What to know about Levemir (insulin detemir)

Levemir (insulin detemir) is a long-acting synthetic (man-made) human insulin used to help control blood sugar levels. It is approved by the U.S. Food and Drug Administration (FDA) for use in children and adults with type 1 diabetes and adults with type 2 diabetes.

Levemir comes in a vial that can be administered with a needle and syringe, or in an injection pen with a pushless extension, allowing you to inject up to 100 units of insulin once or twice a day. Levemir has no generic form.

use

Both children and adults can use Levemir to help control blood sugar. People with type 1 diabetes often do not produce insulin at all, while people with type 2 diabetes may produce insulin, but not enough to control blood sugar.

Insulin detemir (the type of synthetic insulin found in Levemir) is injected subcutaneously (subcutaneously). This man-made insulin helps move glucose out of the bloodstream by replacing the body’s normal insulin production and binding to insulin receptors.

The benefits of using synthetic insulin include a longer duration of action, less variability, and no distinct peaks, thus reducing the risk of hypoglycemia.

Levemir reaches the blood a few hours after injection and balances glucose levels within 24 hours. It can also help prevent the liver from releasing more sugar into the bloodstream. Levemir has been shown to lower hemoglobin A1C and has a lower incidence of hypoglycemia when used as directed. It can be used once or twice a day, depending on individual needs.

Before taking

Your healthcare team will assess your suitability for Levemir based on your fasting blood sugar levels, recent A1C levels, and your ability to produce insulin and manage blood sugar balance.

If you have type 1 diabetes, Levemir may be a first-line treatment as a form of background basal insulin, but it must be given with short-acting insulin with meals. In type 2 diabetes, oral medications such as metformin (increase insulin sensitivity) or sulfonylureas (stimulate insulin release) are often prescribed before insulin injections (such as Levemir).

Precautions and contraindications

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

If you have liver or kidney problems, you may need additional monitoring and dosage adjustments 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. Get medical attention right away if you use Levemir and experience any symptoms of an allergic reaction:

  • rash all over the body
  • difficulty breathing or shortness of breath
  • fast heartbeat
  • sweat
  • swelling of the face, tongue, or throat
  • extreme drowsiness, dizziness, or confusion
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Other long-acting basal insulin medications include:

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

dose

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

Levemir is a concentrated insulin product with 100 units per milliliter. It can be administered in one-unit increments and is available in two forms:

  • 3 mL Single Use Levemir FlexTouch Pen
  • 10 mL multi-dose vials (for use with syringes)

Dosing should be administered by subcutaneous injection in once-daily or twice-daily divided doses. Rotate the injection site within your preferred injection area, which may be your abdomen, upper arm (deltoid), or thigh.

Site rotation reduces the risk of lipomegaly, or swelling of subcutaneous adipose tissue, which can lead to poor insulin absorption and thus poor blood sugar control.

How to take and store

Levemir is available as a pushless extension pen, which means minimal force and dexterity are required for injection. After turning up the insulin dose, you will gently press the dose button and the spring-loaded mechanism will inject the insulin. This is especially helpful for delivering large doses of insulin.

You may or may not hear a click once the dose reaches zero. This is important when using this device to hold the needle in place for at least six seconds: the prescribed dose will not be fully delivered until six seconds after the dose counter shows 0.

If the needle is pulled out early, you may see a flow of insulin from the needle, which means you are not getting the full dose of insulin. If this happens unintentionally, check your blood sugar levels more often and give extra insulin if necessary.

If taken once a day, Levemir should be taken with dinner or at bedtime. If taking twice a day, take the second dose 12 hours after dinner or at bedtime.

Missed dose: If you miss a dose or take a dose that is too small, you may have high blood sugar levels (hyperglycemia). Take the missed dose as soon as you remember and adjust the second dose accordingly (either 12 or 24 hours later).

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Watch for symptoms of high blood sugar, including:

  • Excessive thirst (polydipsia)
  • Increased hunger (eating more)
  • need to urinate more often than usual (polyuria)
  • blurred vision
  • fatigue and weakness

Overdose: Also take a lot of Insulin may cause blood sugar to be too low to perform daily activities and bodily functions.

To correct mild hypoglycemic episodes, eat 15-20 grams of fast-acting carbohydrates (or preferably glucose) and continue monitoring blood sugar levels every 15 minutes until they return to normal. If your blood sugar levels are still low 15 minutes after the initial treatment, the treatment should be repeated.

