Ryzodeg FlexTouch
Co-formulated 70/30 insulin (insulin degludec ultra-long-acting basal plus insulin aspart rapid-acting prandial) delivered via a pre-filled pen for diabetes mellitus
Ryzodeg FlexTouch is a unique co-formulated insulin product containing insulin degludec 70% (an ultra-long-acting basal insulin analogue with a duration of action longer than 42 hours) and insulin aspart 30% (a rapid-acting prandial insulin analogue). It provides both background and mealtime insulin coverage in a single, once- or twice-daily injection, simplifying complex diabetes regimens. Ryzodeg is a prescription medicine used in adults, adolescents and children aged 2 years and older with diabetes mellitus, and should always be used as part of an individualized treatment plan supervised by a qualified healthcare professional.
Quick Facts
Key Takeaways
- Ryzodeg FlexTouch is a fixed 70/30 co-formulation of insulin degludec (ultra-long-acting basal) and insulin aspart (rapid-acting prandial), delivering both basal and mealtime insulin in a single injection.
- Inject once or twice daily with the main meal(s). Because the aspart component starts working within 10-20 minutes, give the injection immediately before eating – never 20-30 minutes ahead, as is required for soluble human insulin.
- The most important side effect is hypoglycemia (low blood sugar). Always carry a fast-acting source of glucose and learn to recognize early warning signs such as sweating, trembling, hunger and confusion.
- Rotate injection sites within the abdomen, thigh or upper arm to prevent lipodystrophy. Ryzodeg must not be mixed with any other insulin or diluted with any other liquid.
- Store unopened pens in a refrigerator at 2-8 °C. Once in use, the pen can be kept at room temperature (below 30 °C) or in a refrigerator for up to 28 days. Never freeze insulin and never share a pen between individuals.
What Is Ryzodeg FlexTouch and What Is It Used For?
Ryzodeg FlexTouch contains two distinct insulin analogues co-formulated in a fixed ratio of 70% insulin degludec and 30% insulin aspart. Both insulins are produced by recombinant DNA technology using genetically engineered Saccharomyces cerevisiae (baker's yeast), then combined into a single soluble solution. This dual-action design allows a single injection to deliver both ultra-long basal insulin coverage and a rapid prandial insulin peak — functions that previously required two separate injections.
The basal component, insulin degludec, has been engineered with a fatty acid side chain that allows it to form long, soluble multi-hexamer chains in the subcutaneous tissue after injection. These chains slowly release individual insulin monomers into the bloodstream over more than 42 hours, providing a smooth, peakless background insulin supply. The intra-individual variability of insulin degludec absorption is approximately four times lower than that of insulin glargine U100, which translates clinically into more predictable fasting glucose levels and a lower risk of nocturnal hypoglycemia in many patients.
The prandial component, insulin aspart, is a modified human insulin in which proline at position B28 has been replaced by aspartic acid. This single amino acid substitution prevents the formation of stable hexamers, allowing insulin aspart to be absorbed rapidly from the subcutaneous depot. Aspart begins working within 10-20 minutes, peaks at 1-3 hours and has a total duration of action of approximately 3-5 hours — matching the post-meal glucose excursion. Crucially, the two components in Ryzodeg are absorbed independently of each other, with no interference between them.
The FlexTouch delivery system is a disposable, pre-filled pen designed to be intuitive and require minimal injection force. Each pen contains 3 mL (300 units) of Ryzodeg 100 units/mL. The dose selector can be set from 1 to 80 units per injection in 1-unit increments, and the end-of-dose click audibly confirms that the full dose has been delivered. The low push-button force is particularly helpful for older adults, patients with arthritis and anyone with reduced manual dexterity.
Ryzodeg FlexTouch is indicated for the treatment of diabetes mellitus in adults, adolescents and children aged 2 years and older. Specific clinical situations where it may be considered include:
- Type 2 diabetes mellitus, when basal insulin alone is no longer sufficient and the patient (and clinician) prefer the simplicity of a single co-formulated injection over a full basal-bolus regimen.
- Type 1 diabetes mellitus in adults and adolescents whose lifestyle and meal pattern align with one or two main meals per day, allowing the fixed 70/30 ratio to provide adequate prandial coverage.
- Patients transitioning from twice-daily premixed insulin (e.g. NovoMix 30 or Humalog Mix25) who would benefit from the lower hypoglycemia risk associated with insulin degludec compared with NPH-based premixes.
- Patients with adherence challenges, cognitive impairment or limited dexterity for whom reducing the daily injection burden may improve glycemic control.
- Pediatric patients aged 2 years and older with type 1 or type 2 diabetes, when individualized assessment by a specialist team supports use of a co-formulation.
Ryzodeg should be distinguished from older premixed insulins (such as biphasic insulin aspart 30, marketed as NovoMix 30 or NovoLog Mix 70/30). Older premixes combine soluble rapid-acting insulin with a protaminated suspension form, resulting in a basal component (NPH-like) that lasts only 12-18 hours and must be re-suspended by gentle rolling before each injection. Ryzodeg is a true solution — both components remain in solution at all times — and the basal component (degludec) lasts beyond 42 hours, eliminating both the resuspension step and the mid-day basal trough. Internationally, Ryzodeg is approved by the European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA) and many national regulators, and is used in over 50 countries worldwide.
What Should You Know Before Taking Ryzodeg FlexTouch?
Contraindications
Ryzodeg FlexTouch must not be used in the following situations:
- Hypoglycemia: Never inject insulin when your blood glucose is already low. Administering insulin during hypoglycemia can cause dangerously low blood sugar, which may lead to unconsciousness, seizures, permanent brain injury or death.
- Known hypersensitivity: Do not use Ryzodeg FlexTouch if you have experienced an allergic reaction to insulin degludec, insulin aspart or any of the excipients in the formulation. Symptoms of a severe allergy include generalized urticaria, difficulty breathing, wheezing, rapid heartbeat, sweating and a drop in blood pressure (anaphylaxis).
- Diabetic ketoacidosis (DKA): Ryzodeg is not appropriate for the acute treatment of DKA. Treatment of DKA requires intravenous regular (soluble) insulin, fluid resuscitation and electrolyte correction in a hospital setting.
Warnings and Precautions
Before starting Ryzodeg FlexTouch, discuss the following with your healthcare provider:
- Blood glucose monitoring: Regular self-monitoring of blood glucose (SMBG) is essential to verify that the dose, timing and diet are appropriate. Continuous glucose monitoring (CGM) provides additional safety and pattern recognition. Your healthcare team will advise on individualized target ranges and testing frequency.
- Hypoglycemia awareness: Learn to recognize the early warning signs of low blood sugar — sweating, trembling, rapid heartbeat, hunger, dizziness, difficulty concentrating — and carry fast-acting glucose (glucose tablets, juice or honey) at all times. Patients with long-standing diabetes, tight glycemic control, autonomic neuropathy or who take beta-blockers may have reduced hypoglycemia awareness.
- Fixed 70/30 ratio: Ryzodeg cannot be adjusted for individual basal or bolus needs separately. If your meal pattern is irregular or you require flexible carbohydrate counting, a separate basal-bolus regimen (e.g. Tresiba once daily plus NovoRapid at meals) may be more appropriate.
- Changes in insulin regimen: Any change in strength, manufacturer, type, species or method of manufacture can result in a change of dose. Such changes should only be made under medical supervision, and glucose monitoring should be intensified for at least the first 1-2 weeks. Never inject Ryzodeg with a syringe drawn from the pen cartridge — doses become inaccurate and the rapid-acting fraction may be over- or under-delivered.
- Impaired kidney or liver function: The liver and kidneys metabolize and clear insulin. Reduced function in either organ prolongs insulin action and can increase the risk of hypoglycemia. Dose adjustments and closer monitoring may be needed.
