How to start and convert your adult patients to once-daily, long-acting Tresiba®



Step 1: Initiate1




Two Green Arrows

Insulin naïve

1/3 to 1/2

of total daily insulin dosea


10 units

once daily

Converting

1 to 1 Conversion

same unit dose as total daily long- or intermediate-acting insulin dose


Type 1 and type 2 initiate chart and long or intermediate insulin conversion ratio

aThe remainder of the total daily insulin dose should be administered as a short-acting insulin and divided between each daily meal. As a general rule, 0.2 to 0.4 units of insulin per kilogram of body weight can be used to calculate the initial total daily insulin dose in insulin-naïve patients with type 1 diabetes.


Step 2: Titrate2-4


Based on ADA and AACE Guidelines2,3

FPG Bar


The recommended time between dose increases is 3 to 4 days1

  • Tresiba® was not studied in clinical trials using this algorithm
  • Individualize and titrate the dose of Tresiba® based on the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goal. Dose adjustments may be needed with changes in physical activity, changes in meal patterns, changes in renal or hepatic function, or during acute illness to minimize the risk of hypoglycemia or hyperglycemia1
One Kid
Find out how to prescribe Tresiba® for your pediatric patients. Tresiba® is the only basal insulin indicated for type 1 and type 2 diabetes in children as young as 1 year of age.1



Add Tresiba® FlexTouch® to your ePrescribing system



Light Green FlexTouch® pen


Form/Strength:

100 units/mL


Quantity per box:

15 mL (5 x 3 mL)
1500 units total


NDC:

0169-2660-15



Dark Green FlexTouch® pen


Form/Strength:

200 units/mL


Quantity per box:

9 mL (3 x 3 mL)
1800 units total


NDC:

0169-2550-13



White Laptop


Prescribing Tresiba®

When sending prescribing information, be sure to specify the right formulation of Tresiba® for your patients. The U-100 formulation has a maximum dose of 80 units per injection and is dosed in 1-unit increments, and U-200 has a maximum dose of 160 units per injection and is dosed in 2-unit increments.

Also be sure to include:

  • Starting dose (units per day)
  • Titration information
  • Separate prescription for pen needles (if necessary)

Find resources for you and your patients


Eligible patients pay as little as $15 per prescriptionb

See what to do when patients miss their scheduled dose of Tresiba®

bFor up to 24 months. Maximum savings of $500 per prescription. Eligibility and other restrictions apply.

Selected Important Safety Information

Contraindications

  • Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients

Warnings and Precautions

  • Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens
  • Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed
  • Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening

Indications and Usage

Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus.

Limitations of Use

Tresiba® is not recommended for treating diabetic ketoacidosis or for pediatric patients requiring less than 5 units of Tresiba®.

Important Safety Information

Contraindications

  • Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients

Warnings and Precautions

  • Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens
  • Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed
  • Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment
  • Accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. To avoid medication errors, always instruct patients to check the insulin label before each injection
  • Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulin products, including Tresiba®
  • As with all insulins, Tresiba® use can lead to life-threatening hypokalemia, which then may cause respiratory paralysis, ventricular arrhythmia, and death. Closely monitor potassium levels in patients at risk of hypokalemia and treat if indicated
  • Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Tresiba®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered

Adverse Reactions

  • Adverse reactions commonly associated with Tresiba® are hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain

Drug Interactions

  • Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs and symptoms of hypoglycemia may be reduced or absent in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine)

Please click here for Prescribing Information.

 

References:

  1. Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; December 2016.
  2. Inzucchi SE, Bergenstal RM, Buse JB, et al. Diabetes Care. 2015;38(1):140-149.
  3. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Endocr Pract. 2017;23(2):207-238.
  4. Philis-Tsimikas A, Brod M, Niemeyer M, Ocampo Francisco AM, Rothman J. Adv Ther. 2013;30(6):607-622.