RYZODEG® - 70% insulin degludec and 30% insulin aspart

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RYZODEG® 70/30 (insulin degludec and insulin aspart injection)

(Combination of ultra–long acting insulin degludec + rapid acting insulin aspart)

DOSAGE FORM

Ryzodeg is supplied as a clear solution for subcutaneous injection in:

  • Pre-filled pen devices (FlexTouch®)
  • Cartridge/prefilled multidose insulin pen systems

It contains:

  • 70% insulin degludec (long-acting basal insulin)
  • 30% insulin aspart (rapid-acting prandial insulin)

It is administered subcutaneously only.

INDICATIONS

Ryzodeg is indicated for the treatment of diabetes mellitus requiring insulin therapy, including:

  • Type 1 Diabetes
    (as part of a total insulin regimen with additional mealtime insulin when required)
  • Type 2 Diabetes
    (when oral antidiabetic drugs and/or basal insulin alone are insufficient)

It is used for improving glycaemic control by covering both:

  • Basal glucose levels (between meals and overnight)
  • Postprandial glucose spikes (after meals)

DOSAGE & ADMINISTRATION

  • Given once or twice daily, depending on clinical need and regimen
  • Administered with main meals (especially when twice daily dosing is used)
  • Dose is individualised based on blood glucose monitoring

Typical principles:

  • Initiation depends on prior insulin regimen
  • Dose adjustments are made gradually based on fasting and postprandial glucose levels
  • Must be injected subcutaneously in abdomen, thigh, or upper arm
  • Injection sites should be rotated to avoid lipodystrophy
  • Can be taken with or without food, but consistent meal timing improves control

CONTRAINDICATIONS

Ryzodeg is contraindicated in:

  • Hypersensitivity to insulin degludec, insulin aspart, or any excipients
  • Episodes of hypoglycaemia (during active low blood sugar)
  • Not for intravenous or intramuscular use

ADVERSE REACTIONS

Common and clinically important

  • Hypoglycaemia (most important and most common risk)
  • Weight gain
  • Injection site reactions (pain, redness, swelling, itching)

Less common

  • Lipodystrophy at injection sites
  • Visual disturbances (transient due to glucose changes)
  • Peripheral oedema

Rare but serious

  • Severe allergic reactions (including anaphylaxis)
  • Severe hypokalaemia (low potassium levels)

DRUG INTERACTIONS

Ryzodeg may interact with drugs that affect blood glucose levels:

Increase risk of hypoglycaemia

  • Oral antidiabetics (e.g., sulfonylureas)
  • Alcohol
  • ACE inhibitors
  • Beta-blockers (may mask hypoglycaemia symptoms)
  • MAO inhibitors

Decrease insulin effect (hyperglycaemia risk)

  • Corticosteroids
  • Thiazide diuretics
  • Sympathomimetics (e.g., adrenaline)
  • Oral contraceptives (may reduce insulin sensitivity)
  • Thyroid hormones

PATIENT COUNSELING

Patients should be advised to:

  • Take insulin exactly as prescribed without skipping doses
  • Recognise and manage hypoglycaemia symptoms (sweating, tremor, confusion, hunger)
  • Always carry a fast-acting sugar source (glucose tablets or juice)
  • Rotate injection sites to prevent skin damage
  • Never share insulin pens or needles
  • Dispose of needles safely in a sharps container
  • Monitor blood glucose regularly
  • Inform healthcare providers before surgery or major procedures
  • Avoid excessive alcohol intake
  • Store insulin properly (refrigerated before opening; room temperature after opening for a limited period as per instructions)

RYZODEG is a premixed insulin preparation used in the management of diabetes mellitus. It is manufactured by Novo Nordisk and is marketed as Ryzodeg. 

It combines two different insulin analogues in a single formulation: insulin degludec (a long-acting basal insulin) and insulin aspart (a rapid-acting prandial insulin).

Ryzodeg contains 70% insulin degludec and 30% insulin aspart. 

Insulin degludec provides a very long and stable basal insulin effect lasting more than 24 hours, while insulin aspart provides quick onset of action to control blood glucose spikes after meals. 

This combination allows Ryzodeg to cover both basal and mealtime insulin needs with a single injection.

After subcutaneous injection, insulin degludec forms multi-hexamers in the subcutaneous tissue, from which insulin monomers are slowly and continuously released into the bloodstream. 

This results in a flat and prolonged glucose-lowering effect that mimics physiological basal insulin secretion. 

In contrast, insulin aspart rapidly dissociates into monomers and is quickly absorbed into circulation, producing a fast onset of action that helps control postprandial glucose levels.

Ryzodeg is indicated for the treatment of both Type 1 Diabetes and Type 2 Diabetes when insulin therapy is required. 

It is particularly useful in patients who require both basal and prandial glucose control but prefer fewer daily injections compared to full basal–bolus regimens.

The main advantage of Ryzodeg is its ability to simplify insulin therapy by combining basal and rapid insulin effects in a single injection. 

This can improve adherence and reduce injection burden. However, it is less flexible than separate insulin regimens because the ratio of basal to bolus insulin is fixed, and dose adjustments cannot be made independently for each component.

Ryzodeg provides a convenient insulin option that balances effective glycaemic control with simplified dosing, making it suitable for selected patients who need both basal and mealtime insulin coverage.



INDICATIONS

RYZODEG® 70/30 (insulin degludec and insulin aspart injection) is indicated for the treatment of diabetes mellitus requiring insulin therapy to improve glycaemic control.

It is used in both Type 1 Diabetes and Type 2 Diabetes, particularly in patients who need both basal and prandial (mealtime) insulin coverage.

In Type 1 diabetes, Ryzodeg is used as part of a total insulin regimen to provide both background (basal) insulin and meal-time glucose control, often in combination with additional rapid-acting insulin depending on the clinical regimen.

In Type 2 diabetes, it is used when oral antidiabetic medicines and/or basal insulin alone are insufficient to achieve adequate glycaemic control, and there is a need for both fasting and postprandial glucose management.

DOSAGE

The dosage of RYZODEG® 70/30 (insulin degludec and insulin aspart injection) is individualized based on the patient’s blood glucose levels, insulin requirements, type of diabetes, diet, and level of physical activity. 

It is administered as a subcutaneous injection once or twice daily, usually taken with the main meal(s) of the day to ensure coverage of both fasting and postprandial blood glucose levels.

In Type 2 diabetes, the usual starting dose is typically 10 units once daily, given with the main meal. The dose is then gradually adjusted based on blood glucose monitoring to achieve optimal glycaemic control while minimizing the risk of hypoglycaemia. 

In Type 1 diabetes, dosing is more individualized, with total daily insulin requirements generally estimated at 0.2–0.4 units per kilogram of body weight per day. 

Ryzodeg may provide a portion of the total insulin requirement, while additional rapid-acting insulin may still be required for full mealtime coverage depending on the treatment regimen.

When switching from other insulin therapies, such as basal insulin or premixed insulin, the initial dose of Ryzodeg is often based on the previous total daily insulin dose, with careful adjustment thereafter according to glucose response. 

Dose titration is typically done gradually every few days based mainly on fasting blood glucose levels and overall glycaemic control. 

It is important that Ryzodeg is injected only subcutaneously in sites such as the abdomen, thigh, or upper arm, and injection sites should be rotated regularly to prevent lipodystrophy. 

If a dose is missed, it should be taken with the next main meal, but double dosing should be avoided.

ADVERSE EFFECTS

The most important adverse effect of Ryzodeg is hypoglycaemia, which may occur due to its insulin action lowering blood glucose. This can range from mild episodes (sweating, tremor, hunger, dizziness) to severe hypoglycaemia requiring assistance, and in extreme cases may lead to seizures or loss of consciousness if untreated.

Another significant adverse effect is weight gain, which is commonly associated with insulin therapy due to increased glucose uptake and anabolic effects. This may be more noticeable with long-term use.

Injection site reactions may also occur, including pain, redness, swelling, itching, or lipodystrophy (fat thickening or loss under the skin), especially if injection sites are not rotated properly.

Allergic reactions are rare but important. These may present as rash, urticaria, or in severe cases systemic hypersensitivity reactions, including anaphylaxis.

There is also a risk of hypokalaemia (low blood potassium levels), as insulin drives potassium into cells, which may be clinically significant in patients with other risk factors or on potassium-lowering medications.


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