- Illness and infection: Fever, infection, surgery and trauma usually increase insulin needs (due to stress hormones such as cortisol and adrenaline). Gastrointestinal illness, nausea and vomiting may reduce food intake and lower insulin requirements. A sick-day management plan from your healthcare provider is strongly recommended.
- Physical activity: Exercise increases insulin sensitivity and can lower blood glucose during and for several hours after activity. Dose and carbohydrate intake around exercise may need to be adjusted, particularly for unplanned or vigorous activity.
- Travel across time zones: Crossing more than two time zones may require adjustments to the timing of Ryzodeg. The ultra-long action of degludec gives some flexibility, but discuss travel plans with your diabetes team before departure.
- Injection site rotation: Always rotate injection sites within the same general area (abdomen, thigh or upper arm) to reduce the risk of lipohypertrophy or lipoatrophy, which can impair insulin absorption and cause unexpected glucose swings.
- Thiazolidinediones (TZDs): Combining insulin with thiazolidinediones such as pioglitazone has been associated with fluid retention and, rarely, heart failure, especially in patients with pre-existing cardiovascular disease.
- Driving and operating machinery: Hypoglycemia may impair concentration and reaction time. Always check your blood glucose before driving a vehicle or operating machinery, and carry a fast-acting carbohydrate. Patients who experience impaired hypoglycemia awareness should discuss driving safety with their doctor.
Pregnancy and Breastfeeding
There is limited clinical experience with Ryzodeg in pregnancy. While insulin aspart has an extensive safety record during pregnancy, randomized controlled trial data for insulin degludec in pregnancy are still emerging. Many international guidelines therefore recommend switching to a separate basal-bolus regimen using insulin detemir or NPH insulin (basal) plus insulin aspart (bolus) during pregnancy — combinations that have decades of safety evidence. Decisions about insulin during pregnancy should always be made jointly with an obstetrician and diabetes specialist.
Insulin requirements typically decrease during the first trimester (often leading to increased hypoglycemia risk) and progressively increase during the second and third trimesters as placental hormones cause insulin resistance. Requirements drop rapidly after delivery and usually return to pre-pregnancy levels. Close monitoring and frequent dose adjustments are essential throughout pregnancy and the postpartum period, ideally within a specialist multidisciplinary team.
Insulin can be used during breastfeeding. Insulin is a protein that is broken down in the infant's gastrointestinal tract and is not absorbed in biologically active amounts. However, breastfeeding women may need to adjust their insulin dose and carbohydrate intake, particularly during the first weeks postpartum and when night feeds reduce sleep.
Always tell your healthcare provider about every medicine you take, including over-the-counter medicines, herbal products and supplements. Many substances (steroids, thyroid hormones, antidepressants, antipsychotics, alcohol and even some herbal remedies) can affect blood glucose and may require adjustments to your insulin dose.
How Does Ryzodeg FlexTouch Interact with Other Drugs?
Drug interactions with Ryzodeg are clinically important because they can shift glycemic control in either direction, sometimes dramatically. Some agents enhance the glucose-lowering effect of insulin, increasing the risk of hypoglycemia; others counteract insulin's action, leading to hyperglycemia. Still others (such as beta-blockers) do not change glucose directly but mask the warning symptoms of hypoglycemia, making it more dangerous.
The tables below summarize the most clinically relevant drug interactions with Ryzodeg FlexTouch. The lists are not exhaustive. Patients should always inform every healthcare provider they see (including dentists, pharmacists and emergency staff) that they use insulin, and check with a pharmacist before starting any new medication or supplement.
Major Interactions (Increased Hypoglycemia Risk)
| Drug / Drug Class | Mechanism | Clinical Significance |
|---|---|---|
| Sulfonylureas (glimepiride, gliclazide, glipizide, glyburide) | Stimulate endogenous insulin secretion from pancreatic beta cells | High – Additive hypoglycemia risk; dose reduction or discontinuation of one agent often required when initiating Ryzodeg |
| GLP-1 receptor agonists (liraglutide, semaglutide, dulaglutide, tirzepatide) | Enhance glucose-dependent insulin secretion; slow gastric emptying | Moderate to High – Insulin dose often needs reduction by 20-30% when starting a GLP-1 agonist |
| SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) | Promote urinary glucose excretion; increase insulin sensitivity | Moderate – Hypoglycemia risk; also rare risk of euglycemic diabetic ketoacidosis |
| ACE inhibitors (ramipril, lisinopril, enalapril) | Improve insulin sensitivity; increase bradykinin-mediated glucose uptake | Moderate – Monitor glucose when starting or uptitrating |
| Non-selective beta-blockers (propranolol, carvedilol) | Blunt adrenergic hypoglycemia symptoms and delay recovery from hypoglycemia | High – Sweating may be the only remaining warning sign; use cardioselective agents (metoprolol, bisoprolol) where possible |
| Fibrates (fenofibrate, gemfibrozil) | Improve insulin sensitivity (PPAR-alpha activation) | Moderate – Monitor glucose when starting or stopping |
| Salicylates (high-dose aspirin) | Displace insulin from protein binding; reduce gluconeogenesis | Moderate – Relevant mainly at anti-inflammatory doses (above 3 g/day) |
| MAO inhibitors (phenelzine, tranylcypromine) | Potentiate insulin action via unclear mechanism | Moderate – Increased blood glucose monitoring recommended |
| Pentamidine | Initial pancreatic beta-cell stimulation followed by destruction | High – Causes biphasic glucose response; severe hypoglycemia followed by hyperglycemia |
| Alcohol | Inhibits hepatic gluconeogenesis; can cause hypoglycemia unawareness | High – Risk of severe, delayed nocturnal hypoglycemia, especially when consumed without food |
Medications That May Reduce Insulin Effectiveness
| Drug / Drug Class | Mechanism | Clinical Significance |
|---|---|---|
| Corticosteroids (prednisone, dexamethasone, hydrocortisone) | Increase hepatic glucose output and peripheral insulin resistance | High – Insulin doses may need to increase by 50-100% during systemic steroid therapy; anticipate dose reduction on taper |
| Thiazide diuretics (hydrochlorothiazide, bendroflumethiazide) | Reduce insulin secretion via hypokalemia; increase insulin resistance | Moderate – Monitor glucose and potassium; dose-dependent effect |
| Atypical antipsychotics (olanzapine, clozapine, quetiapine) | Increase weight and insulin resistance; directly affect beta-cell function | High – Can cause significant glycemic deterioration; rare cases of new-onset diabetes |
| Thyroid hormones (levothyroxine, liothyronine) | Increase hepatic glucose production and intestinal glucose absorption | Moderate – Insulin needs may change when thyroid function changes; monitor during titration |
| Oral contraceptives / estrogens | Reduce insulin sensitivity | Low to Moderate – Modest dose adjustments may be required |
| Sympathomimetics (salbutamol, terbutaline, epinephrine) | Stimulate glycogenolysis and gluconeogenesis | Moderate – Transient effect, especially during acute bronchodilator use |
| Protease inhibitors (HIV antiretrovirals) | Induce insulin resistance | Moderate – May precipitate or worsen diabetes |
| Octreotide / lanreotide | Suppress both insulin and glucagon secretion; unpredictable glucose effect | Moderate – Can cause either hypoglycemia or hyperglycemia depending on context |
| Danazol | Anti-insulin effect on glucose metabolism | Moderate – Increase glucose monitoring; consider higher Ryzodeg dose |
Alcohol inhibits the liver's ability to produce new glucose (gluconeogenesis) and can cause severe, delayed hypoglycemia — sometimes occurring several hours after drinking or overnight. If you choose to drink alcohol, do so with food, in moderation, and consider testing your blood glucose before bed. Never drink alcohol on an empty stomach while using insulin, and make sure someone nearby knows how to treat hypoglycemia.
What Is the Correct Dosage of Ryzodeg FlexTouch?
