Insulin Degludec and Liraglutide (Subcutaneous)

Overview

Diabetes mellitus occurs when the body's insulin is not produced or used properly. As insulin is used to metabolize glucose, patients without enough insulin are unable to process glucose effectively. This can result in episodes of hyperglycemia, or high blood sugar.

The symptoms associated with type 2 diabetes tend to occur fairly slowly but, over time, patients may complain of frequent urination, unexplained weight loss, increased thirst or hunger and fatigue. If left untreated, type 2 diabetes can increase the patient's risk of further health problems, such as stokes, heart attack, diabetic retinopathy and/or kidney failure. In addition to this, type 2 diabetes can affect blood circulation. If blood flow to the limbs is affected, patients can require amputations as a result of this condition.

Type 2 diabetes occurs when the patient is able to produce insulin but it is ineffective in controlling their blood sugar. In many cases, type 2 diabetes can be managed if the patient changes their lifestyle and their diet. If patients reduce the amount of sugar they consume, for example, their natural levels of insulin may be able to process the amount of glucose in their system effectively.

If this isn't possible or if the patient's condition is caused by insulin resistance, medication can be used to supplement the patient's levels of insulin. As insulin levels are increased, the patient's system is able to process and metabolize glucose effectively. As a result, the patient's blood sugar levels remain more stable and the symptoms of type 2 diabetes are reduced.

When Insulin Degludec is administered, it helps to keep the patient's blood sugar within a normal range. As a long-acting form of insulin, it tends to work across a 24 hour period and reduces the need for patients to administer insulin numerous times per day.

Although some patients are treated with only Insulin Degludec, Liraglutide can be used to form a combination medication. As a glucagon-like peptide-1 receptor agonist, Liraglutide can improve the patient's glucose control. When the body's glucose levels require it, Liraglutide will increase insulin secretion, suppress prandial glucagon secretion and delay gastric emptying.

As many patients can control type 2 diabetes with Insulin Degludec and/or lifestyle changes, Insulin Degludec and Liraglutide is most-commonly prescribed to patients who have been unable to achieve good blood sugar control via diet and insulin alone.

Conditions Treated

  • Type 2 diabetes

Type Of Medicine

  • Long-acting basal insulin analogue (Insulin Degludec)
  • Long-acting glucagon-like peptide-1 receptor agonist (Liraglutide)

Side Effects

When patients are prescribed medication, their doctor may warn them about the most common side effects associated with the particular drug they're using. Often, physicians are able to give advice which can help to reduce unpleasant side effects associated with the patient's treatment.

Often, when patients first start using a medication, their side effects will be more pronounced. Over time, however, these side effects tend to reduce. When patients first start using Insulin Degludec and Liraglutide, for example, they may experience the following side effects:

  • Body pain or aches
  • Loss of voice
  • Chills
  • Muscle aches
  • Diarrhea
  • Sneezing
  • Ear congestion
  • Sore throat
  • Runny or stuffy nose
  • Blistering, coldness, feeling of pressure, infection or hives at injection site
  • Numbness, bleeding, discoloration or skin, lumps, itching or pain at injection site
  • Tenderness, inflammation, ulceration, soreness or swelling at injection site
  • Rash, burning, scarring, redness, warmth or tingling at injection site

Providing the above symptoms are fairly mild and not troublesome, the patient may not require medical intervention. However, if these side effects are severe or continue for some time, patients should obtain medical advice.