Symptoms of hypoglycemia vary and may include:

  • trembling or weakness
  • fast heartbeat
  • sweat
  • headache
  • fatigue or feeling sleepy
  • pale complexion
  • anxiety or irritability
  • talking or yelling while sleeping
  • tingling around the mouth
  • hunger
  • Dizziness
  • Puzzled
  • double vision or blurred vision
  • lack of coordination
  • as if you were drunk
  • Convulsions or loss of consciousness

Overdose: An insulin overdose can be life-threatening because it causes too little glucose circulating in the blood for the body to function properly. If you accidentally take too much insulin, mild hypoglycemia can be treated with oral glucose tablets, but severe cases require prompt medical intervention, such as glucagon injections, to prevent seizures, coma, or even death. Severe hypoglycemia can also cause hypokalemia (low levels of potassium), which requires treatment by a medical professional.

Storage: Unopened Levemir vials and pens should be stored in the refrigerator. After using the pen or vial, it will last up to 42 days without refrigeration. Never freeze insulin.

side effect

There may be some side effects from taking Levemir, some mild and some serious.

Common

The most common side effect of taking any insulin is low blood sugar. Others include injection site reactions such as:

  • itching
  • rash
  • swelling
  • Allergic reactions, including injection site reactions, skin thickening, or pitting at the injection site (lipodystrophy)

serious

Potentially serious side effects are rare but may include the following. Get help right away if you have a severe reaction.

  • extremely low blood sugar
  • Severe allergic reactions: systemic reactions, including rash, shallow breathing, heart palpitations, and sweating
  • Fluid retention and heart failure with thiazolidinediones (TZDs): Taking another diabetes medicine with Levemir, such as Actos (pioglitazone) or Avandia (rosiglitazone), can cause fluid retention, which may worsen or lead to heart failure. Watch for swelling of the feet or ankles (edema) and/or shortness of breath.
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Warning and Interaction

Many factors can affect the rate of absorption of Levemir, or any insulin, including dietary changes, exercise, sleep, and stress. Therefore, it is important to measure blood sugar frequently while taking Levemir.

When you start taking Levemir, the manufacturer recommends not driving or using heavy machinery until you know how the drug will affect you.

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

Drug Interactions: Taking Levemir with any other blood sugar lowering drugs may cause your blood sugar levels to increase or decrease.

Medications that may increase the risk of low blood sugar when taken with Levemir include:

  • Oral antidiabetic medications, such as Actoplus Met (pioglitazone) and Avandamet (rosiglitazone), among others
  • Symlin (pramlintide acetate)
  • Angiotensin-Converting Enzyme (ACE) Inhibitors
  • Norpax (disopyramide)
  • Antara, Lofibra, TriCor, Triglide (fenofibrate)
  • Prozac (fluoxetine)
  • Monoamine oxidase (MAO) inhibitors, such as Marplan (isocarboxazid), Nardil (phenelzine), etc.
  • Darvon and Darvocet (propoxyphene)
  • Trental (pentoxifylline)
  • Salicylates (such as aspirin)
  • somatostatin analogs
  • Sulfonamide antibiotics

Medications that may decrease insulin function include:

  • corticosteroids
  • niacin
  • Danazol
  • Diuretics such as Diuril, Hygroton, etc.
  • Sympathomimetics (eg, epinephrine, salbutamol, terbutaline)
  • Glucagon
  • Isoniazid
  • Phenothiazine Derivatives
  • growth hormone
  • Thyroid hormone
  • Estrogen
  • Progestins (eg, in oral contraceptives)
  • Protease inhibitors and atypical antipsychotics (eg, olanzapine and clozapine)

In addition, beta-blockers, clonidine, and lithium salts may increase or decrease the effects of insulin. Taking pentamidine may cause low blood sugar and then sometimes high blood sugar.

Drinking alcohol, using alcohol-based medicines, or taking other medicines can also raise or lower your blood sugar levels, which can be 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, please consult your healthcare provider and medical team first.

Before stopping Levemir, if necessary, work with your healthcare provider to develop a weaning schedule, as quitting cold turkey may cause blood sugar levels to rise. Be sure not to mix Levemir with any other type of insulin.