Diabetes control with Ryzodeg® 70/30

Ryzodeg® 70/30 is a co-formulation of: 

• Insulin degludec (70%) – ultra-long-acting basal insulin. 
• Insulin aspart (30%) – rapid-acting prandial insulin. 

This co-formulation allows for simplified insulin regimens in patients with type 2 diabetes, with once or twice daily dosing administered alongside the main carbohydrate-containing meal(s) using a NovoPen® device.  

In selected patients, Ryzodeg® may simplify basal–bolus regimes.   

Pharmacokinetics 

• Degludec has a half-life of ~25 hours, providing basal coverage for > 42 hours. 
• Steady state is achieved after approximately 3 days. 
• This long duration necessitates caution in elderly patients and those with renal impairment, due to increased risk of hypoglycaemia. 

People living with diabetes requiring basal insulin, with or without prandial insulin.  

As part of a basal-bolus regimen for selected people living with types 1 and 2 diabetes. 

A useful option for patients transitioning from NovoMix® 30, which is scheduled for discontinuation in late 2025/early 2026.

Ryzodeg® 70/30 may be particularly suitable for individuals who consume one main meal per day and/or where a once-daily injection regimen is preferred. 
 

• Administer once daily with the main carbohydrate-containing meal. 
• Once-daily or twice-daily regimen, depending on meal patterns. 
• Sulfonylureas at the meal should be discontinued to reduce hypoglycaemia risk. 
• Ryzodeg® 70/30 does not need to be mixed/inverted - it is a co-formulation rather than a pre-mixed suspension.
• Patients must receive clear dietary education: If Ryzodeg® 70/30 is administered and the meal is delayed or skipped, or unplanned strenuous exercise occurs, hypoglycaemia may result. Referral to a dietitian for carbohydrate awareness may be helpful. 
• Patients need to be shown how to use the NovoPen device. Patients with dexterity and cognitive challenges may require additional support or an alternative product.   
• Patient-centred lifestyle management should be continued at all stages of the glycaemic management journey. 
   

Ryzodeg® 70/30 can be administered: 

• in combination with other diabetes medications (except sulphonylureas at a meal)
• alone 
• in combination with rapid-acting insulin at the other mealtimes.

Basal insulin initiation is recommended for all patients diagnosed with type 2 diabetes presenting with significant hyperglycaemia at any stage, including: 

• at diagnosis (e.g. HbA1c > 90) 
• if glycaemic targets are not met despite maximal non-insulin therapy and lifestyle support.   

Ryzodeg® 70/30 is a good option for those whose HbA1c is above target despite basal insulin, or may be used first-line instead of other intermediate or long-acting insulins. 

 Ryzodeg® 70/30 may be used to replace Novomix 30, which will likely be discontinued by the end of 2025/early 2026.

Refer to NZSSD guidelines for further details on type 2 diabetes management.

For insulin naive patients, the registered starting dose of  Ryzodeg® 70/30 is 10 units once daily with the main meal, followed by individualised dosage adjustments.

While the MedSafe datasheet currently recommends a starting dose of 10 units, the national diabetes guidelines recommend a weight-based starting dose, with adjustments made for contextual factors such as hypoglycaemia risk, degree of glycaemic control, meal size and timing, and co-morbidities.  These factors must be balanced with the potential for hypoglycaemia: 

• 0.2 units/kg/day if HbA1c > 64 mmol/mol + BMI > 18 kg/m² 
• 0.1 units/kg/day if HbA1c < 64 mmol/mol OR BMI < 18 kg/m²OR elderly OR renal or hepatic impairment.

Titrate the dose according to self-monitored blood glucose readings, aiming for agreed glycaemic targets and adjusted as needed based on clinical judgement.

From once-daily basal or premixed insulin:  

• Switch unit for unit. 
• Administer once daily. 
• Ensure timing is just before the main meal to reduce the risk of hypoglycaemia. 

A key consideration for patients on larger doses of basal insulin is to reduce to 0.5 units/kg/day equivalent.

Example

Your patient weighs 100kg and takes 80 units of glargine insulin daily. Reduce total basal insulin to 0.5units/kg/day. This equates to 50 units of Ryzodeg® 70/30, administered with the largest meal.

It is important to consider whether 15 units of rapid-acting insulin (30% of 50 units) is appropriate for their meal size. 

From basal–bolus regimen: 

• A quick method is to calculate based on total basal insulin. 
• Ryzodeg® 70/30 replaces basal component. 
• Some patients may require more insulin at that meal, so be prepared to up-titrate or adjust based on individual patient factors. 
• For patients taking larger doses of basal insulin, reduce to 0.5 units/kg/day equivalent. 
• Maintain separate rapid insulin for remaining meals, this may need to be adjusted.
• Doses need to be converted/adjusted based on individual needs.

Example 

Your female patient weighs 78 kg and is currently taking 36 units of glargine insulin with her evening meal, along with 6 units of rapid-acting insulin at breakfast, lunch, and dinner. Her main meal is dinner.  Her HbA1c is 68, fasting glucose 11 mmol/L, and 2 hour post-meal glucose 11-16 mmol/L.

You convert her to 36 units of Ryzodeg® 70/30 at dinner, discontinuing both the glargine and the rapid-acting insulin previously taken at that time. 

Note that with this approach you have replaced 36 units of basal insulin and 6 units of rapid insulin with Ryzodeg 36 units.  This equates to 25 units of basal insulin and 3.6 units of rapid insulin.  Careful monitoring and adjustment is required to avoid underdosing and deterioration in control.  

You advise her that her rapid-acting insulin doses at breakfast and lunch should be continued, but may need to be reviewed and adjusted depending on her blood glucose readings.  

If she has a large breakfast and a large dinner, an alternative approach may be splitting the Ryzodeg®, administering Ryzodeg® 18 units with breakfast, and 18 units with dinner, discontinuing the rapid insulin with those meals, maintaining rapid insulin with lunch. Contact with the practice nurse is arranged for the following week. 

As with all insulin products, close monitoring is required during transition and throughout the early post-transition period.  

Further guidance on insulin regimens is available from NZSDD, including bolus dose adjustment. 

For elderly patients and those with renal or hepatic dysfunction, a start-low, go-slow approach with intensified monitoring is advised.  

Other glucose-lowering therapies may need to be adjusted. 

• Monitor pre-meal and postprandial (2–3 hour) glucose. 
• Adjust dose by 2 units or 10% of total dose if post-meal glucose increases > 3 mmol/L and fasting glucose > 10 mmol/L. 
• Titrate every 3–7 days based on consistent readings. 
• Once stable on the new regimen, repeat HbA1c after 3 months. 

An initial starting dose of 0.2 units/kg/day, administered as Ryzodeg® 70/30 with the main meal and supplemented with rapid-acting insulin at other meals, is a reasonable and commonly used approach in clinical practice. 

The New Zealand Medsafe datasheet currently recommends that the starting dose of Ryzodeg® 70/30 should comprise 60–70% of the total daily insulin requirement, with the remainder provided by a rapid-acting insulin at other meals if needed. 

Dose adjustments should be individualised based on patient needs and dietary requirements.

Specialist guidance may be required.

Prescribe: 

• NovoPen® device.
• Ryzodeg® 70/30 Penfill® cartridges (3mL). 
• 4–5 mm needles. 

Ensure patients have: 

• Glucometer and strips or CGM.
• Education on insulin use, injection technique, sick day rules, and driving safety. 
• Memory aids (e.g., NovoPen Echo®, InsulCheck®) if needed. 

Currently only available with Penfill ® cartridges and NovoPen® delivery system.   

Patients with visual, cognitive, or dexterity impairments may need support or alternative options. 

• If a dose is missed, take with the next main meal that day. 
• Do not double-dose. 
• Resume regular schedule the following day. 

Elderly / renal impairment: May be used safely with caution; monitor closely. Start low, go slow.   

Children > 6 years: May be used under specialist care; children are at increased risk of hypoglycaemia. 

Pregnancy/lactation: No data available – avoid, or consult specialist. 

This MedCase was created Dr Danuta Amelung, BHB, MbChB, FRNZCGP, AFRACMA, Dip. Paed, PGCertWHlth, PGDipTrvMed with expert review by  Dr Ryan Paul, Endocrinologist and Diabetologist.