Part 3: Insulin - What you need to know
The Family Centre’s diabetes educator Amy Rush is back with the final instalment of her three-part series on insulins. Read on to understand two of the newer insulins on the Australian market that have ultra-long action: Tresiba and Ryzodeg.
Tresiba: Ultra-long-acting insulin Tresiba, which is made by Danish company Novo Nordisk, was approved by the Australian regulator in 2018 and is the first ‘ultra-long-acting’ insulin. It is a consistent and virtually peak-free insulin that lasts for up to 42 hours. Pros Tresiba’s stable, flat profile may benefit people who experience overnight hypoglycaemia. Indeed, some research shows that Tresiba can decrease overnight hypoglycaemia rates by up to 25% compared with Lantus (Lantus and other long-acting insulins were discussed in last month’s Tribe Talk here). Cons Basal (background insulin) requirements change for many people over the course of the day, and the ultra-long-acting nature of Tresiba may make adjusting for changing basal needs challenging; what works to stay stable overnight may be too much to have on board for lots of activity the following day. As such, Tresiba may be a good insulin for people who don't vary their activity levels from day to day very much. Although Tresiba was approved for use in Australia in 2018, it not available on the Pharmaceutical Benefits Scheme (PBS), which did not find that Tresiba was safer or more cost-effective than other long-acting insulins that are available on the PBS. However, Tresiba is available in Australia as part of the mixed insulin Ryzodeg, which is on the PBS. Mixed insulin: Ryzodeg Ryzodeg is a mixed insulin, containing 30% Novorapid (a rapid-acting insulin used to cover carbohydrates) and 70% Tresiba. It can be taken once a day with the main meal or twice daily - in both cases, you may need to also give rapid-acting insulin for other meals. The amount of Ryzodeg is calculated based on how many grams of carbohydrate are consumed in the meal with which it is being taken, to ensure that the Novorapid in the dose effectively covers the carbohydrate. Ryzodeg is on the PBS and is available for people aged 18 and over. Pros For Australians who want the benefits of the peak-free ultra-long-acting insulin Tresiba, the options are to either buy it with no PBS subsidy or try it by using Ryzodeg. The benefits of Tresiba’s flat profile include a lower risk of overnight hypoglycaemia compared with other long-acting insulins. Cons Dosing Ryzodeg can be challenging because the amount of ultra-long-acting insulin is locked up with the dose of rapid-acting insulin you need. To eat a meal that is high in carbohydrates you’ll need a significant dose of rapid, which means you’ve automatically got more long-acting on board because they’re mixed. It’s best to work with your endocrinologist and diabetes educator to learn how to best dose Ryzodeg. This three-part series has covered the insulins available to Australians with type 1. At the Family Centre, we believe people with type 1 should have access to information about the wide range of tools at their disposal: different insulins, insulin delivery devices, ways to test and measure blood glucose, and dietary approaches that can support blood glucose management. Deeply understanding the tools helps us to build and adapt regimens that suit our lifestyles, and thrive with type 1.