Ultra-long-acting Insulin Analogue Pregnancy: Limited data in pregnancy — switch to human insulin (isophane) or insulin detemir if not established pre-pregnancy. Discuss with specialist.

Insulin Degludec

Brand names: Tresiba

Adult dose

Dose: Type 1 DM: 0.2–0.4 units/kg OD (as part of basal-bolus regimen); Type 2 DM: 10 units OD initially, titrated to fasting glucose 4–7 mmol/L

Route: Subcutaneous injection

Frequency: Once daily (flexible timing — can be given at any time of day, with ≥8h gap between doses)

Max: Individualised — no absolute maximum

MHRA safety requirement: always prescribe by brand name (Tresiba). Duration of action >42 hours (ultra-long-acting). Available as Tresiba 100 units/mL and 200 units/mL — do not confuse concentrations. Flexible dosing window reduces adherence barriers.

Paediatric dose

Dose: 0.2 units/kg

Route: Subcutaneous injection

Frequency: Once daily

Max: Individualised per glycaemic target

BNFc: Licensed from age 1 year. DEVOTE paediatric study supported safety profile. Seek specialist paediatric endocrinology opinion.

Dose adjustments

Renal

Monitor glucose closely — insulin requirements may fall in renal impairment.

Hepatic

Monitor glucose closely — insulin requirements may fall in hepatic failure.

Paediatric weight-based calculator

Patient weight (kg)

BNFc: Licensed from age 1 year. DEVOTE paediatric study supported safety profile. Seek specialist paediatric endocrinology opinion.

Clinical pearls

DEVOTE trial: degludec vs. glargine U100 — significantly lower rates of severe and nocturnal hypoglycaemia
Ultra-long half-life (>25h) means steady state achieved after 3–4 days — do not adjust dose more frequently than every 3 days
Antidote for hypoglycaemia: oral glucose if conscious; IM glucagon 1mg or IV dextrose 10% if unconscious
Two concentrations available (U100 and U200) — always verify concentration to avoid dosing errors

Contraindications

Hypoglycaemia
Hypersensitivity to insulin degludec or excipients

Side effects

Hypoglycaemia
Injection site reactions
Peripheral oedema
Weight gain

Interactions

Beta-blockers — mask hypoglycaemia symptoms
Corticosteroids, thiazides, sympathomimetics — antagonise effect
Alcohol, ACE inhibitors, salicylates — potentiate hypoglycaemia

Monitoring

Fasting blood glucose
HbA1c 3–6 monthly
Hypoglycaemia frequency
Injection site rotation

Reference: BNFc; BNF 90; NICE NG17; DEVOTE Trial (NEJM 2017); MHRA Insulin Safety Alert. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways