What to Know About Levemir (Insulin Detemir)

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

Older man giving himself injection
Chris Ryan / Getty Images

In This Article

Levemir is a long-acting insulin that is used to help with the daily management of blood glucose and has been approved for use in adults with both type 1 and type 2 diabetes and in children with type 1 diabetes. Levemir comes in a vial or injection pen with a no-push extension and allows you to inject up to 100 units of Levemir in one or two daily doses.

Uses

Levemir may be used by both children and adults for assistance with blood glucose control. People without diabetes make the necessary amount of insulin to cover the body's normal everyday needs. In contrast, people with type 1 diabetes generally do not produce insulin at all and those with type 2 diabetes may make insulin, but sometimes not enough to keep blood sugar controlled.

Levemir is a long-acting (or basal) form of insulin known as insulin detemir that is injected under the skin (subcutaneously). Levemir reaches the bloodstream several hours after injection and balances glucose levels over a 24-hour period. It is proven to lower hemoglobin A1c and has a low rate of hypoglycemia when used as directed. Levemir may be used once or twice daily, depending on your 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 first before insulin injections such as Levemir.

Precautions and Contraindications

Levemir is not intended for the treatment of 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 in some cases.

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 of the following symptoms of an allergic reaction:

  • A rash over your entire body
  • Trouble breathing
  • 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. Take care to rotate the injection site around your preferred injection area, which may be your abdomen, upper arm (deltoid), or thigh. Site rotation reduces your risk of lipodystrophy, 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 less force is required to give the injection (which can be helpful for those with dexterity issues). After dialing up your dose of insulin, you'll gently push a dose button and a spring-loaded mechanism will inject the insulin. This is helpful, especially when delivering a larger dose of insulin.

Once the dose reaches zero, you may or may not hear a click. It is very important when using this device that the needle is held in the skin for a minimum of 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. In this case, check your blood glucose levels more frequently and deliver additional insulin if necessary.

If taken just once daily, Levemir should be administered with your 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 of a dose, you may wind up with elevated blood glucose levels, known as hyperglycemia. Take the missed dose as soon as you remember, and further 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
  • Feeling tired and weak

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 your normal range.

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 unconsciousness

Overdosage: An insulin overdose can be dangerous and may be life-threatening, as it will result in your body having too little glucose circulating in the blood to function properly. If you accidentally take too much insulin, mild cases of hypoglycemia may be treated by taking oral glucose tablets, but more severe cases require swift medical intervention, as if left untreated, may lead to a seizure, coma, or even death. Severe hypoglycemia may also result in hypokalemia, or having too little potassium, and this should only be remedied by a medical professional.

Storage: Levemir vials and pens should be stored in the refrigerator if unopened and when not in use. 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 may include a reaction at the injection site, including:

  • 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.

  • Severe hypoglycemia: A condition marked by very low blood sugar requiring immediate medical attention
  • Low blood potassium (hypokalemia)
  • Severe allergic reaction: A whole-body reaction including a rash, shallow breathing, heart palpitations, and sweating
  • Fluid retention and heart failure with use of thiazolidinediones (TZDs): Taking another diabetes medication such as Actos or Avandia while simultaneously taking Levemir could result in fluid retention, which may worsen or cause heart failure. Take note of any new swelling in your feet or ankles and shortness of breath.

Warnings and Interactions

When taking Levemir or any insulin, note that there are several other factors that may affect insulin's rate of absorption of insulin, such as changes in diet, exercise, sleep, and stress. Be sure to continue to monitor your blood glucose levels frequently while taking Levemir.

The manufacturer suggests avoiding driving or using any heavy machinery until you know how taking Levemir affects you.

If you have a history of kidney or liver problems, work with your provider to carefully monitor your insulin and glucose levels, as some studies of human insulin have shown increased circulating insulin levels.

Drug interactions: Taking Levemir in conjunction with any other blood-glucose-lowering drugs may impact your glucose levels and contribute to hypo/hyperglycemia. Examples of medications that may increase your risk of hypoglycemia include:

  • Oral antidiabetic medications
  • Pramlintide acetate
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Disopyramide
  • Fibrates
  • Fluoxetine
  • Monoamine oxidase (MAO) inhibitors
  • Propoxyphene
  • Pentoxifylline
  • Salicylates (e.g. in aspirin)
  • Somatostatin analogs
  • Sulfonamide antibiotics

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

  • Corticosteroids
  • Niacin
  • Danazol
  • Diuretics
  • 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.

Was this page helpful?

Article Sources