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Insulin Detemir, Injectable Solution

Highlights for insulin detemir

  1. Insulin detemir injectable solution is available as a brand-name drug only. It doesn’t have a generic version. Brand names: Levemir, Levemir FlexTouch.
  2. Insulin detemir comes only as a solution you inject under your skin.
  3. Insulin detemir is used to treat high blood sugar (hyperglycemia) in people with type 1 or type 2 diabetes.
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Important warnings

Important warnings

  • Low blood sugar warning: Insulin detemir can cause hypoglycemia (very low blood sugar levels). Severe low blood sugar can be dangerous. It can harm your heart or brain, cause unconsciousness or seizures, and even be fatal. Low blood sugar can happen very quickly and come on without symptoms. This is why it’s important to check your blood sugar as often as your doctor says to do so. Low blood sugar symptoms occur most frequently when your blood sugar level is less than 70 mg/dL.
  • Allergic reaction warning: Insulin detemir can cause a severe allergic reaction. Don’t take insulin detemir if you’ve ever had an allergic reaction to it or any ingredients in the injection. Taking it a second time after an allergic reaction could be fatal.
  • Proper usage warning: Insulin detemir shouldn’t be used to treat diabetic ketoacidosis, a condition that can occur in people with type 1 diabetes. If you have type 1 diabetes and your blood sugar levels are high, your body may try to break down fat to get energy. In this process, chemicals called ketones are produced. High levels of ketones can poison your body and cause diabetic ketoacidosis. Seek medical help right away if you have symptoms of diabetic ketoacidosis.
  • Heart failure warning: Taking diabetes pills called thiazolidinediones (TZDs) with insulin may cause heart failure. Tell your doctor if you have any new or worse symptoms of heart failure, including shortness of breath, swelling of your ankles or feet, orsudden weight gain. If you have these symptoms, your doctor may adjust your TZD dosage.
  • Infection warning: Insulin vials, syringes, or prefilled pens must never be shared between patients. Sharing or reusing needles or syringes with another person puts you at risk for various infections.

About

What is insulin detemir?

Insulin detemir is a prescription drug. It comes as an injectable solution and a prefilled syringe. The drug is self-injectable.

Insulin detemir injectable solution is available as the brand-name drugs Levemir and Levemir FlexTouch. It doesn’t have a generic version.

This drug may be used as part of a combination therapy. That means you may need to take it with other medications.

Why it's used

Insulin detemir is used to decrease blood sugar levels in people who have type 1 or type 2 diabetes.

How it works

Insulin detemir belongs to a class of medications called insulin. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. Insulin detemir is a long-acting insulin.

If you have type 1 diabetes, your pancreas can not make insulin. Insulin detemir replaces part of the insulin that your body needs.

If you have type 2 diabetes, your pancreas doesn’t make enough insulin, or your body can’t use the insulin that your pancreas makes.

Insulin detemir helps the sugar in your blood go to your muscles so that they can work. It helps store extra sugar in muscle and fat. It also stops your liver from releasing more sugar into your bloodstream.

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Side effects

Insulin detemir side effects

Insulin detemir doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with insulin detemir include:

  • low blood sugar
  • injection site reactions, with symptoms such as:
    • redness
    • swelling
    • itching
  • weight gain
  • swelling (edema) in your arms, legs, feet, or ankles

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Severe low blood sugar (less than 35–40 mg/dL). Symptoms can include:
    • hunger
    • nervousness
    • shakiness
    • sweating, chills, and clamminess
    • dizziness
    • fast heart rate
    • lightheadedness
    • sleepiness
    • confusion
    • vision changes
    • headache
    • mood changes
    • irritability
    • nightmares or crying out in your sleep

    If you don’t treat low blood sugar, you can have a seizure, pass out, and possibly develop brain damage. Low blood sugar can even be fatal. If you pass out because of a low sugar reaction or can not swallow, someone will have to give an injection of glucagon to treat the low sugar reaction. You may need to go to the emergency room.

  • Skin thickening (lipohypertrophy) or pits at the injection site (lipodystrophy). Change where you inject your insulin to prevent these skin changes from happening. Don’t inject insulin into this type of skin.
  • Allergic reaction. Symptoms can include:
    • rash all over your body
    • itching
    • trouble breathing
    • fast heart rate
    • swelling of your tongue and throat (angioedema)
    • feeling faint

Treating low blood sugar

The main side effect of insulin detemir is low blood sugar. Symptoms include hunger, nervousness, shakiness, sweating, chills, and clamminess. They also include dizziness, a fast heart rate, lightheadedness, sleepiness, confusion, blurred vision, headache, feeling confused or not like yourself, and irritability. If you have a low blood sugar reaction, you’ll need to treat it.

  • For hypoglycemia (55–70 mg/dL), treatment is 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:
    • 3–4 glucose tablets
    • a tube of glucose gel
    • ½ cup of juice or regular, non-diet soda
    • 1 cup of nonfat or 1% cow’s milk
    • 1 tablespoon of sugar, honey, or corn syrup
    • 8–10 pieces of hard candy, such as lifesavers
  • Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, repeat the above treatment.

Once your blood sugar level is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Interactions

Insulin detemir may interact with other medications

Insulin detemir injectable solution can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with insulin detemir are listed below.

Diabetes drugs

These medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • oral diabetes medications such as pioglitazone or rosiglitazone
  • pramlintide

Oral diabetes medications should be used with caution with insulin detemir. Using them together may increase your risk of water retention and heart failure.

Depression drugs

Certain depression medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • fluoxetine
  • monoamine oxidase inhibitors (MAOIs)

Medications to treat infections

These medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • sulfonamide antibiotics
  • sulfamethoxazole with or without trimethoprim

Pain medications

Certain pain medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • salicylates

Drugs for a condition called acromegaly

These medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • octreotide
  • pasireotide
  • lanreotide

Blood thinner

Pentoxyfylline can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased.

Medication for ulcerative colitis or rheumatoid arthritis

Sulfasalazine can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased.

High blood pressure medications

These medications can interact with insulin detemir and lower your blood sugar more. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be decreased. Examples of these drugs include:

  • enalapril
  • lisinopril
  • captopril

Medication for heart rate disorders

Disopyramide can interact with insulin detemir and lower your blood sugar more. If you use these drugs together, your insulin detemir dosage may need to be decreased.

Medications to treat high triglycerides

Drugs called fibrates can interact with insulin detemir and lower your blood sugar more. If you use a fibrate and insulin detemir together, your insulin detemir dosage may need to be decreased.

Allergy or asthma medications

These drugs can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be increased. Examples of these drugs include:

  • corticosteroids
  • epinephrine
  • albuterol
  • terbutaline

Female hormones

Hormones commonly used in birth control can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs together, your insulin detemir dosage may need to be increased. Examples of these hormones include:

  • estrogen
  • progestogens

HIV drugs

These drugs can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be increased. Examples of these drugs include:

  • protease inhibitors such as ritonavir or saquinavir

Antipsychotic medications

These drugs can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be increased. Examples of these drugs include:

  • olanzapine
  • clozapine
  • phenothiazine

Heart or cholesterol drugs

These drugs can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be increased. Examples of these drugs include:

  • niacin
  • diuretics (water pills)

Tuberculosis drug

Isoniazid can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs together, your insulin detemir dosage may need to be increased.

Endocrine disorder drugs

These drugs can increase your blood sugar levels. This can make insulin detemir less effective. If you use these drugs with insulin detemir, your insulin detemir dosage may need to be increased. Examples of these drugs include:

  • danazol
  • glucagon
  • thyroid hormones

Somatostatin, another endocrine disorder drug, can decrease your blood sugar levels when taken with insulin detemir.

High blood pressure drugs (beta blockers)

These medications may either increase or decrease your blood sugar levels when they’re taken with insulin detemir. Some of these drugs can also make it harder to spot the symptoms of low blood sugar. Examples of these drugs include:

  • propranolol
  • metoprolol
  • atenolol
  • clonidine

The following medications can keep you from noticing symptoms of low blood sugar:

  • guanethidine
  • reserpine

Mood disorder drugs

Lithium salts can either increase or decrease your blood sugar levels when they’re taken with insulin detemir.

Pneumonia medication

When taken with insulin detemir,pentamidine can decrease your blood sugar levels at first, and then increase your blood sugar levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

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Other warnings

Insulin detemir warnings

This drug comes with several warnings.

Allergy warning

Insulin detemir can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue
  • itching
  • feeling faint
  • rash all over your body
  • fast heart rate
  • sweating

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interaction warning

The amount and type of food you eat can affect how much insulin detemir you need. Talk to your doctor if you change your diet. They may need to adjust your insulin detemir dosage.

Alcohol interaction warning

Drinking alcohol while taking insulin detemir can affect your blood sugar levels. Avoid drinking while taking this medication.

Contact with drug warning

Don’t share insulin detemir with others even if they have the same medical condition. It can harm them.

Warnings for people with certain health conditions

For people with liver problems: Your liver may not be able to make glucose and break down insulin detemir as well as it should. Your doctor may lower your dosage of this medication.

For people with kidney problems: Your kidneys may not be able to break down insulin detemir as well as they should. Your doctor may lower your dosage of this medication.

For people with heart failure: Taking oral diabetes pills called thiazolidinediones (TZDs) with insulin detemir can trap fluid in the tissues of your body and worsen or cause heart failure.

Warnings for other groups

For pregnant women: Insulin detemir is a pregnancy category B drug. That means two things:

  1. Studies of the drug in pregnant animals haven’t shown risk to the fetus.
  2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.
When to call the doctor
Tell your doctor if you’re sick or throwing up, or if you’ve changed your eating or exercise habits. Your insulin detemir dosage may need to be adjusted or you may need to be checked for complications of diabetes. Talk to your doctor before you start any new prescription or over-the-counter medications, herbal products, or supplements.

Tell your doctor if you’re pregnant or plan to become pregnant. Insulin detemir should be used during pregnancy only if the potential benefit justifies the potential risk.

