Insulin degludec

Identification

Summary

Insulin degludec is a long acting insulin used to treat hyperglycemia caused by type 1 and 2 diabetes mellitus.

Brand Names

Ryzodeg, Tresiba, Xultophy

Generic Name

Insulin degludec

DrugBank Accession Number

DB09564

Background

Insulin degludec is an ultra-long-acting form of insulin used for the treatment of hyperglycemia caused by Type 1 and Type 2 Diabetes.^1,2,3,4,5 Insulin is typically prescribed for the management of diabetes mellitus to mimic the activity of endogenously produced human insulin, a peptide hormone produced by beta cells of the pancreas that promotes glucose metabolism.^1,2,3,4,5 Insulin is released from the pancreas following a meal to promote the uptake of glucose from the blood into internal organs and tissues such as the liver, fat cells, and skeletal muscle.^1,2,3,4,5 Absorption of glucose into cells allows for its transformation into glycogen or fat for storage.^1,2,3,4,5 Insulin also inhibits hepatic glucose production, enhances protein synthesis, and inhibits lipolysis and proteolysis among many other functions.^1,2,3,4,5

Insulin is an essential treatment in the management of Type 1 Diabetes (T1D) which is caused by an autoimmune reaction that destroys the beta cells of the pancreas, resulting in the body not being able to produce or synthesize the insulin needed to manage circulating blood sugar levels.^1,2,3,4,5 As a result, people with T1D rely primarily on exogenous forms of insulin, such as insulin degludec, to lower glucose levels in the blood.^1,2,3,4,5 Insulin is also used in the treatment of Type 2 Diabetes (T2D), another form of diabetes mellitus that is a slowly progressing metabolic disorder caused by a combination of genetic and lifestyle factors that promote chronically elevated blood sugar levels.^1,2,3,4,5 Without treatment or improvement in non-pharmacological measures such as diet and exercise to lower blood glucose, high blood sugar eventually causes cellular resistance to endogenous insulin, and in the long term, damage to pancreatic islet cells.^1,2,3,4,5 Insulin is typically prescribed later in the course of T2D, after several oral medications such as Metformin, Gliclazide, or Sitagliptin have been tried, when sufficient damage has been caused to pancreatic cells that the body is no longer able to produce insulin on its own.^1,2,3,4,5

Marketed as the brand name product Tresiba, insulin degludec has a duration of action up to 42 hours allowing for once-daily dosing, typically at bedtime.^1,2,3,4,5 Due to its duration of action, Tresiba is considered "basal insulin" as it provides low concentrations of background insulin that can keep blood sugar stable between meals or overnight.^1,2,3,4,5 Basal insulin is often combined with short-acting "bolus insulin" such as Insulin lispro, Insulin glulisine, or Insulin aspart to provide higher doses of insulin required following meals. Use of basal and bolus insulin together is intended to mimic the pancreas' production of endogenous insulin, with the goal of avoiding any periods of hypoglycemia.^1,2,3,4,5

Compared to endogenous insulin, insulin degludec has an added hexadecanedioic acid on lysine at the B29 position, allowing for the formation of multi-hexamers.^1,2,3,4,5 When injected subcutaneously, these multi-hexamers form a drug depot store from which monomers are slowly and continuously absorbed into circulation.^1,2,3,4,5 As a result, Insulin Degludec has a protracted time action profile due to the delayed absorption from subcutaneous tissue depots into the systemic circulation.^1,2,3,4,5 Compared to available long-acting analogs such as Insulin glargine and Insulin detemir, which have a duration of action of 20-24 hours, insulin degludec provides a consistent level of basal insulin over 42 hours with a low peak: trough ratio.^1,2,3,4,5 Limitations of shorter-acting analogs include more frequent dosing and less stable pharmacokinetics, which may negatively impact patient adherence and glucose control, particularly nocturnal control.^1,2,3,4,5

Without an adequate supply of insulin to promote absorption of glucose from the bloodstream, blood sugar levels can climb to dangerously high levels and can result in symptoms such as fatigue, headache, blurred vision, and increased thirst.^1,2,3,4,5 If left untreated, the body starts to break down fat, instead of glucose, for energy which results in a build-up of ketone acids in the blood and a syndrome called ketoacidosis, which is a life-threatening medical emergency. In the long term, elevated blood sugar levels increase the risk of heart attack, stroke, and diabetic neuropathy.^1,2,3,4,5

Insulin Degludec was approved by the FDA in September 2015 as the product Tresiba, for use in providing glycemic control to adults with diabetes mellitus.

Type

Biotech

Groups

Approved

Biologic Classification

Protein Based Therapies
Hormones / Insulins

Protein Structure

Protein Chemical Formula

C₂₇₄H₄₁₁N₆₅O₈₁S₆

Protein Average Weight

6103.97 Da

Sequences

>A Chain
GIVEQCCTSICSLYQLENYCN

>B Chain
FVNQHLCGSHLVEALYLVCGERGFFYTPK

References:

1. FDA Approved Drug Products: Tresiba (insulin degludec) for subcutaneous injection [Link]

Download FASTA Format

Synonyms

• Insulin degludec
• Insulina degludec

External IDs

• NN-1250
• NN1250

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Pharmacology

Indication

Insulin degludec is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus.¹⁰

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Associated Conditions

Indication Type	Indication	Combined Product Details	Approval Level	Age Group	Patient Characteristics	Dose Form
Used in combination to manage	Diabetes mellitus	Combination Product in combination with: Insulin aspart (DB01306)	••••••••••••	••••••••••• •••••• ••••••••		•••••••••• ••••••••
Management of	Diabetes mellitus		••••••••••••	•••••		•••••••••• ••••••••
Management of	Diabetes mellitus		••••••••••••	•••••• ••••••••		•••••••••• ••••••••
Management of	Diabetes mellitus type 1		••••••••••••	•••••••••		•••••••••• ••••••••
Used as adjunct in combination to manage	Type 2 diabetes mellitus	Combination Product in combination with: Liraglutide (DB06655)	••••••••••••	•••••	•••••••••••• •••• •••• •• ••••• •••••••••••	•••••••••• ••••••••

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Pharmacodynamics

Insulin is a natural hormone produced by beta cells of the pancreas. In nondiabetic individuals, the pancreas produces a continuous supply of low basal insulin levels and spikes of insulin following meals.^1,2,3,4,5 Increased insulin secretion following meals is responsible for the metabolic changes that occur as the body transitions from a postabsorptive to an absorptive state.^1,2,3,4,5 Insulin promotes cellular uptake of glucose, particularly in muscle and adipose tissues, promotes energy storage via glycogenesis, opposes catabolism of energy stores, increases DNA replication and protein synthesis by stimulating amino acid uptake by the liver, muscle and adipose tissue, and modifies the activity of numerous enzymes involved in glycogen synthesis and glycolysis.^1,2,3,4,5 Insulin also promotes growth and is required for the actions of growth hormone (e.g. protein synthesis, cell division, DNA synthesis).^1,2,3,4,5 Insulin detemir is a long-acting insulin analogue with a flat and predictable action profile.^1,2,3,4,5 It mimics the basal insulin levels in diabetic individuals. The onset of action of insulin detemir is 1 to 2 hours and its duration of action is up to 24 hours. Interestingly, it has a lower affinity (30%) for the insulin receptor than human insulin.^1,2,3,4,5

Mechanism of action

Insulin detemir binds to the insulin receptor (IR), a heterotetrameric protein consisting of two extracellular alpha units and two transmembrane beta units.⁸ The binding of insulin to the alpha subunit of IR stimulates the tyrosine kinase activity intrinsic to the beta subunit of the receptor.⁸ The bound receptor autophosphorylates and phosphorylates numerous intracellular substrates such as insulin receptor substrates (IRS) proteins, Cbl, APS, Shc, and Gab 1.⁸ Activation of these proteins leads to activation of downstream signaling molecules including PI3 kinase and Akt.⁸ Akt regulates the activity of glucose transporter 4 (GLUT4) and protein kinase C (PKC), both of which play critical roles in metabolism and catabolism.⁸

Target	Actions	Organism
AInsulin receptor	agonist	Humans
UInsulin-like growth factor 1 receptor	activator	Humans

Absorption

In patients with type 1 diabetes, after 8 days of once-daily subcutaneous dosing with 0.4 U/kg, maximum insulin degludec concentrations of 4472 pmol/L were attained at a median of 9 hours (t_max).¹⁰ After the first dose, the median onset of appearance was around one hour. The glucose-lowering effect lasted at least 42 hours after the last of 8 once-daily injections. Insulin degludec concentration reaches steady-state levels after 3-4 days.¹⁰

Volume of distribution

Using a one-compartment pharmacokinetics model, the apparent volume of distribution was estimated to be 10.6 L for the pediatric population and 13.9 L for the adult population.¹⁴

Protein binding

The affinity of insulin degludec to serum albumin corresponds to a plasma protein binding of >99% in human plasma.¹⁰ The results of the in vitro protein binding studies demonstrate that there is no clinically relevant interaction between insulin degludec and other protein-bound drugs.¹⁰

Metabolism

All insulin degludec metabolites are inactive.¹⁰ The liver and kidney play the major role in metabolizing insulin.⁷However, while the liver predominantly metabolizes endogenous insulin, exogenous insulin is primarily metabolized due to the kidney since it is not directly delivered into the portal system.⁷

Route of elimination

30 to 80% of circulating insulin is removed by the kidney.⁶

Half-life

The half-life after subcutaneous administration is determined primarily by the rate of absorption from the subcutaneous tissue. On average, the half-life at a steady state is approximately 25 hours independent of dose.¹⁰

Clearance

The mean apparent clearance of insulin degludec is 0.03 L/kg (2.1 L/h in 70 kg individuals) after a single subcutaneous dose of 0.4 units/kg.¹⁰

Adverse Effects

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Toxicity

An excess of insulin relative to food intake, energy expenditure, or both may lead to severe and sometimes prolonged and life-threatening hypoglycemia and hypokalemia [see Warnings and Precautions (5.3, 5.6)]. Mild episodes of hypoglycemia can usually be treated with oral glucose. Lowering the insulin dosage and adjusting meal patterns or exercise may be needed. More severe episodes of hypoglycemia with coma, seizure, or neurologic impairment may be treated with glucagon for emergency use or concentrated intravenous glucose. After apparent clinical recovery from hypoglycemia, continued observation and additional carbohydrate intake may be necessary to avoid the reoccurrence of hypoglycemia. Hypokalemia must be corrected appropriately.¹⁰

Insulin degludec was investigated in studies covering fertility, embryo-fetal development, and pre and post-natal development in rats and during the period of embryo-fetal development in rabbits. Human insulin (NPH insulin) was included as a comparator. In these studies, insulin degludec caused pre and post-implantation losses and visceral/skeletal abnormalities when given subcutaneously at up to 21 U/kg/day in rats and 3.3 U/kg/day in rabbits, resulting in 5 times (rat) and 10 times (rabbit) the human exposure (AUC) at a human subcutaneous dose of 0.75 U/kg/day. Overall, the effects of insulin degludec were similar to those observed with human insulin, which was probably secondary to maternal hypoglycemia.¹⁰

Pathways

Not Available

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Not Available

Interactions

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This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drug	Interaction
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Acarbose	The risk or severity of hypoglycemia can be increased when Acarbose is combined with Insulin degludec.
Acebutolol	The therapeutic efficacy of Insulin degludec can be increased when used in combination with Acebutolol.
Acetazolamide	The risk or severity of hypoglycemia can be increased when Acetazolamide is combined with Insulin degludec.
Acetohexamide	The risk or severity of hypoglycemia can be increased when Acetohexamide is combined with Insulin degludec.
Acetophenazine	The therapeutic efficacy of Insulin degludec can be decreased when used in combination with Acetophenazine.

Food Interactions

• Avoid alcohol. Alcohol may impair blood glucose control.

Products

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Brand Name Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End	Region	Image
Insulin Degludec	Injection, solution	100 U/1mL	Subcutaneous	Novo Nordisk Pharma, Inc.	2022-07-01	Not applicable
Insulin Degludec	Injection, solution	100 U/1mL	Subcutaneous	Novo Nordisk Pharma, Inc.	2022-07-01	Not applicable
Insulin Degludec	Injection, solution	200 U/1mL	Subcutaneous	Novo Nordisk Pharma, Inc.	2022-07-01	Not applicable
Tresiba	Injection, solution	200 U/ml	Subcutaneous	Novo Nordisk	2016-09-08	Not applicable
Tresiba	Injection, solution	100 U/ml	Subcutaneous	Novo Nordisk	2016-09-08	Not applicable

Mixture Products

Name	Ingredients	Dosage	Route	Labeller	Marketing Start	Marketing End	Region	Image
RYZODEG	Insulin degludec (70 U/ML) + Insulin aspart (30 U/mL)	Injection, solution	Subcutaneous	Novo Nordisk	2014-07-08	Not applicable
Ryzodeg	Insulin degludec (2.56 mg/ml) + Insulin aspart (1.05 mg/ml)	Injection, solution	Subcutaneous	Novo Nordisk	2016-09-08	Not applicable
RYZODEG	Insulin degludec (70 U/ML) + Insulin aspart (30 U/mL)	Injection, solution	Subcutaneous	Novo Nordisk	2014-07-08	Not applicable
Ryzodeg	Insulin degludec (2.56 mg/ml) + Insulin aspart (1.05 mg/ml)	Injection, solution	Subcutaneous	Novo Nordisk	2016-09-08	Not applicable
RYZODEG	Insulin degludec (70 U/ML) + Insulin aspart (30 U/mL)	Injection, solution	Subcutaneous	Novo Nordisk	2014-10-06	Not applicable

Categories

ATC Codes

A10AD06 — Insulin degludec and insulin aspart

• A10AD — Insulins and analogues for injection, intermediate- or long-acting combined with fast-acting
• A10A — INSULINS AND ANALOGUES
• A10 — DRUGS USED IN DIABETES
• A — ALIMENTARY TRACT AND METABOLISM

A10AE56 — Insulin degludec and liraglutide

• A10AE — Insulins and analogues for injection, long-acting
• A10A — INSULINS AND ANALOGUES
• A10 — DRUGS USED IN DIABETES
• A — ALIMENTARY TRACT AND METABOLISM

A10AE06 — Insulin degludec

• A10AE — Insulins and analogues for injection, long-acting
• A10A — INSULINS AND ANALOGUES
• A10 — DRUGS USED IN DIABETES
• A — ALIMENTARY TRACT AND METABOLISM

Drug Categories

• Alimentary Tract and Metabolism
• Amino Acids, Peptides, and Proteins
• Blood Glucose Lowering Agents
• Cytochrome P-450 CYP1A2 Inducers
• Cytochrome P-450 CYP1A2 Inducers (strength unknown)
• Cytochrome P-450 Enzyme Inducers
• Drugs Used in Diabetes
• Hormones
• Hormones, Hormone Substitutes, and Hormone Antagonists
• Insulin
• Insulin Analog
• Insulin, Long-Acting
• Long-acting Insulins
• Pancreatic Hormones
• Peptide Hormones
• Peptides

Chemical TaxonomyProvided by Classyfire

Description

Not Available

Kingdom

Organic Compounds

Super Class

Organic Acids

Class

Carboxylic Acids and Derivatives

Sub Class

Amino Acids, Peptides, and Analogues

Direct Parent

Peptides

Alternative Parents

Not Available

Substituents

Not Available

Molecular Framework

Not Available

External Descriptors

Not Available

Affected organisms

Not Available

Chemical Identifiers

UNII

54Q18076QB

CAS number

844439-96-9

References

General References

1. Garber AJ, King AB, Del Prato S, Sreenan S, Balci MK, Munoz-Torres M, Rosenstock J, Endahl LA, Francisco AM, Hollander P: Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. Lancet. 2012 Apr 21;379(9825):1498-507. doi: 10.1016/S0140-6736(12)60205-0. [Article]
2. Wang F, Surh J, Kaur M: Insulin degludec as an ultralong-acting basal insulin once a day: a systematic review. Diabetes Metab Syndr Obes. 2012;5:191-204. doi: 10.2147/DMSO.S21979. Epub 2012 Jul 5. [Article]
3. Haahr H, Heise T: A review of the pharmacological properties of insulin degludec and their clinical relevance. Clin Pharmacokinet. 2014 Sep;53(9):787-800. doi: 10.1007/s40262-014-0165-y. [Article]
4. Jonassen I, Havelund S, Hoeg-Jensen T, Steensgaard DB, Wahlund PO, Ribel U: Design of the novel protraction mechanism of insulin degludec, an ultra-long-acting basal insulin. Pharm Res. 2012 Aug;29(8):2104-14. doi: 10.1007/s11095-012-0739-z. Epub 2012 Apr 7. [Article]
5. Thuillier P, Alavi Z, Kerlan V: Long-term safety and efficacy of insulin degludec in the management of type 2 diabetes. Diabetes Metab Syndr Obes. 2015 Oct 1;8:483-93. doi: 10.2147/DMSO.S54953. eCollection 2015. [Article]
6. Morello CM: Pharmacokinetics and pharmacodynamics of insulin analogs in special populations with type 2 diabetes mellitus. Int J Gen Med. 2011;4:827-35. doi: 10.2147/IJGM.S26889. Epub 2011 Dec 12. [Article]
7. Donner T, Sarkar S: Insulin - Pharmacology, Therapeutic Regimens, and Principles of Intensive Insulin Therapy . [Article]
8. De Meyts P: The Insulin Receptor and Its Signal Transduction Network . [Article]
9. FDA Approved Drug Products: Tresiba (insulin degludec) for subcutaneous injection [Link]
10. FDA Approved Drug Products: Tresiba (insulin degludec) for subcutaneous injection 2022 [Link]
11. FDA Approved Drug Products: XULTOPHY® 100/3.6 (insulin degludec and liraglutide) injection, for subcutaneous use [Link]
12. EMA Approved Drug Proucts: RYZODEG® 70/30 (insulin degludec and insulin aspart injection), for 7 subcutaneous use [Link]
13. Health Canada Approved Drug Proucts: Tresiba (insulin degludec) for subcutaneous injection [Link]
14. Clinical Pharmacology Review: Tresiba [Link]

External Links

KEGG Drug

D09727

PubChem Substance

347910463

RxNav

1670007

ChEMBL

CHEMBL2107869

RxList

RxList Drug Page

Drugs.com

Drugs.com Drug Page

Wikipedia

Insulin_degludec

FDA label

Download (7.77 MB)

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">

Phase	Status	Purpose	Conditions	Count
4	Active Not Recruiting	Treatment	Type 1 Diabetes Mellitus	2
4	Completed	Treatment	Nocturnal Hypoglycemia / Recurrent Severe Hypoglycaemia / Type 1 Diabetes Mellitus	1
4	Completed	Treatment	Type 1 Diabetes Mellitus	6
4	Completed	Treatment	Type 2 Diabetes Mellitus	8
4	Recruiting	Treatment	Diabetes Mellitus / Diabetic Kidney Disease (DKD)	1

Pharmacoeconomics

Manufacturers

Not Available

Packagers

Not Available

Dosage Forms

Form	Route	Strength
Injection, solution	Subcutaneous
Injection
Injection, solution	Subcutaneous	100 U/1mL
Injection, solution	Subcutaneous	200 U/1mL
Solution	Subcutaneous	100 unit / mL
Solution	Subcutaneous	100 U
Solution	Subcutaneous	200 unit / mL
Injection, solution	Subcutaneous
Solution	Subcutaneous	100 IU
Solution	Subcutaneous	10000000 IU
Injection, solution	Subcutaneous	100 U/ml
Injection, solution	Subcutaneous	200 U/ml
Solution	Subcutaneous	200 IU
Injection	Subcutaneous	100 IU/ml
Injection, solution	Parenteral; Subcutaneous
Solution	Subcutaneous
Injection	Subcutaneous
Injection, solution
Injection, solution	Subcutaneous	100 iu/1ml

Prices

Not Available

Patents

Patent Number	Pediatric Extension	Approved	Expires (estimated)	Region
US8672898	Yes	2014-03-18	2022-07-02
US8684969	Yes	2014-04-01	2026-04-20
US9132239	Yes	2015-09-15	2032-08-01
US8920383	Yes	2014-12-30	2027-01-17
US7686786	No	2010-03-30	2026-08-03
US6899699	Yes	2005-05-31	2022-07-01
US5866538	Yes	1999-02-02	2017-12-20
US9108002	Yes	2015-08-18	2026-07-26
US6458924	No	2002-10-01	2017-08-22
US6268343	Yes	2001-07-31	2023-02-22
US8846618	Yes	2014-09-30	2022-12-27
US7235627	No	2007-06-26	2017-08-22
US7615532	Yes	2009-11-10	2029-12-28
US9486588	Yes	2016-11-08	2022-07-02
US9457154	Yes	2016-10-04	2028-03-27
USRE46363	Yes	2017-04-11	2027-02-03
US8937042	Yes	2015-01-20	2029-11-05
US9687611	Yes	2017-06-27	2027-08-27
US9775953	Yes	2017-10-03	2027-01-17
US8579869	Yes	2013-11-12	2023-12-30
US7762994	Yes	2010-07-27	2024-11-23
US9884094	No	2018-02-06	2033-05-01
US9861757	Yes	2018-01-09	2026-07-20
US9616180	Yes	2017-04-11	2026-07-20
US10220155	Yes	2019-03-05	2027-01-17
US10357616	No	2019-07-23	2026-01-20
US10376652	No	2019-08-13	2026-01-20

Properties

State

Liquid

Experimental Properties

Not Available

Targets

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insights and accelerate drug research.

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Details1. Insulin receptor

Kind

Protein

Organism

Humans

Pharmacological action

Yes

Actions

Agonist

General Function

Receptor signaling protein tyrosine kinase activity

Specific Function

Receptor tyrosine kinase which mediates the pleiotropic actions of insulin. Binding of insulin leads to phosphorylation of several intracellular substrates, including, insulin receptor substrates (...

Gene Name

INSR

Uniprot ID

P06213

Uniprot Name

Insulin receptor

Molecular Weight

156331.465 Da

References

1. De Meyts P: The Insulin Receptor and Its Signal Transduction Network . [Article]

Details2. Insulin-like growth factor 1 receptor

Kind

Protein

Organism

Humans

Pharmacological action

Unknown

Actions

Activator

General Function

Protein tyrosine kinase activity

Specific Function

Receptor tyrosine kinase which mediates actions of insulin-like growth factor 1 (IGF1). Binds IGF1 with high affinity and IGF2 and insulin (INS) with a lower affinity. The activated IGF1R is involv...

Gene Name

IGF1R

Uniprot ID

P08069

Uniprot Name

Insulin-like growth factor 1 receptor

Molecular Weight

154791.73 Da

References

1. Wang F, Surh J, Kaur M: Insulin degludec as an ultralong-acting basal insulin once a day: a systematic review. Diabetes Metab Syndr Obes. 2012;5:191-204. doi: 10.2147/DMSO.S21979. Epub 2012 Jul 5. [Article]
2. Varewijck AJ, Janssen JA: Insulin and its analogues and their affinities for the IGF1 receptor. Endocr Relat Cancer. 2012 Sep 5;19(5):F63-75. doi: 10.1530/ERC-12-0026. Print 2012 Oct. [Article]

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Drug created at November 30, 2015 19:10 / Updated at September 05, 2022 12:50