Insulin Degludec (Tresiba)

Clinical Summary

Insulin degludec is an ultra-long-acting basal insulin analog with a half-life of approximately 25 hours, providing flat and stable glucose-lowering effect over 42+ hours. Marketed as Tresiba by Novo Nordisk.

Long-term continuous medication confirmed. Documented on both November 2022 medication list ("Tresiba") and May 2026 handwritten prescription at the same dose (10 units SC once daily morning). Dose unchanged across at least 3.5 years.

Dosing History

[!info] Long-Term Continuity: at least Nov 2022 → May 2026
Dose unchanged at 10 units. In 2022, this was the only basal insulin. The second basal insulin Insulin Glargine (Glin) was added at an unknown date between Nov 2022 and May 2026 — rationale unknown.

By 2026 Ishamma is on BOTH degludec (Tresiba) AND glargine (Glin). This is not standard practice. The addition of glargine after 2022 suggests inadequate glycemic control on degludec alone, but this is undocumented.

Indication

Type 2 Diabetes Mellitus. Ishamma's HbA1c was 6.7–6.8% (diabetic range) in 2025. Most recent HbA1c 5.7% (Mar 2026) appears spuriously low due to AML-related RBC turnover; fructosamine 310 µmol/L (Apr 2026, HIGH) confirms ongoing poor glycemic control.

Basal insulin provides 24-hour background glucose control.

Pharmacology

• Drug class: Ultra-long-acting basal insulin analog
• Mechanism: Binds to insulin receptors, facilitates cellular glucose uptake, suppresses hepatic glucose production
• Half-life: ~25 hours (allows once-daily dosing at any time of day)
• Duration: Stable effect over 42+ hours
• Onset: 1 hour
• Peak: Minimal peak (flat profile)

Dosing Considerations

• Typical starting dose: 10 units once daily (matches current dose)
• Titrate by 2 units every 3–7 days to fasting glucose target
• Can be given at any consistent time of day
• Dose requirements may increase during acute illness, stress, infection

Monitoring

• Fasting blood glucose (preferred over HbA1c in AML setting)
• Fructosamine (reflects 1–2 week glycemic control, not affected by RBC turnover)
• Hypoglycemia symptoms/episodes
• Injection site reactions

Drug Interactions

• Azacitidine/Venetoclax: No direct pharmacokinetic interaction. However, AML treatment may alter insulin requirements due to:
• Changes in appetite/nutrition
• Steroid co-administration (if any — prednisolone documented in same Rx)
• Infection/inflammation

• Renal/hepatic function changes

• Prednisolone: Corticosteroids cause hyperglycemia and insulin resistance — insulin dose requirements may increase during steroid therapy. See Prednisolone.

Adverse Effects

• Hypoglycemia (most common)
• Weight gain
• Injection site reactions (lipohypertrophy, lipoatrophy)
• Hypokalemia (insulin drives K+ intracellularly)

Storage

• Unopened vials/pens: Refrigerate 2–8°C
• In-use pens: Room temperature (up to 30°C) for 56 days

Related

• Diabetes Mellitus — Primary indication
• Insulin Glargine — Alternative basal insulin (may be "Glin" on same Rx)
• Fructosamine — Preferred glycemic marker in AML setting
• Hba1C — Unreliable in AML due to altered RBC turnover
• Prednisolone — May increase insulin requirements if co-administered

Medication page created during ingest of 2026-05-04 handwritten prescription.