Insulin Detemir

Insulin Detemir Brand Names- Levemir | Levemir FlexTouch

What is Insulin Detemir

Insulin detemir is a recombinant, soluble, long-acting basal insulin analog.

Fatty acid acylation allows for a protracted duration of effect with no pronounced peak via delayed absorption due to albumin binding in subcutaneous adipose tissue and plasma.

Unlike insulin glargine and NPH insulin, insulin detemir is soluble at a neutral pH and exists as a liquid following subcutaneous injection, increasing surface area and reducing variability in absorption.

Insulin detemir is used in adult and pediatric patients 2 years and older with type 1 diabetes mellitus (DM), and adults with type 2 DM.

Insulin detemir has been used in children and adolescents with type 2 DM; however, oral agents are typically first-line therapy. Basal insulin may be added to metformin therapy in pediatric patients with type 2 DM when additional glycemic control is needed.

Insulin detemir is considered to be equipotent to NPH insulin. Advantages of insulin detemir versus NPH insulin, for example, can include less variability in patient response, similarity or improvement in glycemic control, less weight gain, and a decrease in the incidence of hypoglycemia, including both nocturnal and severe hypoglycemia.

No clinically relevant differences regarding glucose control between insulin detemir and insulin glargine have been demonstrated in adults with type 1 or type 2 diabetes mellitus; however, to achieve glycemic control insulin detemir may need to be administered twice daily.

Insulin glargine and insulin detemir had similar rates of A1C reduction in a 52-week clinical trial of insulin-naive patients taking basal insulin as add-on therapy to oral glucose-lowering medications; A1C decreased by 1.5% in both treatment groups (7.1% for insulin glargine and 7.2% for insulin detemir).

In the treatment of type 1 DM, insulin therapy may be initiated with a basal-bolus regimen of insulin detemir and then further individualized to achieve treatment goals. In the treatment of type 2 DM, insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents.

In patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists (GLP-1 RA) are the preferred choice to insulin. Evidence from trials comparing GLP-1 RAs and insulin (basal, premixed, or basal-bolus) shows similar or even better efficacy in A1C reduction; GLP-1 RAs have a lower risk of hypoglycemia and are associated with reductions in body weight compared to weight gain with insulin.

In patients who cannot tolerate a GLP-1 RA, or who fail to meet glycemic targets with dual/triple therapy, insulin therapy with basal insulin, such as insulin detemir should be initiated and titrated to target.

If the A1C remains above target, prandial insulin should be added. Consider an initial injectable combination (i.e., GLP-1 RA plus basal insulin or prandial/basal insulin) if A1C is greater than 10% and 2% above target.

Consider the early introduction of insulin if there is evidence of ongoing catabolism, if symptoms of hyperglycemia are present, or when A1C levels (greater than 10%) or blood glucose levels (300 mg/dL or more) are very high.

In patients who are starting on insulin therapy and are taking a thiazolidinedione or sulfonylurea, discontinue or reduce the dose of the oral medication

Indications

• type 1 diabetes mellitus
• type 2 diabetes mellitus

Side Effects

1. abdominal pain
2. anaphylactoid reactions
3. anemia
4. angioedema
5. antibody formation
6. back pain
7. bronchospasm
8. cough
9. cutaneous amyloidosis
10. diarrhea
11. edema
12. erythema
13. fever
14. headache
15. hyperinsulinemia
16. hypertension
17. hypoglycemia
18. hypokalemia
19. hypotension
20. infection
21. influenza
22. injection site reaction
23. insulin resistance
24. insulin shock
25. lipodystrophy
26. nausea
27. peripheral edema
28. peripheral neuropathy
29. pharyngitis
30. pruritus
31. rash
32. retinopathy
33. rhinitis
34. Somogyi effect
35. spontaneous fetal abortion
36. urticaria
37. vomiting
38. weight gain

Monitoring Parameters

• blood glucose
• glycosylated hemoglobin A1c (HbA1c)

Contraindications

• breast-feeding
• children
• coma
• continuous subcutaneous insulin infusion (CSII) administration
• cresol hypersensitivity
• diabetic ketoacidosis
• diarrhea
• fever
• geriatric
• hepatic disease
• hyperosmolar hyperglycemic state (HHS)
• hypoglycemia
• hypokalemia
• infants
• infection
• intramuscular administration
• intravenous administration
• neonates
• pregnancy
• renal failure
• renal impairment
• surgery
• thyroid disease
• tobacco smoking
• trauma
• visual impairment
• vomiting

Interactions

• Acebutolol
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