Patients will also need to access immediate medical assistance if they experience the following side effects when using Insulin Degludec and Liraglutide:

  • Anxiety
  • Fever
  • Bloating
  • Fast weak pulse
  • Bloody urine
  • Fast heartbeat
  • Blurred vision
  • Dry mouth
  • Chills
  • Lightheadedness, faintness or dizziness when getting up from a lying or sitting position
  • Clammy, cold skin
  • Headache
  • Cold sweats
  • Rash on the skin
  • Coma
  • Hives
  • Confusion
  • Itching
  • Constipation
  • Fruit-like breath odor
  • Convulsions
  • Pale, cool skin
  • Hoarseness when speaking
  • Cough
  • Increased thirst
  • Darkened urine
  • Increased hunger
  • Decreased amount or frequency of urine
  • Increased urination
  • Depression
  • Lumps in the neck
  • Difficulty swallowing
  • Pain in side or lower back
  • Dizziness
  • Loss of appetite
  • Increased urination
  • Lightheadedness
  • Indigestion
  • Irregular heartbeat
  • Muscle cramps or pain
  • Large, hive-like swelling on the eyelids, tongue, lips, hands, throat, feet, legs, face or sex organs
  • Nausea or vomiting
  • Troubled breathing at rest
  • Nightmares
  • Rattling, noisy breathing
  • Trouble swallowing or breathing
  • Tingling or numbness in the lips, feet or hands
  • Weight gain
  • Pains in the abdomen, stomach or side, possibly radiating to the back
  • Swelling or puffiness around the eyes or of the face, tongue, lips or the eyelids
  • Unusual weakness or tiredness
  • Slurred speech
  • Yellowing of the skin or eyes
  • Sweating
  • Unexplained weight loss
  • Tightness in the chest

If patients experience any other side effects when using Insulin Degludec and Liraglutide, they should also obtain medical help.

Dosage

When patients are prescribed Insulin Degludec and Liraglutide, their dose will depend on their blood sugar level. As this can change, patients may not be prescribed a standard dose of Insulin Degludec and Liraglutide. Instead, they will be taught how to test their blood sugar levels and what dose of medication to use, based on the results. Alternatively, the patient's physician will check their blood sugar levels at regular intervals and advise them how much Insulin Degludec and Liraglutide should be used.

As Insulin Degludec and Liraglutide needs to be administered subcutaneously, patients are given this medication via an injection. Whilst patients can visit a healthcare practitioner for this, they may be taught how to administer the medicine themselves. As Insulin Degludec and Liraglutide normally needs to be administered regularly, it can be easier for the patient if they're able to carry out the injection.

It's essential that patients double check their dose and the concentration of Insulin Degludec and Liraglutide before they administer the medication. This will ensure that the appropriate amount of medicine is administered. As serious side effects can occur if too much Insulin Degludec and Liraglutide is used, it's vital that patients check the appropriate concentration and dose each time they use this medicine.

Prior to use, the Insulin Degludec solution should look colorless and clear. If the solution is thick and/or cloudy, patients should not use it and should contact their physician or pharmacist if they require additional medication.

Although Insulin Degludec and Liraglutide can normally be injected into the thigh, upper arm, stomach or abdomen, patients are usually advised to use a different injection site each time they administer the medication. As Insulin Degludec and Liraglutide works over a 24 hour period, patients are generally instructed to administer the medication at approximately the same time each day.

When patients are prescribed Insulin Degludec and Liraglutide, their physician may also provide them with a special meal plan or dietary instructions. It's important that patients follow these plans and enact any lifestyle changes which have been recommended by their doctor.

Taking Insulin Degludec and Liraglutide at the appropriate time is extremely important in controlling type 2 diabetes. If patients forget to use the medication, they should administer the dose as soon as they remember to do so. However, if their next dose of Insulin Degludec and Liraglutide is almost due, patients will need to skip the missed dose and continue with their normal treatment schedule. It is not safe to administer a double dose of Insulin Degludec and Liraglutide, even if an earlier dose of medicine has been missed.

If patients have forgotten to administer Insulin Degludec and Liraglutide for three days or longer, they should obtain medical advice before restarting their treatment.

Before using Insulin Degludec and Liraglutide, patients should ensure that they know how to prepare the medicine, how much to use and how to administer it. If patients are unsure how or when to use Insulin Degludec and Liraglutide, they should seek medical advice from their physician or pharmacist.

Potential Drug Interactions:

Although some medications can be taken at the same time, certain drugs should not be taken together. Due to the possibility of interactions occurring, Insulin Degludec and Liraglutide is not usually recommended for use alongside the following medications:

  • Balofloxacin
  • Insulin Degludec
  • Besifloxacin
  • Insulin Aspart, Recombinant
  • Ciprofloxacin
  • Insulin Glargine, Recombinant
  • Enoxacin
  • Insulin Glulisine
  • Fleroxacin
  • Insulin Detemir
  • Flumequine
  • Insulin Bovine
  • Gatifloxacin
  • Levofloxacin
  • Gemifloxacin
  • Octreotide
  • Insulin
  • Ofloxacin
  • Insulin Lispro, Recombinant
  • Norfloxacin
  • Lanreotide
  • Pefloxacin
  • Liraglutide
  • Pazufloxacin
  • Lomefloxacin
  • Pramlintide
  • Metreleptin
  • Prulifloxacin
  • Moxifloxacin
  • Rosiglitazone
  • Nadifloxacin
  • Sparfloxacin
  • Pasireotide
  • Tosufloxacin
  • Pioglitazone
  • Thioctic Acid
  • Rufloxacin

Although patients are not normally prescribed Insulin Degludec and Liraglutide in conjunction with the above medicines, doctors may feel that it is in the patient's best interests in some cases. If so, the patient's dose of medicine may be reduced in order to try and prevent an interaction occurring or they may be advised to use the medicine at a specific time.

If Insulin Degludec and Liraglutide is used at the same time as any of the following medicines, it may increase the patient's risk of developing side effects:

  • Acebutolol
  • Lixisenatide
  • Albiglutide
  • Linezolid
  • Atenolol
  • Labetalol
  • Betaxolol
  • Levobunolol
  • Bisoprolol
  • Methylene Blue
  • Carteolol
  • Isocarboxazid
  • Carvedilol
  • Iproniazid
  • Celiprolol
  • Practolol
  • Dulaglutide
  • Procarbazine
  • Esmolol
  • Pindolol
  • Exenatide
  • Phenelzine
  • Furazolidone
  • Propranolol
  • Metipranolol
  • Rasagiline
  • Metoprolol
  • Selegiline
  • Moclobemide
  • Nadolol
  • Tranylcypromine
  • Nebivolol
  • Safinamide
  • Nialamide
  • Sotalol
  • Oxprenolol
  • Timolol
  • Penbutolol

As well as interacting with other prescription medicine, Insulin Degludec and Liraglutide could interact with over-the-counter medicines, supplements, vitamins, foods and drinks. Using Insulin Degludec and Liraglutide and consuming ethanol (alcohol) is not recommended, for example, and patients may be advised to stop drinking or consuming alcohol while they are using this medicine.

In addition to this, patients should tell their doctor if they are using any over-the-counter medicines, vitamins or supplements before they begin treatment with this medication. They should also obtain medical advice before using any new supplements, vitamins or medicines once they have started treatment with Insulin Degludec and Liraglutide.

Warnings

Before Insulin Degludec and Liraglutide is prescribed, patients should discuss their current health conditions and medical history with their physician. There are some conditions which may affect the patient's treatment with this medicine and they may include:

  • Gallstones (Cholelithiasis)
  • Alcohol abuse
  • Gastroparesis
  • Dehydration
  • Angioedema
  • Pancreatitis
  • Kidney disease
  • Low blood sugar (Hypoglycemia)
  • Multiple endocrine neoplasia syndrome type 2 (MEN 2)
  • Low levels of potassium in the blood (Hypokalemia)
  • Cancer of the thyroid (Medullary thyroid carcinoma)

As the effects of Insulin Degludec and Liraglutide on pediatric patients have not been studied, this medicine is not normally prescribed to infants or children.

Although Insulin Degludec and Liraglutide can be used to treat geriatric patients, older people are more likely to suffer from episodes of hypoglycemia and this may affect their treatment.

Patients should never share needles or medical pens with any other individuals. This can result in serious viruses and blood-borne illnesses being transferred from one person to another.

