Generic Name

Insulin degludec

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Classification

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

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.