acid chains and linkers allow multi-hexamer formation at the subcutaneous injection site. The large depot dissolves very slowly, providing insulin monomers that are absorbed over >42 hours, creating a nearly peakless, highly stable pharmacokinetic profile.
insulin receptor (IR)
Indications
- type 1 diabetes mellitus
- type 2 diabetes mellitus
Contraindications
- hypoglycemia
- hypersensitivity to insulin degludec
Adverse Effects
Common
- hypoglycemia
- injection site reactions
- nasopharyngitis
Serious
- severe hypoglycemia
- hypokalemia
- anaphylaxis
Pharmacokinetics (ADME)
| Absorption | subcutaneous only; extremely slow, continuous absorption |
| Distribution | albumin-bound in circulation |
| Metabolism | proteolytic degradation |
| Excretion | proteolytic |
| Half-life | 25 hours |
| Onset | 1 hour |
| Peak | none (truly peakless) |
| Duration | >42 hours (allows flexible dosing window) |
| Protein Binding | albumin >99% |
| Vd | 0.1 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| beta-blockers | mask hypoglycemia symptoms | moderate |
| corticosteroids | increase insulin resistance | moderate |
| GLP-1 receptor agonists | synergistic glucose lowering; dose reduction may be needed | minor |
Nursing Considerations
- Once-daily administration; flexible dosing window (can be taken at different times each day, as long as at least 8 hours between doses) due to ultra-long duration.
- Do NOT administer IV or IM; subcutaneous injection only.
- Also available as a fixed-ratio combination with liraglutide (Xultophy 100/3.6); do not mix with other insulins.
- Lower rates of nocturnal hypoglycemia compared to glargine in clinical trials; discuss with prescriber when transitioning patients.
Clinical Pearls
- Insulin degludec's half-life of 25 hours and action duration >42 hours create a truly steady-state pharmacokinetic profile that minimizes day-to-day glucose variability.
- The flexible dosing window (shift of up to 8 hours permitted between doses) offers a practical advantage for patients with irregular schedules.
Safety Profile
Pregnancy use-with-caution
Lactation safe
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.