Diabetes update: Ryzodeg® 70/30 Penfill® insulin

A new formulation of insulin will be available from 1 May 2025. Ryzodeg® 70/30 contains insulin degludec (an ultra-long-acting insulin) and insulin aspart (rapid acting mealtime insulin) administered in one injection. This is licensed for patients aged 6 years and over.

This is the first true long-acting insulin funded in Aotearoa. It has an elimination half-life of 25 hours, so remains in the body for a few days. Ryzodeg® 70/30 insulin must therefore only be injected up to a maximum of twice daily, with particular care taken when prescribing for the elderly population.

Please note: patients will need to be supplied with a NovoPen for administration

• Ryzodeg® 70/30 can be administered once or twice daily with the main meal/s.
• If once daily dosing is appropriate, ensure Ryzodeg® 70/30 is administered with the largest meal.
• Ryzodeg® 70/30 insulin must be taken with a carbohydrate containing meal. If a meal is then missed, or unplanned strenuous exercise occurs, this may lead to hypoglycaemia.
• In patients with type 2 diabetes, Ryzodeg® 70/30 can be used in combination with non-insulin therapies, and in combination with rapid acting insulin at the remaining mealtimes if required.
• In patients with type 1 diabetes, Ryzodeg® 70/30 can be used in combination with rapid-acting insulin at the remaining mealtimes (note: Ryzodeg® 70/30 also contains 30 units per ml of rapid acting insulin).

See NZSSD guidelines. 

Be sure to adjust the timing/dosing of other insulin and/or oral medications (i.e. those that lower blood glucose levels such as sulphonylureas, which would need to be stopped at the meal of administration).

A NovoPen will need to be provided on initiation.

Please note: these are starting points, and some patients may need dose alterations based on meal size and blood glucose levels.

Patients with type 2 diabetes

• Switching from once daily basal or premix insulin therapy can be converted to the same number of units of Ryzodeg® 70/30 once daily, or twice daily Ryzodeg® 70/30 using half the daily dose split into two dose times
• Switching from basal-bolus to Ryzodeg® 70/30 will need to convert the number of units based on individual needs. In general, patients will be converted to the same number of basal units as a starting point

Patients with type 1 diabetes

• Please discuss with specialist diabetes team.

This is a good opportunity to check that lifestyle management and non-insulin glucose lowering therapies are maximised. Consider insulin treatment for any person with type 2 diabetes who has not met their HbA1c target despite optimal lifestyle modification and pharmacological management with non-insulin glucose-lowering medicines. Insulin initiation is recommended for all patients with significant hyperglycaemia (e.g. HbA1c > 90 mmol/mol) at any stage, including diagnosis.

Ryzodeg® 70/30 is a good option for those whose HbA1c is above target despite basal insulin, or could be used first-line instead of Lantus/Protaphane/Humulin N alone.

Ryzodeg® 70/30 can also be used to replace Novomix 30 which will likely be discontinued by the end of 2025/early 2026. Ryzodeg® 70/30 can be used twice daily, but is not recommended to be used three times daily.

Patients who have one main meal per day.

Need to be extra vigilant with sick day advice - due to long duration of action.

Prescribers

• Starting dose of Ryzodeg® 70/30 for T2DM patients is 10 units with the main meal
• Please prescribe needles alongside the Ryzodeg® 70/30 penfill vials. Best practice suggests 4mm or 5mm needles.

If switching insulins, increase checking to ensure stable blood glucose levels and follow up with patient to adjust dosing as required.

Pharmacists

• As always, be vigilant with patients who are changing formulations of insulin – encourage patients to return their old insulin to the pharmacy to remove the risk of confusion.
• Check if patients have been provided with a pen to inject the insulin, if not, provide one free of charge. Provide education on how to use the pen, particularly if they are switching from a pre-loaded pen device.
• Ensure that the patient has been prescribed needles to enable injection of insulin.
• Check that patients have a glucometer and adequate supply of testing strips or CGM sensors at home.
• Check that patients have been provided with sick day advice.

Contact details for Novo Nordisk (to order pens): Lee Carruthers, 027 369 4963.