Prescribing Tresiba® FlexTouch®


How I approach basal insulin injections with my patients


In my 30 years as a primary care physician, I’ve talked with a number of patients about getting started on an insulin therapy, and what to do when it’s time to add a basal insulin to their treatment regimen.

As Executive Vice President for Education for the Primary Care Education Consortium (PCEC), I tell the residents and practicing physicians I work with that an important part of our job is being open and honest with our patients, every step of the way.

When it’s time for a patient to start taking insulin, I sit with them and talk in detail about the next steps. We also have a conversation about adding an injection to their daily routine.

In my practice, I prescribe Tresiba® for my adult patients starting on basal insulin. After writing the prescription, I take time to discuss the features of Tresiba® FlexTouch®, and give them an idea of how it works. We can then work together to integrate basal insulin injections into their daily routine.

Stephen Brunton, MD

Stephen Brunton, MD

  • 30+ years as a practicing physician
  • Executive Vice President for Education for the Primary Care Education Consortium (PCEC)
  • Serves in an editorial role for 8 peer-reviewed journals
  • Former President of the California Academy of Family Physicians and the Association of Family Medicine Residency Directors
  • Winner of the American Medical Writers Association’s John P. McGovern Award for Excellence in Communication

How I introduce Tresiba® FlexTouch®


A patient once told me, “You always remember your first injection. You don’t remember your second.” I like to share this sentiment with my patients as we address any questions they may have about taking basal insulin injections. Then, right there in my office, I give them their first injection, and they can see what it’s like. With Tresiba® FlexTouch®, they can also experience the NovoFine® Plus needle,a which is Novo Nordisk’s shortest and thinnest needle available.  

aTresiba® FlexTouch® can also be used with NovoFine®, NovoFine® Autocover®, and NovoTwist® needles.


Stephen Brunton, MD


bDose determined on an individual basis. The mean end basal doses across Tresiba® clinical trials in adult patients ranged from 19 units to 74 units. Sixteen units was the mean end basal dose in the pediatric study.1


Features of Tresiba® FlexTouch® U-200

References:

  1. Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; September 2015.
  2. Lantus [package insert]. Bridgewater, NJ: sanofi-aventis US LLC; August 2015.



Features of Tresiba® FlexTouch® U-200


Tresiba® FlexTouch® pen


Tresiba® U-200 - the only basal insulin with a 160-unit max dose pen

Up to 160 units in a single dose
Tresiba® U-200 can dose up to 160 units in a single injection.1



Insulin pen

Same dose, half the volume
Only Tresiba® FlexTouch® U-200 delivers the same dose in half the volume of insulin glargine U-100.1,2




A chart icon

Lasts twice as long as insulin glargine U-100 after opening
Tresiba® FlexTouch® lasts up to 8 weeks after being opened, if it is refrigerated (36°F to 46°F) or kept at room temperature below 86°F vs 4 weeks for insulin glargine U-100 and 6 weeks for insulin glargine U-300.1-3



Tresiba® U-200 FlexTouch® contains 160 units, with 2-unit dose adjustments

Additional dosing considerations
Tresiba® FlexTouch® U-200 contains 600 total units, with 2-unit dose adjustments. Also, there is no push-button extension.1

Needles are sold separately and may require a prescription in some states.

AN ENDOCRINOLOGIST'S POINT OF VIEW

Dr Steven Edelman explores the efficacy and safety of Tresiba®


PRIMARY CARE PERSPECTIVE

Dr Stephen Brunton on the Tresiba® duration of action

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 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 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

  • There are certain drugs that may cause clinically significant drug interactions with Tresiba®.
    • Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors
    • Drugs that may decrease the blood glucose lowering effect: atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones
    • Drugs that may increase or decrease the blood glucose lowering effect: alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
    • Drugs that may blunt the signs and symptoms of hypoglycemia: beta-blockers, clonidine, guanethidine, and reserpine

Please click here for Prescribing Information.

 

References:

  1. Tresiba [package insert]. Plainsboro, NJ: Novo Nordisk Inc; August 2018.
  2. Lantus [package insert]. Bridgewater, NJ: sanofi-aventis US LLC; August 2015.
  3. Toujeo [package insert]. Bridgewater, NJ: sanofi-aventis US LLC; March 2018.