This article is sponsored by Novo Nordisk.
Please see Prescribing Information for Tresiba® (insulin degludec injection).

Tresiba® (insulin degludec injection) 100 U/mL and 200 U/mL is a once-daily, long-acting insulin indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus.1 During patient counseling on Tresiba®, pharmacists are ideally positioned to address several important points regarding administration, its safety profile, starting dose and dosing, as well as storage. Pharmacists can also provide eligible patients with information on financial assistance programs available for Tresiba®.

ADMINISTRATION AND DOSING
Tresiba® is injected subcutaneously once daily, and it is available in more administration options than any other basal insulin:
1) Tresiba® FlexTouch® U-100, 2) Tresiba® FlexTouch® U-200, and 3) U-100 multiple-dose, 10-mL vial (TABLE).1-5 Instruct patients that the recommended time between dose increases is 3 to 4 days.1



Adult Patients
With a 1:1 dose conversion, adults already taking insulin can start on the same unit dose of Tresiba® as their current basal insulin and administer their injection of Tresiba® at any time of day.1 Tresiba® is the only basal insulin that gives adult patients the option to change day-to-day dose timing if needed.1-5 During counseling, instruct adult patients to ensure that at least 8 hours have elapsed between consecutive Tresiba® injections.1 Advise adult patients who miss a dose of Tresiba® to inject their daily dose during waking hours upon discovering the missed dose and to then continue with their regular dosing schedule.1

Pediatric Patients
Tresiba® U-100 is the only basal insulin indicated for type 1 and type 2 diabetes in children as young as 1 year of age.1-5 In pediatric patients, Tresiba® is started at 80% of the current dose of basal insulin to minimize the risk of hypoglycemia and is titrated every 3 to 4 days.1 Tresiba® must be dosed at the same time each day for pediatric patients.1 If a dose of Tresiba® is missed, instruct pediatric patients and their caregivers to contact their health care provider for guidance and to monitor blood glucose levels more frequently until the next scheduled dose.1

STORAGE
Tresiba® vials should be stored in the original packaging and protected from light. Unused Tresiba® products should be refrigerated until use and may be used up until their labeled expiration date, at which point they should not be used. Once opened and in use, Tresiba® can be kept at room temperature (below 86ºF) or be refrigerated (36ºF to 46ºF) for up to 8 weeks, after which it should not be used. Advise patient that they should not freeze Tresiba®.1

PATIENT SUPPORT AND RESOURCES
Affordability and access can be important considerations for a pharmacist to address when counseling patients starting treatment with a basal insulin. NovoCare® is a resource that provides information on copay cards and patient assistance programs available for patients who are starting or currently using Tresiba®. Pharmacists can also use NovoCare® for benefit verification, prior authorization assistance, and appeals support.

With the Tresiba® Instant Savings Card, eligible commercially insured patients may pay as little as $5 per 30-day supply for up to 24 months (maximum savings of $150 per 30-day supply). Full eligibility and other restrictions apply and can be found by visiting NovoCare.com/eligibility/diabetes-savings-card.html. The Novo Nordisk Patient Assistance Program provides medication at no cost to those who qualify. Full eligibility requirements can be found by visiting NovoCare.com/psp/PAP.html.

Pharmacists can encourage patients taking Tresiba® to register for personalized support through Cornerstones4Care®, a free support program offered by Novo Nordisk to help patients manage their diabetes. This program includes personal phone calls with a Certified Diabetes Educator, access to online coaching sessions, and tools, trackers, and diabetes-friendly recipes.

Visit Tresibapro.com for professional resources and more information for pharmacists.

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.

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, Needle, or Syringe Between Patients, even if the needle is changed. Patients using Tresiba® vials should never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens
  • Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, or site or method of administration) may affect glycemic control and predispose to hypoglycemia  or hyperglycemia. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia. Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia. 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 see Prescribing Information for Tresiba® (insulin degludec injection).
REFERENCES
  1. Tresiba [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; 2018.
  2. Lantus [prescribing information]. Bridgewater, NJ: sanofi-aventis US LLC; 2018.
  3. Levemir [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; 2019.
  4. Toujeo [prescribing information]. Bridgewater, NJ: sanofi-aventis US LLC; 2019.
  5. Basaglar [prescribing information]. Indianapolis, IN: Lilly USA LLC; 2018.

Cornerstones4Care®, FlexTouch®, NovoFine®, and Tresiba® are registered trademarks and Novo Nordisk is a registered trademark of Novo Nordisk A/S.
All other trademarks, registered or unregistered, are the property of their respective owners.
© 2019 Novo Nordisk                                                                         US19TSM00463 08/2019