Insulin degludec is a long-acting basal insulin analogue used for the management of diabetes mellitus. It is produced by recombinant DNA technology in Saccharomyces cerevisiae (baker's yeast). Its unique structure involves the deletion of threonine at position B30 and the addition of a 16-carbon fatty diacid chain (hexadecanedioic acid) via a glutamic acid linker to lysine at position B29. This modification allows for the formation of multi-hexamers upon subcutaneous injection, creating a soluble depot from which insulin monomers are slowly and continuously released, resulting in an ultra-long and stable pharmacokinetic profile with a duration of action exceeding 42 hours.
Adult: Dose is individualized based on metabolic needs, blood glucose monitoring, and glycemic control goals. Typically initiated at 10 IU once daily or at 0.1-0.2 IU/kg/day in insulin-naïve patients. Titrated based on fasting blood glucose (FBG) targets.
Note: For subcutaneous injection only. Administer once daily at any time of day, but consistently at the same time each day. Rotate injection sites (thigh, abdomen, or upper arm) to prevent lipodystrophy. Do not administer intravenously or intramuscularly. Do not mix with other insulins in the same syringe. Use a new needle for each injection.
Insulin degludec binds to the insulin receptor on target cells (primarily liver, muscle, and adipose tissue), initiating a cascade of intracellular signaling events. This leads to increased cellular uptake of glucose, promotion of glycogen, fat, and protein synthesis, and inhibition of gluconeogenesis and lipolysis, thereby lowering blood glucose levels.
Pregnancy: Pregnancy Category C. Limited human data. Insulin is the drug of choice for glycemic control in pregnancy. Use only if clearly needed and under strict medical supervision. Dose requirements may decrease in first trimester and increase in second/third trimesters.
Driving: Caution advised. Hypoglycemia can impair concentration and reaction time. Patients should check blood glucose before driving and avoid driving if hypoglycemic or if warning symptoms occur.
| Other Antidiabetic Agents (Sulfonylureas, Meglitinides, SGLT2 inhibitors, GLP-1 RAs) | Additive glucose-lowering effect, increased risk of hypoglycemia. | Major |
| Corticosteroids (e.g., Prednisolone, Dexamethasone) | Antagonize insulin effect, leading to hyperglycemia and increased insulin requirement. | Major |
| Beta-blockers (e.g., Propranolol) | May mask tachycardia (a warning sign of hypoglycemia) and potentially impair counter-regulatory response. | Moderate |
| Thiazide Diuretics | May cause hyperglycemia, increasing insulin requirement. | Moderate |
| Alcohol | Potentiates glucose-lowering effect, increasing risk of delayed hypoglycemia. | Major |
| MAO Inhibitors, ACE Inhibitors | May potentiate hypoglycemic effect. | Moderate |
| Atypical Antipsychotics (e.g., Olanzapine) | May cause hyperglycemia, increasing insulin requirement. | Moderate |
Same composition (Insulin Degludec (100IU)), different brands: