What to Know About Levemir (Insulin Detemir)

A Long-Acting Insulin for Type 1 and Type 2 Diabetes

Levemir (insulin detemir) is a long-acting, synthetic (man-made) version of human insulin that is used to help manage blood glucose levels. It is approved by the U.S. Food and Drug Administration (FDA) for children and adults with type 1 diabetes and adults with type 2 diabetes. Levemir comes in a vial to be administered with a needle and syringe or in an injection pen with a no-push extension that allows you to inject up to 100 units of insulin in one or two daily doses. There is no generic form of Levemir.

Uses

Levemir may be used by both children and adults to assist with blood glucose control. People with type 1 diabetes generally do not produce insulin at all and those with type 2 diabetes may make insulin, but not enough to keep blood sugar controlled.

Insulin detemir (the type of synthetic insulin found in Levemir) is injected under the skin (subcutaneously). This man-made insulin works by replacing the body's normal insulin production and binding to insulin receptors to help shuttle glucose from the bloodstream. Benefits of using synthetic insulin include longer duration of action with less variability, no significant peak, and therefore a reduced risk of hypoglycemia.

Levemir reaches the bloodstream several hours after injection and balances glucose levels over a 24-hour period. It also can help prevent the liver from releasing more sugar into the bloodstream. Levemir is proven to lower hemoglobin A1c and has a low rate of hypoglycemia when used as directed. It may be used once or twice daily, depending on individual needs.

Before Taking

Your healthcare team will assess if you're a good candidate for Levemir based on your fasting blood glucose levels, your recent A1c levels, and your ability to produce insulin and manage your glycemic balance.

If you have type 1 diabetes, Levemir may be the first-line treatment as a form of background basal insulin, but it must be used in conjunction with short-acting insulin at mealtimes. In type 2 diabetes, oral medications such as metformin (which increases insulin sensitivity) or sulfonylureas (which stimulate insulin release) are normally prescribed before insulin injections such as Levemir.

Precautions and Contraindications

Levemir is not intended to treat diabetic ketoacidosis, which requires rapid-acting insulin.

If you have liver or kidney issues, you may need additional monitoring and dose adjustment by your healthcare team, as these pre-existing conditions may increase the circulation of insulin.

Do not use Levemir if you are allergic to insulin or any of the inactive substances in Levemir. Seek immediate medical care if you use Levemir and develop any symptoms of an allergic reaction:

  • A rash over your entire body
  • Trouble breathing or shortness of breath
  • Fast heartbeat
  • Sweating
  • Swelling of your face, tongue, or throat
  • Extreme drowsiness, dizziness, or confusion

Other long-acting basal insulin drugs include:

  • Levemir and Levemir FlexTouch (insulin detemir)
  • Toujeo, Lantus, and Basaglar (insulin glargine)
  • Tresiba (insulin degludec)

Dosage

According to the manufacturer, Novo Nordisk, the dosage of Levemir is best determined by your prescribing doctor and may depend on several factors, including the type of diabetes you have, whether you've used insulin before, and your current control over your blood glucose levels.

Levemir is a concentrated insulin product at 100 units per milliliter. It can be dosed in one-unit increments and comes in two forms:

  • 3 mL single-patient-use Levemir FlexTouch pen
  • 10 mL multiple-dose vial (for syringe use)

Dosages should be administered via injection beneath the skin either once daily or in divided doses twice daily. Rotate the injection site within your preferred injection area, which may be your abdomen, upper arm (deltoid), or thigh.

Site rotation reduces your risk of lipohypertrophy, or swelling of the fatty tissue beneath the skin, which may lead to poor insulin absorption and thus poor glycemic control.

How to Take and Store

Levemir is available as a no-push extension pen, meaning that a minimum of force and dexterity are required to give the injection. After dialing up your dose of insulin, you'll gently push a dose button and a spring-loaded mechanism will inject the insulin. This can be especially helpful for delivering large doses of insulin.

Once the dose reaches zero, you may or may not hear a click. It's important when using this device to hold the needle in place for at least six seconds: The prescribed dose is not completely delivered until six seconds after the dose counter shows 0.

If the needle is removed earlier, you may see a stream of insulin coming from the needle, which means you're not getting your full dose of insulin. If this inadvertently happens, check your blood glucose levels more frequently and deliver additional insulin if necessary.

If taken once daily, Levemir should be administered with the evening meal or at bedtime. If taken twice daily, take the second dose 12 hours after the evening meal or bedtime dose.

Missing a dose: If you miss a dose or take too small a dose, you may wind up with elevated blood glucose levels (hyperglycemia). Take the missed dose as soon as you remember and adjust your second dose accordingly (whether 12 hours or 24 hours later).

Be on the lookout for symptoms of hyperglycemia, including:

  • Excessive thirst (polydipsia)
  • Increased hunger (polyphagia)
  • The need to urinate more frequently than usual (polyuria)
  • Blurred vision
  • Fatigue and weakness

Exceeding a dose: Taking too much insulin may result in having too little blood sugar to perform daily activities and bodily functions.

