Insulin Degludec + Insulin Aspart is a co-formulation of a long-acting basal insulin analogue (degludec) and a rapid-acting insulin analogue (aspart). It is designed to provide both basal glycemic control and prandial coverage in a single injection. Degludec forms multi-hexamers upon subcutaneous injection, resulting in a slow, stable, and ultra-long duration of action. Aspart provides a rapid onset to control postprandial glucose spikes. This combination is particularly useful for patients with type 1 or type 2 diabetes requiring intensive insulin therapy, aiming to simplify regimens and potentially improve adherence.
Adult: Individualized. Typically initiated at 0.1-0.2 U/kg/day or 10 U once daily, given with the main meal. Dose is titrated based on fasting and pre-meal blood glucose targets. The ratio is fixed (70% Degludec, 30% Aspart).
Note: For subcutaneous injection only. Administer once daily with the main meal (to cover prandial needs from the Aspart component). Rotate injection sites (abdomen, thigh, upper arm) to prevent lipodystrophy. Inject into the subcutaneous tissue, not intramuscularly. Do not mix with other insulins. Use a new needle for each injection. Allow the insulin to reach room temperature before injection.
This combination provides dual insulin receptor agonism. Insulin Degludec provides a steady, peakless basal level of insulin by forming soluble multi-hexamer chains upon injection, which slowly dissociate to release monomers into the bloodstream. Insulin Aspart, with its rapid monomerization, mimics the physiological prandial insulin surge. Both bind to the alpha-subunit of the insulin receptor, activating tyrosine kinase and initiating a cascade that promotes glucose uptake (via GLUT4 translocation) in muscle and fat, inhibits hepatic gluconeogenesis and glycogenolysis, and promotes glycogenesis, lipogenesis, and protein synthesis.
Pregnancy: Pregnancy Category B (US FDA). Insulin is the drug of choice for glycemic control in pregnancy. Requirements may decrease in first trimester and increase significantly in second/third trimesters. Close monitoring of glucose is mandatory. Use under specialist supervision.
Driving: Hypoglycemia can impair concentration and reaction time. Patients should check blood glucose before driving and avoid driving if hypoglycemic or if warning signs are present.
| Beta-blockers (e.g., Propranolol, Atenolol) | Mask hypoglycemic symptoms (tachycardia, tremor); may potentiate or weaken glucose-lowering effect. | Major |
| Corticosteroids (e.g., Prednisolone, Dexamethasone) | Increase insulin resistance, leading to hyperglycemia and increased insulin requirement. | Major |
| Thiazolidinediones (e.g., Pioglitazone) | Increased risk of fluid retention and heart failure, especially in combination with insulin. | Major |
| Alcohol | Potentiates glucose-lowering effect, increasing risk of hypoglycemia, which can be delayed and prolonged. | Major |
| ACE Inhibitors (e.g., Ramipril), MAOIs, Octreotide | May increase hypoglycemic effect. | Moderate |
| Oral Hypoglycemics (Sulfonylureas, Meglitinides) | Additive hypoglycemic effect, increasing hypoglycemia risk. | Major |
| Thyroid hormones, Diuretics (Thiazides, Loop) | May decrease glucose-lowering effect, increasing insulin requirement. | Moderate |
Same composition (Insulin Degludec (2.56mg/1ml) + Insulin Aspart (1.05mg/1ml)), different brands: