Insulin Detemir

Insulin Detemir is a prescription medication used to treat Type I or II Diabetes Mellitus. 

• Insulin Detemir is available under the following different brand names: Levemir, Levemir FlexTouch.

Adult and pediatric dosage

Injectable solution

• 100 units/mL (10mL vial)

Prefilled syringe

• 100 units/mL (3mL FlexTouch)

Type I or II Diabetes Mellitus

Adult dosage

• Once daily dosage: Administer SC with evening meal or bedtime
• Twice daily dosage: Administer SC with morning meal and either with evening meal, at bedtime, or 12 hours after the morning dose

Type I diabetes

Initial dose

Adult dosage

• Approximately one third or total daily insulin requirements SC
• Use rapid-acting or short acting, premeal insulin to satisfy remained or daily insulin requirements
• Usual daily maintenance range is 0.5-1 unit/kg/day in divided doses
• Nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.6-1.2 units/kg/day

Pediatric dosage

• Children younger than 2 years of age: Safety and efficacy not established
• Children 2 years of age or older: 
• Approximately one-third of the total daily insulin requirements SC
• Rapid-acting or short-acting, premeal insulin should be used to satisfy remainder of daily insulin requirements
• Usual daily maintenance range in adolescents is than 1.2 units/kg/day during growth spurts

Type II diabetes

Adult dosage

• Type 2 diabetes inadequately controlled on oral medical: 10 units/day SC (or 0.1-0.2 unit/kg/day) in the evening or divided every 12 hours
• Type 2 diabetes inadequately controlled on GLP-1 receptor agonist: 10 units/day SC given once daily in the evening
• Subsequently adjust dose based on blood glucose measurements 

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Insulin Detemir include:

• low blood sugar, 
• weight gain, 
• swelling in the hands and feet, 
• rash, 
• itching, and
• thickening or hallowing of the skin at the injection site

Serious side effects of Insulin Detemir include:

• redness or swelling at the injection site, 
• itching skin rash over the entire body, 
• trouble breathing, 
• fast heartbeats, 
• lightheadedness, 
• swelling in the tongue or throat, 
• weight gain, 
• swelling in the hands or feet, 
• shortness of breath, 
• leg cramps, 
• constipation, 
• irregular heartbeats, 
• fluttering in the chest, 
• increased thirst or urination, 
• numbness or tingling, 
• muscle weakness, and
• limp feeling

Rare side effects of Insulin Detemir include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Insulin Detemir has severe interactions with the following drug:
  • pramlintide
• Insulin Detemir has serious interactions with the following drugs:
  • ethanol
  • macimorelin 
• Insulin Detemir has moderate interactions with at least 126 other drugs.
• Insulin Detemir has minor interactions with at least 77 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Systemic allergic reactions
• During episodes of hypoglycemia

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Insulin Detemir?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Insulin Detemir?”

Cautions

• Never share pen between patients even if needle is changed
• Long-acting insulin; do not use for circumstances that require rapid-acting insulin
• Use with caution in patients with decreased insulin requirements, including those with diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, or hepatic impairment
• Rapid changes in serum glucose may induce symptoms of hypoglycemia
• Frequent glucose monitoring and insulin dose reduction may be required with renal or hepatic impairment; not recommended during periods of rapidly declining renal or hepatic function, because of risk for prolonged hypoglycemia
• May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium
• Use with caution in patients with increased insulin requirements, including those with fever, hyperthyroidism, trauma, or infection or who have undergone surgery
• Lower dose when used in combination with a GLP-1 receptor agonist to minimize the risk of hypoglycemia
  • Hyperglycemia or hypoglycemia with changes in insulin regimen
  • Changes in insulin, insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia
  • Changes should be made cautiously and only under close medical supervision and frequency of blood glucose monitoring should be increased
  • Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis reported to result in hyperglycemia; a sudden change in the injection site (to unaffected area) has been reported to result in hypoglycemia
  • Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring
  • Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change injection site to unaffected areas and closely monitor for hypoglycemia
  • The time and course of action for insulin may vary in different individuals or at different times in the same individual and is dependent on many conditions, including local blood supply, local temperature, and physical activity
• Heart Failure
  • Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin
  • Fluid retention may lead to or exacerbate heart failure
  • Monitor for signs and symptoms of heart failure, treat accordingly, and consider discontinuing thiazolidinediones

Pregnancy and Lactation

• May be acceptable during pregnancy.  Randomized, controlled trial (n=310) observed insulin detemir reduced Hgb A1C similarly to insulin NPH in pregnant women; no differences observed in fetuses and newborns. 
• Lactation: Safe.