When using Insulin Degludec and Liraglutide, patients will need to have regular check-ups with their physician. These may be more frequent when patients first start using this medicine. Regular blood tests may also be carried out as these can help to determine whether the medication is working properly.

Patients may be given specific lifestyle instructions when using Insulin Degludec and Liraglutide. It's important that these are followed as they can help to improve the patient's condition. Patients may be advised:

  • Not to drink alcohol due to its effects on blood sugar
  • To engage in counselling as this can help patients to make the appropriate lifestyle changes
  • To educate their family and close friends so they know to react to a medical emergency
  • Not to use any medications which have not been approved by their doctor, particularly sinus medicine, cold, cough and flu remedies, asthma medicine, allergy medication and/or aspirin
  • To keep a copy of their medical history, copies of prescriptions and medication with them when they travel

Patients may be advised to wear a medical identification bracelet and to carry a medical information card with them at all times. This helps to alert healthcare practitioners that the patient has type 2 diabetes and is being treated with Insulin Degludec and Liraglutide in the event of an emergency.

Patients are usually advised to keep an extra supply of Insulin Degludec and Liraglutide and needles with them. If their blood sugar suddenly increases or they suffer an emergency hyperglycemic episode, additional medication may be required.

Even if patients have typically high blood sugar levels, they may also be prescribed an emergency glucagon kit. This is to treat episodes of low blood sugar (hypoglycemia) and may be required if too much Insulin Degludec and Liraglutide is administered.

If patients use too much Insulin Degludec and Liraglutide or if this medicine is used in conjunction with another form of insulin, the patient may experience hypoglycemia. Similarly, if patients exercise more than usual, drink alcohol or miss a meal, their blood sugar levels may drop. If the patient exhibits symptoms of low blood sugar, they must be treated quickly and before they lose consciousness. Common symptoms of low blood sugar include:

  • Headaches
  • Trembling
  • Shaking
  • Nervousness
  • Vision problems
  • Confusion
  • Anxiety
  • Slurred speech
  • Tingling in the extremities
  • Restless sleep
  • Fast heartbeat
  • Abnormal behavior
  • Irritability
  • Lightheadedness
  • Drowsiness
  • Dizziness
  • Nightmares
  • Agitation

However, everyone experiences different symptoms when they are affected by low blood sugar. Patients should learn to recognize the symptoms they experience during periods of low blood sugar so that they can react accordingly.

If patients experience an episode of low blood sugar, they may use a glucose gel or tablet to increase their blood sugar and reduce their symptoms. Alternatively, patients can consume honey, non-diet soft drinks, fruit juice, sugar cubes or sugar dissolved in water in order to increase their blood sugar levels.

If symptoms of low blood sugar persist, patients must obtain urgent medical treatment. If the patient experiences severe symptoms, such as loss of consciousness or seizures, emergency assistance is required. Patients should keep a glucagon kit available for emergency purposes and should ensure that their family are aware of how to use it, in the event of a hypoglycemic episode.

Patients should not operate machinery, drive or perform any other potentially dangerous tasks whilst suffering from low blood sugar.

If patients forget to administer a dose of Insulin Degludec and Liraglutide, don't take enough medication, fail to follow their meal plan or overeat, they may experience symptoms associated with hyperglycemia (high blood sugar). These symptoms can include:

  • Drowsiness
  • Blurred vision
  • Dry, flushed skin
  • Nausea
  • Vomiting
  • Ketones in urine
  • Loss of appetite
  • Stomach pain or ache
  • Difficulty breathing
  • Rapid and deep breathing
  • Increased urination
  • Unconsciousness
  • Fruit-like breath odor
  • Unusual thirst

If patients experience an episode of high blood sugar, they should check their blood sugar level and contact their physician for advice.

