Degludec

Insulin degludec is a long-acting basal insulin analog used to improve glycemic control in people with diabetes mellitus. It is available as a once-daily injectable monotherapy under the brand name Tresiba in many countries and as part of the fixed-dose combination product Ryzodeg (70% degludec / 30% insulin aspart). It is approved for use in adults and, in some regions, pediatric patients, for type 1 diabetes and type 2 diabetes.

Degludec achieves its ultra-long action through pharmacokinetic and pharmacodynamic properties that create a stable, nearly peakless insulin exposure. After subcutaneous injection, it forms multi-hexamer complexes in the subcutaneous tissue, which slowly disassemble to release active insulin degludec monomers. This depot effect yields a long duration of action, typically extending beyond 42 hours, with a flat time–action profile and relatively low day-to-day variability.

The onset of action is gradual, with detectable effects within about an hour, but the overall profile is designed to cover basal insulin needs with minimal pronounced peaks. Dosing is individualized and can be scheduled flexibly in many patients, commonly as a once-daily injection at a regular time of day. The combination product Ryzodeg provides both basal and prandial coverage in a single injection.

Common adverse effects include hypoglycemia, weight gain, and injection-site reactions. Other possible effects are edema or lipodystrophy at the injection site, and rare hypersensitivity reactions. Contraindications include known hypoglycemia and hypersensitivity to insulin degludec or excipients; safety in pregnancy should be assessed by a clinician on a case-by-case basis.