Detemir is the generic name for Levemir. It is a long acting insulin that was approved by the FDA in 2005 for use in adult and children with diabetes mellitus. It is a clear liquid and is closely related to the insulin made by the human body, except for little change in the insulin protein.
The length of action of Levemir insulin is about 24 hours and it has no peaks. This length of action can vary a little from one individual to another depending on factors like activity level, age, kidney and liver function and sometimes, the site of injection.
Levemir can be given once a day with the evening meal or twice a day, twelve hours apart. It may be better for type 1 diabetics to inject this medication twice a day as the physician may direct. The effectiveness of Levemir insulin in diabetes control is equivalent to that of insulin NPH.
It is supplied as a 10ml vial and a 3ml FlexPen.
* Keep vials in the refrigerator and inside the carton to protect from light.
* Open vials can be kept at room temperature below 86°F or 30°C for up to 42days.
* Always check the label on the vial to avoid mistaking Detemir for another insulin.
* Use each FlexPen for one patient only.
* Do not share the same FlexPen with other patients.
* Use new sterile needle each time you inject Detemir using a FlexPen.
* Set the FlexPen to the desired dose and inject into the fat layer below the skin as instructed. It is good practice to have someone else confirm your insulin dose before injection.
* Protect FlexPen from light or heat.
* Store FlexPen that is open and in use at room temperature away from light and heat for no more than 42days - Do not store open FlexPen in the refrigerator.
* Remove the needle and discard in a secure container after each injection from the FlexPen.
* Levemir insulin should not be used in diabetic ketoacidosis or any other diabetic coma. IV short acting or rapid-acting insulin is used under those conditions.
*It should not be given to people with allergy to Levemir.
*The doctor orders the starting dose and adjusts the dose as necessary.
* Store in the refrigerator, but do not freeze.
* Always keep the bottle of the insulin in the carton to protect it from light.
* If it is not possible to store in the refrigerator, this insulin can be stored at room temperature below 86°F or 30°C for up to 42days.
* Always rotate injection site to prevent lipodystrophy, which is the thickening or thinning of the fat layer.
* Always check the label to make sure that you have the correct insulin.
* Administer once or twice a day as ordered by your doctor. When administered once a day, evening is the preferred time. Twice a day doses should be administered 12 hours apart.
* Patients with type 1 diabetes should also receive meal time rapid acting or short-acting insulin to accommodate post meal blood sugar spikes. Detemir should constitute 1/3 of the daily insulin dose in type 1 diabetic. Short-acting or rapid acting mealtime insulin should constitute the remaining 2/3 of the daily dose.
* The usual starting dose in type 2 diabetics who take oral diabetic medicines or GLP-1 receptor agonist is 10 units a day or as modified by the doctor. The dose may be lowered for patients with kidney or liver disease.
* The doctor adjusts the dose until glycemic control is achieved.
* Finger stick blood sugar check should be done about 4 times a day at the initial stage of use and frequency decreased as glycemic control is achieved.
* Changes in activity, stress and illness may affect the action of insulin Detemir and may require dosage adjustment.
*Levemir insulin may be used concurrent, that is together with, oral diabetes drugs in the treatment of type 2 diabetes. It may also be used concurrent with glucagon-like peptide (GLP)-1 receptor agonist. Insulin dose may be lowered as the physician sees fit.
*Levemir should always be administered alone and not mixed with other medications. This is because the action of Detemir is altered when mixed with other medications.
* Patient should be familiar with signs and symptoms of hypoglycemia and be able to take foods with immediate release of glucose like skim milk, orange juice and regular soda.
*Inject insulin into the fat layer under the skin in the upper arm, thighs and abdomen as instructed by your healthcare professional.
* Patients should consult the doctor to review and maybe change the dosage in the event of illness, change in diet or activity patterns or introduction of other medications in patient's usual regimen
* Patient should be aware that hypoglycemia may affect ability to drive or operate machinery.
* Hypoglycemia is the most common adverse reaction of Levemir. Hypoglycemia may be prolonged because of the prolonged effect of Detemir.
* Lipodystrophy - which is the thickening or thinning of the fat layer at the site of injection. This can be avoided by rotating the site of injection.
*Allergic reactions like rash, itch and anaphylaxis.
* Swelling in hands and feet which is also called edema.
* Upper respiratory infections.
Side effects include:
* Increased heart rate
* Changes in mood
* Tingling in hands and feet
* Blurred vision
* Weight gain. This occurs because of the normalization of the use of glucose use in the body. This can sometimes be a desired effect if patient has been losing excess weight due to uncontrolled diabetes.
* Medications, such as beta blockers, clonidine, and lithium may make it difficult for the patient to notice the effects of hypoglycemia early.
* Some medications decrease blood sugar and may increase the incidence of hypoglycemia in patients taking insulin Detemir. These medications include ACE inhibitors; MAO inhibitors; propoxyphene; salicylates, like aspirin; somatostatin; sulfonamides and similar medications.
* The medications that increase blood sugar will decrease the blood glucose lowering actions of levemir. Some of these medications are corticosteroids like prednisone and dexamethasone; diuretics; niacin; sympathomimetic drugs like albuterol and epinephrine; thyroid hormones; somatotropin; glucagon; isoniazid; atypical antipsychotics like olanzapine and clozapine and oral contraceptives.
* Medications, such as beta blockers, clonidine, lithium and alcohol may affect the glycemic action of Levemir in an unpredictable manner.
* Do not inject insulin Detemir into the muscle or use it IV because this will cause severe low blood sugar or hypoglycemia.
* Do not use in insulin pumps.
* Do not mix with other insulin or other medications because this will change how levemir works.
* Do not share the same Levemir FlexPen between different patients.
* Do not store Levemir FlexPen with needle attached.
Levemir can be used in pregnancy with close monitoring by a physician.
Use in breastfeeding mothers with caution.
Use cautiously in pediatric patients as the doctor decides.
Use cautiously in geriatric patients. Dose may be lowered because of possible decrease in kidney and liver function in this population. Also this population may have reduction in their ability to recognize the signs and symptoms of hypoglycemia.
Detemir overdose can occur when a patient takes more than the prescribed dose. This can happen when a patient mistakes Detemir for rapid-acting or quick-acting insulin. Overdose of levemir can be life-threatening because of the potential for prolonged hypoglycemia. Mild overdose can be treated by frequent finger stick blood sugar monitoring and consumption of foods with quick release of glucose like skim milk, orange juice and regular soda. Severe overdose and hypoglycemia is treated in the hospital setting with injection of glucagon or IV glucose. Always report all Detemir overdose and or hypoglycemia to your doctor.
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