To remedy a mild episode of hypoglycemia, eat 15 grams of fast-acting carbs, take an oral glucose tablet, and continue to monitor your glucose levels every 15 minutes until they return to normal.

Symptoms of hypoglycemia vary and may include:

  • Trembling or weakness
  • Fast heartbeat
  • Sweating
  • Headache
  • Fatigue or feeling sleepy
  • Pale skin
  • Anxiety or irritability
  • Talking or yelling when you're sleeping
  • A tingling feeling around your mouth
  • Hunger
  • Dizziness
  • Confusion
  • Double or blurred vision
  • Lack of coordination
  • Seeming as if you're intoxicated
  • Convulsions or loss of consciousness

Overdosage: An insulin overdose can be life-threatening, as it will result in too little glucose circulating in the blood for the body to function properly. If you accidentally take too much insulin, mild hypoglycemia may be treated by taking oral glucose tablets, but a severe case requires swift medical intervention to prevent seizure, coma, or even death. Severe hypoglycemia may also result in hypokalemia (low levels of potassium) which requires treatment by a medical professional.

Storage: Unopened Levemir vials and pens should be stored in the refrigerator. Once a pen or vial is in use, it lasts 42 days without refrigeration. Never freeze insulin.

Side Effects

There are several side effects that may occur in conjunction with taking Levemir, some mild and some severe.

Common

The most common side effect of taking any insulin is hypoglycemia. Others include a reaction at the injection site, such as:

  • Itching
  • Rash
  • Swelling
  • Allergic reactions, including reactions at the injection site, skin thickening or pits at the injection site (lipodystrophy)

Severe

Potential severe side effects are rare but may include the following. If you experience a severe reaction, call for help immediately.

  • Extreme hypoglycemia
  • Severe allergic reaction: a whole-body reaction including a rash, shallow breathing, heart palpitations, and sweating
  • Fluid retention and heart failure with the use of thiazolidinediones (TZDs): Taking another diabetes medication such as Actos (pioglitazone) or Avandia (rosiglitazone) along with Levemir can result in fluid retention, which may worsen or cause heart failure. Be on the lookout for swelling (edema) in your feet or ankles and/or shortness of breath.

Warnings and Interactions

A number of factors can affect the rate at which Levemir or any insulin is absorbed, including dietary changes, exercise, sleep, and stress. For that reason, it's vital to measure your blood glucose frequently while taking Levemir.

When you begin taking Levemir, the manufacturer advises against driving or using heavy machinery until you know how the drug affects you.

If you have a history of kidney or liver problems, you and your doctor will need to work closely together to monitor your insulin and glucose levels, as some studies of human insulin have shown increased circulating insulin levels.

Drug interactions: Taking Levemir at the same time as any other blood-glucose-lowering drugs may cause your glucose levels to increase or to decrease.

Medications that may increase the risk of hypoglycemia when taken with Levemir include:

  • Oral antidiabetic medications such as Actoplus Met (pioglitazone) and Avandamet (rosiglitazone), and others
  • Symlin (pramlintide acetate)
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Norpace (disopyramide)
  • Antara, Lofibra, TriCor, Triglide (fenofibrates)
  • Prozac (fluoxetine)
  • Monoamine oxidase (MAO) inhibitors such as Marplan (isocarboxazid), Nardil (phenelzine), and others
  • Darvon and Darvocet (propoxyphene)
  • Trental (pentoxifylline)
  • Salicylates (e.g. in aspirin)
  • Somatostatin analogs
  • Sulfa-antibiotics

Examples of medications that may reduce the function of insulin include:

  • Corticosteroids
  • Niacin
  • Danazol
  • Diuretics such as Diuril, Hygroton, and others
  • Sympathomimetic agents (e.g., epinephrine, albuterol, terbutaline)
  • Glucagon
  • Isoniazid
  • Phenothiazine derivatives
  • Somatropin
  • Thyroid hormones
  • Estrogens
  • Progestogens (e.g., in oral contraceptives)
  • Protease inhibitors and atypical antipsychotic medications (e.g. olanzapine and clozapine)

Additionally, beta-blockers, clonidine, and lithium salts may increase or decrease the effects of insulin. Taking pentamidine may cause hypoglycemia, which then may be sometimes followed by hyperglycemia.

Drinking alcohol, using medications that contain alcohol, or taking other drugs may also raise or lower your blood glucose levels, which is dangerous when you're already taking insulin.

If you are pregnant or nursing and have type 1 or type 2 diabetes and are interested in taking Levemir, consult your physician and healthcare team first.

Before stopping Levemir, work with your doctor to create a weaning schedule, if necessary, as quitting cold-turkey may result in elevated blood glucose levels. Be sure never to mix Levemir with any other type of insulin.

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Article Sources
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