Insulin Degludec + Insulin Aspart

Insulin degludec + insulin aspart is a combination of two insulin analogues used to help control blood glucose in people with diabetes mellitus. It is commonly available as a fixed-ratio formulation containing 70% insulin degludec and 30% insulin aspart. Insulin degludec is an ultra-long-acting basal insulin that provides sustained insulin activity between meals and overnight. Insulin aspart is a rapid-acting insulin that starts working relatively quickly and helps control the rise in blood glucose after meals. Both components act through insulin receptors, helping glucose move from the bloodstream into muscle and fat cells while reducing glucose production by the liver. The combination is administered by subcutaneous injection, generally with a main meal once or twice daily according to the prescribed regimen and individual requirements. By combining basal and mealtime insulin in one preparation, it can provide coverage for both background insulin needs and meal-related glucose increases. It may be used in type 1 or type 2 diabetes according to the relevant product authorization and treatment plan. Because the two insulins are combined in a fixed ratio, their doses cannot be adjusted independently within the same injection. Careful dose selection, consistent meal timing, glucose monitoring, and education about low blood glucose are important for safe treatment.

Insulin degludec and insulin aspart were developed using recombinant DNA technology to produce insulin analogues with different action profiles. Insulin degludec forms multi-hexamers after subcutaneous injection, creating a depot that releases insulin gradually over an extended period. Insulin aspart is absorbed more rapidly and provides mealtime glucose control. Their fixed-ratio combination is marketed in several countries as Ryzodeg, commonly formulated as 70 units of insulin degludec and 30 units of insulin aspart per 100 units of insulin. The European Medicines Agency granted marketing authorization for Ryzodeg in the European Union on 21 January 2013 for diabetes treatment in adults, adolescents, and children aged 2 years and older. The United States Food and Drug Administration approved Ryzodeg 70/30 on 25 September 2015 to improve glycaemic control in adults with diabetes. Clinical development included randomized studies in type 1 and type 2 diabetes assessing glycated haemoglobin, glucose control, and hypoglycaemia. Product availability, approved age groups, and prescribing information can differ by country and should be checked against the applicable local authorization.

Insulin degludec + insulin aspart is used to improve blood glucose control in people with diabetes mellitus when insulin treatment is required. Depending on the local product authorization, it may be prescribed for type 1 diabetes or type 2 diabetes. In type 1 diabetes, the combination may provide basal insulin and coverage for one or more meals, but additional rapid-acting insulin may be needed for other meals. In type 2 diabetes, it may be used alone as an insulin regimen or alongside selected non-insulin glucose-lowering medicines when clinically appropriate. The fixed-ratio formulation is intended to address both background insulin requirements and meal-related increases in blood glucose. It is not intended to treat diabetic ketoacidosis, and it should not be used when the patient’s clinical needs require independent adjustment of the two insulin components that the fixed ratio cannot provide.

Insulin degludec + insulin aspart is administered by subcutaneous injection using the specific product’s approved pen or presentation. It is generally given with a main meal once or twice daily, according to the prescribed regimen, blood glucose results, previous insulin treatment, food intake, physical activity, and individual insulin requirements. The dose must be individualized by a qualified healthcare professional and adjusted according to glucose monitoring and changes in clinical circumstances. The injection should be given in approved sites such as the abdomen, thigh, or upper arm, with sites rotated to reduce the risk of lipodystrophy. Follow the product-specific instructions for injection timing, handling, and resuspension if required; do not assume that different insulin formulations have identical preparation instructions. It must not be administered intravenously or used in an insulin pump unless the specific product information explicitly permits that method. Patients should not change or omit doses without professional guidance, and should understand how to manage missed meals and low blood glucose.

The most common side effect of insulin degludec + insulin aspart is hypoglycaemia, or low blood glucose. Symptoms may include sweating, trembling, hunger, dizziness, palpitations, headache, irritability, or difficulty concentrating. Other possible effects include weight gain, injection-site redness or discomfort, itching, and changes in the fatty tissue beneath the skin, such as lipohypertrophy or lipoatrophy. Swelling may occur in some patients, particularly after changes in glucose control or insulin treatment. The frequency and severity of side effects vary with the dose, meal timing, physical activity, kidney or liver function, and other medicines. Patients should monitor glucose as advised, rotate injection sites, and discuss recurrent symptoms or unexplained glucose fluctuations with their healthcare professional.

Severe hypoglycaemia can cause confusion, seizures, loss of consciousness, or life-threatening complications and requires prompt treatment. Insulin can also cause hypokalaemia, meaning a reduction in blood potassium, which may be serious in susceptible patients. Rarely, severe allergic reactions may occur. Changes in insulin dose, meal intake, physical activity, illness, or kidney and liver function can alter glucose requirements and increase the risk of hypoglycaemia or hyperglycaemia. Giving the wrong insulin product or dose, repeating an injection unintentionally, or confusing insulin concentrations can lead to serious harm. The fixed 70:30 ratio limits the ability to adjust basal and mealtime insulin separately, so this formulation may not suit every treatment requirement. It is not for treating diabetic ketoacidosis. Patients should seek urgent medical assistance for severe hypoglycaemia, serious allergic symptoms, or signs of a major metabolic emergency. Treatment should only be changed under appropriate medical guidance.

Before starting treatment, clinicians should review the patient’s diabetes type, current insulin regimen, glucose records, history of hypoglycaemia, meal patterns, physical activity, and kidney and liver function. Additional care may be needed in older adults and people with renal or hepatic impairment, because insulin requirements can change. Pregnancy, breastfeeding, acute illness, changes in diet or activity, and changes in body weight may also affect dosing needs. Other glucose-lowering medicines can increase the risk of hypoglycaemia when used with insulin. Corticosteroids, some diuretics, thyroid hormones, sympathomimetic medicines, and certain antipsychotics may alter glucose control or insulin requirements. Beta blockers may mask some warning signs of hypoglycaemia. Alcohol can increase or prolong the risk of low blood glucose. Patients should be taught how to recognize and manage hypoglycaemia, maintain consistent meal planning, rotate injection sites, and follow product-specific storage instructions. Insulin pens and needles must not be shared.

Before prescribing or dispensing, confirm the exact formulation, insulin ratio, concentration, delivery device, and prescribed dose to reduce medication errors. Assess whether the patient’s basal and mealtime insulin needs can reasonably be managed by a fixed-ratio product. Review glucose records and hypoglycaemia history before dose adjustments, and provide clear instructions about injection timing, meal coordination, site rotation, and what to do if a meal is delayed or missed. Explain that the two components cannot be independently titrated within the same injection and that additional mealtime insulin may be necessary in some treatment plans. Reinforce glucose monitoring and provide an individualized plan for managing hypoglycaemia, including when to seek emergency assistance. Check for changes in kidney or liver function, illness, physical activity, diet, and concurrent medicines that may affect insulin requirements. Pharmacists should verify the product label and local authorization, demonstrate correct pen use, and counsel patients on storage, expiry, safe needle disposal, and avoiding product or dose confusion.