When using Insulin Degludec and Liraglutide, patients may develop a serious thyroid problem. Patients should contact their physician if they experience any of the following symptoms while using this medicine:

  • Difficulty swallowing
  • Mass in the neck
  • Hoarseness
  • Difficulty breathing

Patients may experience pancreatitis when using Insulin Degludec and Liraglutide. If patients develop the following symptoms, they must seek urgent medical treatment:

  • Severe and sudden stomach pain
  • Fever
  • Chills
  • Nausea
  • Constipation
  • Lightheadedness
  • Vomiting

Using Insulin Degludec and Liraglutide can result in patients having a low level of potassium in their blood. Patients should not use salt substitutes, supplements or medicines which contain potassium unless their doctor has approved them to do so.

In some cases, patients may develop gestational diabetes during pregnancy. In addition to this, patients with diabetes may find it more difficult to control their condition if they become pregnant. It is not known whether Insulin Degludec poses a significant risk to pregnant patients and/or unborn babies. However, Liraglutide may pose a risk to an unborn fetus if it is administered to the expectant mother due to pregnancy.

Due to this, a combination of Insulin Degludec and Liraglutide is not usually prescribed to pregnant patients and should only be used during pregnancy if the benefits clearly outweigh the potential risks.

If patients become pregnant whilst using this medication, they should contact their physician immediately. If patients are being treated with Insulin Degludec and Liraglutide but plan to become pregnant, they should contact their doctor for advice before trying to conceive.

If patients breastfeed while using medication, there is a chance that the drug could be passed on to the infant. It is not known if Insulin Degludec and Liraglutide can be transferred in this way or, if it can, what level of harm it would pose to the infant. Due to this, patients are generally advised not to breastfeed whilst being treated with Insulin Degludec and Liraglutide. If patients have been treated with Insulin Degludec and Liraglutide in the past and are considering breastfeeding, they should obtain medical advice before doing so.

If Insulin Degludec and Liraglutide is prescribed, patients should tell their doctor if they have any allergies before using the medication. In some cases, Insulin Degludec and Liraglutide can cause patients to experience a serious allergic reaction, including anaphylaxis. The symptoms of an allergic reaction may include:

  • Shortness of breath
  • Rash on the skin
  • Hives
  • Chest pain
  • Itching
  • Difficulty breathing
  • Difficulty swallowing
  • Swelling of the tongue, throat, lips, mouth, face or hands

An allergic reaction can be life-threatening and emergency medical treatment will be required if the patient exhibits the symptoms listed above.

Storage

When storing Insulin Degludec and Liraglutide, patients should follow the manufacturer's instructions. Before the medicine is opened, it should usually be kept in a refrigerator, at temperatures between 2?-8?C (36?-46?F). Pre-filled medical pens should be kept in their original container and protected from light and heat.

Once opened, Insulin Degludec and Liraglutide can usually be kept at room temperature for a period of 21 days. However, this temperature should be between 15?-30?C (59?-86?F). Alternatively, opened medication can normally be stored in the refrigerator.

As patients will need to store Insulin Degludec and Liraglutide and medical equipment, such as needles, at home, it's essential that they find a secure location to keep these items. Children and/or pets should not be able to gain access to medicine and/or medical equipment.

If the medicine reaches its use-by date or patients are advised to stop using it, they will need to dispose of it. However, medication and medical equipment should never be thrown out without normal household waste as it can pose a risk to other people. Patients should contact their physician's office or pharmacist and use a specialist medicine disposal service.

Summary

Although type 2 diabetes is a common condition, it can have very serious consequences. As well as causing a number of debilitating symptoms, the condition can increase the patient's risk of heart attacks, strokes, blindness and even amputations.

It's vital, therefore, that type 2 diabetes is well-controlled and that patients make the appropriate lifestyle changes when managing their condition. Whilst dietary and lifestyle changes are often effective in reducing the patient's blood sugar levels, Insulin Degludec and Liraglutide may be prescribed if further reduction is required.

By using Insulin Degludec and Liraglutide, patients can learn to regulate their own blood sugar levels and ensure that their levels stay within a healthy range. Once the patient's condition and blood sugar levels are under control, they should experience fewer symptoms and their risk of suffering an emergency medical crisis should be reduced.