It has not been formally tested in pregnancy and trials testing the safety of degludec in pregnancy are currently ongoing.
In people with type 2 diabetes, Ryzodeg insulin has been tested in people who have never been on insulin (called insulin naïve), as well as people already on insulin who were swapped over to ryzodeg. Those previously on insulin were either on a once daily long acting basal insulin (typically Lantus insulin glargine ) or mixed insulins.
Insulin degludec is an ultra long acting basal insulin that has a very long action after it has been injected under the skin. As compared to insulin glargine it last for about 5 days and is more consistantly released into the blood stream. In studies insulin degludec was a associated with a 30-50 percent lower risk of having a low blood sugar (hypo).
The dose of insulin varies from individual to individual based on their insulin resistance and how much insulin their pancreas is still able to produce. The dose needed is therefore related to glucose levels that the insulin is able to help achieve without causing low sugar readings (known as hypos or hypoglycaemia). You need what you need and it can vary from 10 units to 400 units daily.
In people starting insulin for the first time the trials suggested a starting dose of 10 units Ryzodeg either once or twice per day immediately prior to eating. Ideally the insulin should be administered with the largest carbohydrate meal. The dose of insulin needs titrating based on medical direction but typically would follow a simple titration algorithm outlined below.
In those on mixed insulins already such as Mixtard 30/70, Novomix 30 and Humalog Mix25 a simple swap at the same dose is appropriate. For example if a person is taking Novomix 38 units before breakfast and 16 units before dinner would be changed to Ryzodeg 38 units before breakfast and 16 units at dinner.
What dose to use in people on a single once daily long acting basal insulin such as insulin glargine(lantus) is less clear but the safest strategy and advice is to swap insulins at the same dose and then titrate according to the fasting blood glucose level and the titration algorithm.
|Fasting glucose level
|Fasting glucose level
|New Insulin dose
|more than 90||more than 5||+2 units|
|72-90||4-5||no dose change|
|less than 72||less than 4||-2 units|