Insulin degludec with liraglutide

How it works

Insulin degludec provides a flat, prolonged basal insulin effect by forming soluble multihexamers at the injection site, while liraglutide augments glucose-dependent insulin secretion, suppresses glucagon and slows gastric emptying.

Prescribing in practice

• Because the components are in a fixed ratio, the insulin and GLP-1 doses cannot be titrated independently, so it must not be combined with another GLP-1 receptor agonist and dose adjustment is guided by the basal insulin requirement.
• Initiate cautiously when switching from a previous basal insulin or GLP-1 agonist, reducing or stopping the prior agent to avoid stacking, and titrate gradually against fasting glucose.
• Avoid in type 1 diabetes and diabetic ketoacidosis, and use with care in those with a history of pancreatitis or significant gastrointestinal disease.

Monitoring

Monitor fasting and overall glycaemic control alongside body weight, and review for hypoglycaemia and persistent gastrointestinal symptoms during titration.

Counselling the patient

• Inject under the skin once daily at a consistent time and rotate sites to avoid lipohypertrophy.
• Nausea is common at first and usually settles; report severe or persistent abdominal pain.
• Carry a fast-acting carbohydrate in case of hypoglycaemia, especially if also taking a sulfonylurea.

Evidence & guidelines

Fixed-ratio basal insulin plus GLP-1 agonist combinations are recommended by NICE as an intensification option in type 2 diabetes, reducing HbA1c with less weight gain and hypoglycaemia than uptitrated basal insulin alone.