Home Drug Guide Insulin degludec

Drug Guide

Generic Name

Insulin degludec

Brand Names Tresiba

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Long-acting insulin

FDA Approved Indications

  • Management of blood glucose in adults and children with diabetes mellitus

Mechanism of Action

Insulin degludec is an ultra-long-acting basal insulin that lowers blood glucose by facilitating cellular glucose uptake and inhibiting hepatic glucose production. It forms multi-hexamers upon injection, creating a depot that releases insulin slowly and steadily over time.

Dosage and Administration

Adult: Dosage varies based on individual needs; typically once daily by subcutaneous injection at the same time each day.

Pediatric: Dosage must be individualized based on patient response and blood glucose monitoring.

Geriatric: Use with caution in elderly patients; adjust dose based on renal function and risk of hypoglycemia.

Renal Impairment: Adjust dose as needed; closely monitor blood glucose levels.

Hepatic Impairment: Use with caution; hepatic impairment can alter insulin requirements.

Pharmacokinetics

Absorption: Absorbed slowly with a duration of action exceeding 24 hours.

Distribution: Distributed throughout the body; insulin binds to insulin receptors.

Metabolism: Metabolized locally at the site of injection and by hepatic enzymes.

Excretion: Primarily metabolized to inactive compounds, excreted via urine.

Half Life: Approximately 25 hours, providing a steady basal level.

Contraindications

  • Hypoglycemia
  • Allergy to insulin degludec or excipients

Precautions

  • Use with caution in patients with hypoglycemia unawareness, hepatic or renal impairment, or during illness or stress. Monitor blood glucose frequently.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Injection site reactions (Less common)

Adverse Reactions - Serious

  • Severe hypoglycemia (Serious and requires immediate attention)
  • Anaphylaxis (Rare)

Drug-Drug Interactions

  • Other antidiabetic agents, corticosteroids,beta-blockers, diuretics

Drug-Food Interactions

  • Alcohol may enhance hypoglycemia

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly; assess for signs and symptoms of hypoglycemia and hyperglycemia.

Diagnoses:

  • Risk for unstable blood glucose levels.
  • Ineffective tissue perfusion (related to hypoglycemia or hyperglycemia)

Implementation: Administer subcutaneously at scheduled times; educate patient on injection technique.

Evaluation: Assess blood glucose and HbA1c levels periodically to evaluate treatment efficacy.

Patient/Family Teaching

  • Administer insulin as prescribed, understanding the importance of consistent timing.
  • Recognize symptoms of hypoglycemia and hyperglycemia.
  • Carry quick-acting carbohydrate sources for hypoglycemia episodes.
  • Maintain regular follow-up appointments.

Special Considerations

Black Box Warnings:

  • Severe hypoglycemia can occur; patients should be closely monitored, especially during initiation or dose changes.

Genetic Factors: Pharmacogenomics may influence insulin sensitivity.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe hypoglycemia with rapid onset, potentially leading to loss of consciousness or seizures.

Treatment: Administer immediate carbohydrate intake; in severe cases, administer IV glucose or glucagon as per protocol.

Storage and Handling

Storage: Store unopened vials or pens in the refrigerator (2°C to 8°C). Once in use, can be kept at room temperature (up to 25°C) for up to 8 weeks.

Stability: Stable under recommended storage conditions; avoid freezing and direct sunlight.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.