Insulin dosing is highly personalized and depends on many factors: type of diabetes, body weight, dietary pattern, physical activity, concurrent medications, pregnancy status and overall glycemic targets. There is no single "standard" dose of Ryzodeg FlexTouch. The following guidance reflects general principles from the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), International Society for Pediatric and Adolescent Diabetes (ISPAD) and product labeling. Always follow your healthcare provider's specific instructions.
Adults
Type 2 Diabetes – Insulin-Naive
For patients new to insulin, the recommended starting dose is 10 units once daily with the main meal, in addition to existing oral antidiabetic agents (such as metformin). The dose is titrated based on the fasting blood glucose reading the morning after injection: increase by 1-2 units every 3-4 days until target fasting glucose (typically 4-6 mmol/L or 70-110 mg/dL) is reached. If post-meal glucose remains elevated despite adequate fasting control, the regimen can be intensified to twice-daily dosing.
Type 2 Diabetes – Switching from Other Insulin
When switching from once-daily basal insulin (e.g. insulin glargine or insulin detemir), use the same total daily dose. When switching from twice-daily premixed insulin (e.g. NovoMix 30) or basal-bolus regimens, use the same total daily dose split equally between the main meals. Close monitoring and dose adjustment over the first 1-2 weeks are essential, as Ryzodeg's pharmacokinetic profile differs from older insulins.
Type 1 Diabetes
In type 1 diabetes, Ryzodeg can be used as part of an individualized regimen, often combined with additional bolus insulin aspart at meals not covered by Ryzodeg. The total daily insulin requirement typically ranges from 0.4 to 1.0 units/kg/day. Ryzodeg generally provides about 50-70% of the daily insulin in this setting, with additional rapid-acting insulin given at the remaining meals as needed. Titration should be guided by fasting glucose, post-meal glucose and continuous glucose monitoring data.
Children and Adolescents (2 years and older)
Pediatric Dosing
Ryzodeg is approved for use in children and adolescents aged 2 years and older. The starting dose is typically 0.2 to 0.4 units/kg/day, given once or twice daily with the main meal(s). Pediatric dosing must be supervised by a specialist team, with thorough caregiver training in injection technique, carbohydrate awareness, blood glucose monitoring and hypoglycemia management. School staff should have a written diabetes care plan, and parents should plan for adjustments around growth, illness and changes in physical activity. The fixed 70/30 ratio may be limiting for very young children with variable meal patterns; many pediatric specialists prefer a separate basal-bolus regimen in this age group.
Elderly Patients
Geriatric Considerations
Ryzodeg can be used in older adults but should be initiated cautiously with lower starting doses and gradual titration. Older adults are at increased risk of hypoglycemia because of reduced renal function, impaired counter-regulatory hormone responses, polypharmacy, irregular meals and cognitive impairment. Glycemic targets may be relaxed (for example, HbA1c 7.5-8.0% and fasting glucose below 8.3 mmol/L [150 mg/dL]) in frail older adults or those with limited life expectancy, as recommended by the ADA/EASD consensus on older adults. The ultra-long basal action of degludec and the reduced injection burden make Ryzodeg attractive in this population, but only when the fixed-ratio regimen aligns with the patient's eating pattern.
Renal or Hepatic Impairment
In patients with reduced kidney or liver function, insulin requirements may be reduced because both organs clear insulin and contribute to gluconeogenesis. Close monitoring and individualized dose reduction are recommended. There is no fixed dose-reduction formula for Ryzodeg; adjustments should be made empirically based on blood glucose readings. The pharmacokinetics of insulin degludec have not been shown to be substantially altered in renal impairment, but clinical hypoglycemia risk is increased due to reduced gluconeogenic capacity.
Missed Dose
If you miss a dose of Ryzodeg FlexTouch, take it as soon as you remember, provided it is taken with a meal and there are at least 8 hours before the next scheduled dose. Resume your normal dosing schedule with the next meal. Never inject a double dose to make up for a missed one. The ultra-long action of the degludec component provides some flexibility — missing a single dose is unlikely to cause sustained hyperglycemia, but missing repeated doses will progressively lose basal coverage. If you are unsure, check your blood glucose more frequently for the next 24-48 hours and contact your healthcare team.
Overdose
An overdose of insulin causes hypoglycemia, which can range from mild (treatable with oral glucose) to severe (requiring medical assistance). Because Ryzodeg contains both rapid- and ultra-long-acting components, the hypoglycemia from overdose can be both immediate (from the aspart component) and prolonged (from the degludec component, lasting more than 42 hours). Symptoms include sweating, trembling, rapid heartbeat, confusion, blurred vision, slurred speech, aggression and loss of consciousness. Mild hypoglycemia can be treated by consuming 15-20 grams of fast-acting carbohydrate (4-5 glucose tablets, 150 mL fruit juice or regular soda). Recheck blood glucose after 15 minutes and repeat if still low. Follow with a longer-acting carbohydrate snack. Severe hypoglycemia, in which the patient cannot self-treat, is a medical emergency. Family members should be trained to administer intramuscular or nasal glucagon. If the person is unconscious or unable to swallow, call emergency services immediately. Patients who experience an overdose may need extended hospital observation due to the risk of recurrent hypoglycemia from the long-acting degludec component.
Ryzodeg FlexTouch is administered by subcutaneous injection into the abdomen, thigh or upper arm. The insulin solution must appear clear and colourless — do not use if it is cloudy, discoloured or contains visible particles. Always use a new pen needle for each injection. After injecting, keep the needle under the skin for at least 6 seconds while watching the dose counter return to 0 to ensure the full dose is delivered. Never share a FlexTouch pen between individuals, even if the needle is changed, because of the risk of transmitting bloodborne infections. Ryzodeg should not be administered intravenously or intramuscularly.
What Are the Side Effects of Ryzodeg FlexTouch?
Like all medicines, Ryzodeg FlexTouch can cause side effects, although not everybody gets them. The frequency classifications below follow the Council for International Organizations of Medical Sciences (CIOMS) categories used in European and US regulatory labelling. They are based on controlled clinical trials and post-marketing surveillance of insulin degludec and insulin aspart.
The most important side effect to understand is hypoglycemia. Every patient using insulin should be educated about recognition, self-treatment and prevention of low blood sugar. A healthcare team will work with the individual to minimize risk through careful dose adjustment, timing, dietary planning and use of monitoring technology. Notably, several head-to-head trials have shown that insulin degludec-based regimens produce lower rates of nocturnal hypoglycemia than older basal insulins such as glargine U100, while overall hypoglycemia rates remain comparable.
Very Common (affects more than 1 in 10 people)
- Hypoglycemia – Low blood sugar causing sweating, trembling, rapid heartbeat, hunger, dizziness, confusion, blurred vision, headache, and in severe cases loss of consciousness or seizures. Severe hypoglycemia may require help from another person and glucagon or intravenous glucose.
Common (affects 1 to 10 in 100 people)
- Injection site reactions – Redness, swelling, bruising, pain, itching or a small lump at the injection site; usually mild and transient.
- Lipodystrophy – Lipohypertrophy (firm, rubbery fatty lumps) or lipoatrophy (thinning of fat) at injection sites; can affect insulin absorption and contribute to glucose variability.
- Peripheral edema – Mild swelling of the hands, feet or ankles, particularly at the start of insulin therapy or after intensification.
- Weight gain – Insulin promotes glucose storage and can lead to modest weight gain, especially in the first 6-12 months of therapy. Lifestyle measures and consideration of GLP-1 receptor agonist add-on therapy can help offset this effect.
Uncommon (affects 1 to 10 in 1,000 people)
- Local allergic reactions – Urticaria, rash or persistent itching around the injection area. Most reactions resolve within days to weeks.
- Visual disturbances – Temporary blurred vision can occur when blood glucose control is rapidly improved, due to changes in lens refraction; typically resolves within weeks.
- Worsening of diabetic retinopathy – Rapid intensification of glycemic control can transiently worsen retinopathy. Ophthalmological assessment before intensification is recommended in high-risk patients.
- Peripheral neuropathy (insulin neuritis) – Rarely, rapid glucose improvement can cause painful neuropathy that usually resolves over months.
Rare (affects fewer than 1 in 1,000 people)
- Severe systemic allergic reactions (anaphylaxis) – Generalized rash, angioedema, bronchospasm, hypotension and shock; requires immediate emergency treatment.
- Hypokalemia – Insulin shifts potassium into cells, which can lower serum potassium. Risk is greatest with high-dose intravenous insulin.
- Insulin antibody formation – Usually clinically insignificant; very rarely, antibody-mediated changes in insulin requirements occur.
- Cutaneous amyloidosis at injection sites – Extremely rare; associated with chronic injection into the same site without rotation.
Seek immediate medical attention if you experience severe hypoglycemia with loss of consciousness or seizures; signs of a severe allergic reaction such as widespread rash, difficulty breathing, swelling of the face, tongue or throat; chest pain, confusion or a sudden, severe worsening of your general condition. Call your local emergency number without delay.
If you experience any side effect not listed here, or if any side effect becomes severe, contact your healthcare provider. Reporting side effects helps regulators monitor the safety of medicines. In the EU, side effects can be reported to the national pharmacovigilance system; in the US, via the FDA's MedWatch program; and in the UK, via the MHRA Yellow Card Scheme.
How Should You Store Ryzodeg FlexTouch?
Proper storage is essential to maintain insulin potency and patient safety. Insulin that has been frozen, overheated or stored beyond its shelf life can lose effectiveness without any visible change in appearance, potentially leading to unexpected hyperglycemia.
Unopened pens (not yet in use): Store in the refrigerator at 2 °C to 8 °C. Keep away from the freezer compartment and cooling element. Never freeze insulin — frozen insulin must be discarded because the protein structure is destroyed. Unopened pens stored correctly can be used until the expiration date printed on the label and outer carton. Keep the carton closed to protect from light.
In-use pens (after first use): After the first use, the pen can be stored at room temperature below 30 °C or in a refrigerator (2-8 °C) for up to 28 days. Unlike many other insulins, Ryzodeg can be safely refrigerated even after first use, which is convenient for patients in warm climates. After 28 days, discard the pen even if insulin remains. Writing the date of first use on the pen helps track the 28-day window.
General precautions: Protect the pen from direct sunlight and heat sources. Do not leave the pen in a hot car, near a window in direct sunlight, near a radiator or in checked airline luggage (where cargo-hold temperatures can drop below freezing). When travelling, carry insulin in hand luggage and use an insulated case — but avoid placing ice packs in direct contact with the pen. Before each injection, visually inspect the insulin: the solution should appear clear and colourless, like water. Do not use if it is cloudy, discoloured or contains visible particles or strings.
Disposal: Used pen needles and expired pens must be disposed of in an approved sharps container according to local regulations. Needles should never be placed in household waste because of the risk of needlestick injury. Many pharmacies and healthcare facilities offer sharps collection services. Keep all insulin and needles out of the reach and sight of children.
What Does Ryzodeg FlexTouch Contain?
Knowing the full composition of Ryzodeg FlexTouch helps patients and healthcare providers identify potential allergens and understand why each ingredient is included. Each component has a specific pharmaceutical purpose.
Active ingredients: 100 units total per mL, comprising:
- Insulin degludec 70 units/mL – an ultra-long-acting basal insulin analogue produced by recombinant DNA technology in Saccharomyces cerevisiae. Insulin degludec has a hexadecanedioic acid side chain attached via a glutamic acid spacer to lysine at position B29, allowing the molecule to form soluble multi-hexamer chains in the subcutaneous tissue.
- Insulin aspart 30 units/mL – a rapid-acting insulin analogue in which proline at position B28 has been replaced by aspartic acid, preventing hexamer formation and enabling rapid absorption.
Inactive ingredients (excipients):
- Glycerol (glycerin) – Isotonic agent that matches the formulation to body fluids, reducing discomfort on injection.
- Metacresol (m-cresol) – Antimicrobial preservative that maintains sterility once the pen is in use; also helps stabilize the insulin equilibrium.
- Phenol – Antimicrobial preservative working alongside metacresol.
- Zinc (as zinc acetate) – Stabilizes the insulin molecule and enables the formation of degludec multi-hexamers in the subcutaneous depot.
- Sodium chloride – Adjusts tonicity.
- Sodium hydroxide / hydrochloric acid – Used to adjust pH to approximately 7.4, within physiological range.
- Water for injection – Pharmaceutical-grade water used as the solvent for the solution.
The solution is clear and colourless when properly stored. The FlexTouch pen itself is made from medical-grade plastic and contains a glass cartridge. Patients with known allergy to metacresol or phenol should inform their healthcare provider; although rare, these preservatives are a recognized cause of local allergic skin reactions. The pen does not contain latex and is considered suitable for people with latex allergy. Ryzodeg is suitable for vegetarians and vegans, as it does not contain any animal-derived ingredients (the production yeast is processed and removed during manufacturing).
Frequently Asked Questions About Ryzodeg FlexTouch
Medical References & Sources
All information in this article is based on peer-reviewed medical literature, international guidelines and regulatory agency product information. The following sources were used:
- European Medicines Agency (EMA). Ryzodeg – Summary of Product Characteristics (SmPC). Committee for Medicinal Products for Human Use. Last updated 2025. Available at: www.ema.europa.eu
- U.S. Food and Drug Administration (FDA). Ryzodeg 70/30 (insulin degludec and insulin aspart) Prescribing Information. Novo Nordisk Inc. Last revised 2024. Available at: www.accessdata.fda.gov
- American Diabetes Association (ADA). Standards of Care in Diabetes – 2025. Diabetes Care. 2025;48(Suppl 1). DOI: 10.2337/dc25-SINT
- Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022: A Consensus Report by the ADA and EASD. Diabetes Care. 2022;45(11):2753-2786. DOI: 10.2337/dci22-0034
- Holt RIG, DeVries JH, Hess-Fischl A, et al. The Management of Type 1 Diabetes in Adults: A Consensus Report by the ADA and EASD. Diabetes Care. 2021;44(11):2589-2625. DOI: 10.2337/dci21-0043
- ISPAD (International Society for Pediatric and Adolescent Diabetes). Clinical Practice Consensus Guidelines 2022. Pediatric Diabetes. 2022;23(8).
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list, 2023. Geneva: WHO; 2023.
- National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management (NG28). Last updated 2022.
- British National Formulary (BNF). Insulin degludec with insulin aspart. National Institute for Health and Care Excellence. 2025.
- Heise T, Nosek L, Bottcher SG, et al. Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes. Diabetes Obes Metab. 2012;14(10):944-950. DOI: 10.1111/j.1463-1326.2012.01638.x
- Heise T, Nosek L, Roepstorff C, et al. Distinct prandial and basal glucose-lowering effects of insulin degludec/insulin aspart (IDegAsp) at steady state in subjects with type 1 diabetes mellitus. Diabetes Ther. 2014;5(1):255-265. DOI: 10.1007/s13300-014-0070-2
- Fulcher GR, Christiansen JS, Bantwal G, et al. Comparison of insulin degludec/insulin aspart and biphasic insulin aspart 30 in uncontrolled, insulin-treated type 2 diabetes (BOOST INTENSIFY PREMIX). Diabetes Care. 2014;37(8):2084-2090. DOI: 10.2337/dc13-2908
- Marso SP, McGuire DK, Zinman B, et al. Efficacy and safety of degludec versus glargine in type 2 diabetes (DEVOTE). N Engl J Med. 2017;377(8):723-732. DOI: 10.1056/NEJMoa1615692
- International Diabetes Federation (IDF). IDF Diabetes Atlas, 10th Edition. Brussels: IDF; 2021.
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