Dr. Ahmed The Tresiba to Lantus Conversion guidelines are discussed here. It is a common practice to change from one insulin formulation to another, especially when the blood sugars are not controlled.
It is important to keep in mind that these guidelines are meant for the initial dose conversion. Patients and caregivers need to adjust their insulin doses according to their blood glucose levels.
What is Tresiba?
Tresiba or Degludec is a long-acting Insulin with a duration of action of about 36 hours. It is considered to be ultra-long-acting insulin that is administered once daily as basal insulin.
Like all other basal insulins, it is not intended to control post-meal blood glucose spikes. It only provides basal coverage that primarily lowers the pre-meals or fasting blood glucose levels.
Unlike all other basal insulins, which have to be administered at a fixed time of the day, insulin Tresiba (Degludec) can be administered at any time of the day.
Tresiba is also available in combination with Insulin Aspart under the brand name Ryzodeg. Ryzodeg is usually administered before the major meal of the day.
Ryzodeg is especially best for individuals who consume one large meal throughout the day and during the holy month of Ramadan.
The insulin Aspart in Ryzodeg covers the post-meal glucose spikes while the Degludec provides basal coverage throughout the day.
What is Insulin Glargine?
Insulin glargine is also a basal insulin and has a longer duration of action of about 32 hours. It is available in different formulations:
Insulin Lantus Solostar:
- It contains 100 units per ml
- The disposable pen contains 300 units of insulin
Insulin Toujeo Solostar
- It contains 300 units per ml
- The disposable pen contains 450 units per pen
Insulin Toujeo Max Solostar:
- It contains 900 units per pen
- The concentration of insulin is the same as Toujeo Solostar (300 units per ml)
Insulin Lantus is a basal insulin, like insulin Tresiba (Degludec), and does not cover the post-meal glucose spikes.
Unlike Insulin Tresiba, it has to be administered at a fixed time of the day. Toujeo Insulin is the concentrated form of Lantus, although it contains the same insulin glargine.
Unlike Insulin Lantus, Toujeo Insulin can be administered with some flexibility in the timing.
Tresiba to Lantus Conversion Dosing Guidelines (ADA, European Diabetes Association, JDRF) [Ref]:
When converting from one long-acting basal insulin to another (such as Tresiba to Lantus), some diabetes experts do not recommend dosage adjustment.
This is especially true when switching from glargine to detemir or detemir to glargine.
According to the ADA (American Diabetes Association), Endocrine Society, and JDRF, the following guidelines have been recommended when switching from Tresiba to Lantus, Lantus to Tresiba, or switching from one basal insulin to another basal insulin:
Switching from one basal Insulin analog to another one | |||
Basal Insulin from | TO | Basal Insulin To | Recommendations |
| Injection Levemir (Detemir) | ⇒ ⇒ |
| NPH Insulin dose is reduced by 20%, and the dose is split into two equal halves, depending on the meal frequency: For Example: A person on 40 units of basal insulin may be switched to 32 units of NPH insulin. The total dose is then divided into two equal halves administered in the morning and evening. In this case, 16 units before breakfast and 16 units before dinner |
| ⇒ ⇒ | Insulin NPH | NPH Insulin dose is reduced by 20%, and the dose is split into two equal halves, depending on the meal frequency: For Example: A person on 40 units of basal insulin may be switched to 32 units of NPH insulin. The total dose is then divided into two equal halves administered in the morning and evening. In this case, 16 units before breakfast and 16 units before dinner |
| Tresiba (Degludec) | ⇒ ⇒ |
| When switching from insulin Tresiba to Lantus or another basal insulin, a 20% reduction in the dose is recommended. For example, 40 units of Tresiba are switched to 32 units of Lantus or Toujeo. However, if the dose of Tresiba used was more than 80 units per day, the dose of total basal insulin is divided into two equal halves and administered twice daily. For example: Injection Tresiba 100 units is reduced by 20%. The total daily basal insulin dose will be 80 units, which will be administered as 40 units in the morning and 40 units in the evening. |
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