For women who are breastfeeding: It isn’t known if insulin detemir passes through breast milk. You and your doctor may need to decide if you’ll take insulin detemir or breastfeed.

For seniors: You may be more sensitive to insulin detemir, which may increase your risk of low blood sugar. Your doctor may start you at a lower dosage and make smaller dosage changes if needed.

For children: The safety and effectiveness of insulin detemir haven’t been established in children younger than 18 years with type 2 diabetes.

The safety and effectiveness of insulin detemir haven’t been established in children younger than 2 years with type 1 diabetes.

Keep insulin detemir out of reach of children.Accidental injection can cause a severe low blood sugar reaction. This can be fatal.

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Dosage

How to take insulin detemir

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Brand: Levemir

  • Forms: vial
  • Strength: 100 unit/mL pen-injector (same as 300 units/3mL)

Brand: LevemirFlexTouch

  • Forms: pen-injector
  • Strength: 100 unit/mL pen-injector (same as 300 units/3 mL)

Dosage for type 1 diabetes

Adult dosage (ages 18–64 years)

Insulin detemir will be one-third of your total daily insulin requirement. The rest of your daily dose will be short- or rapid-acting insulin.

Child dosage (ages 2–17 years)

Insulin detemir will be one-third of your total daily insulin requirement. The rest of your daily dose will be short- or rapid-acting insulin.

Child dosage (ages 0–1 year)

The safety and effectiveness of insulin detemir haven’t been established in children younger than 2 years old with type 1 diabetes.

Senior dosage (ages 65 years and older)

You may be more sensitive to insulin detemir, which may increase your risk of low blood sugar. Your doctor may start you at a lower dosage and make smaller dosage changes if needed.

Dosage for type 2 diabetes

Adult dosage (ages 18–64 years)

  • Your starting insulin detemir dosage will be 10 units (0.1 to 0.2 units per kilogram) taken once per day with dinner or at bedtime.
  • Your doctor may have you take insulin detemir two times per day. The starting dosage would be 5 units taken two times per day (every 12 hours).

Child dosage (ages 2–17 years)

A safe and effective dosage for children with type 2 diabetes hasn’t been established.

Child dosage (ages 0–1 year)

The safety and effectiveness of insulin detemir haven’t been established in children younger than 2 years with type 1 or type 2 diabetes.

Senior dosage (ages 65 years and older)

You may be more sensitive to insulin detemir, which may increase your risk of low blood sugar. Your doctor may start you at a lower dose and make smaller dose changes if needed.

Special dosage considerations

For people who are switching from other insulins to insulin detemir:

  • If you’re changing from insulin glargine or NPH insulin to insulin detemir, use the same amount (units) of insulin for your starting insulin detemir dose.
  • Be sure to monitor your blood glucose closely for the first three weeks after switching to insulin detemir. Your doctor may adjust your insulin detemir dosage based on your blood sugar readings.

For people with liver or kidney problems: Your blood sugar levels may need to be closely monitored and your dosage may need to be adjusted.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

Insulin detemir is used for long-term treatment.It comes with serious risks if you don't take it as prescribed.

If you don't take it at all or if you skip or miss doses: Your blood sugar levels can become very high. This can cause complications from diabetes.

In type 1 diabetes, your body may try to break down fat to get energy. This can lead to the dangerous condition called diabetic ketoacidosis. In type 2 diabetes, your blood sugar levels can keep increasing and you may pass out.

If you take too much: If you take too much insulin detemir, you can develop very low blood sugar (hypoglycemia). You should treat a low blood sugar reaction as directed by your doctor. If you feel like passing out due to low blood sugar, seek medical help right away or have someone call 911 for you.

What to do if you miss a dose: If you forget to take your dose, take it as soon as you remember. If it’s just a few hours before the time for your next dose, skip the missed dose and take one dose at your normally scheduled time.

Never try to catch up by taking two doses at once. This could result in a severe low blood sugar reaction (hypoglycemia).

How to tell if the drug is working: You should notice a decrease in your blood sugar levels. Your symptoms of diabetes should also improve. For instance, you won’t urinate as much and you won’t be as thirsty or hungry.

Important considerations

Important considerations for taking insulin detemir

Keep these considerations in mind if your doctor prescribes insulin detemir for you.

General

  • Take insulin detemir with an evening meal or at bedtime.
  • Take insulin detemir at the same time every day.
  • Take this drug exactly as your doctor told you.
  • If you’re taking insulin detemir two times a day, take it with breakfast and dinner, about 12 hours apart.

Self-management

  • Your doctor, pharmacist, nurse, or diabetes educator will show you how to withdraw insulin from the vial, attach needles, and give yourself the insulin detemir injection.
  • Inject insulin detemir into the fatty part or your skin (subcutaneous fat). The best places include your thigh, stomach, and the outer part of your upper arm.
  • Never inject into a vein or muscle. Doing so can cause severe low blood sugar.
  • Be sure to change (rotate) the injection site each time.
  • Don’t give the injection on irritated or red skin.
  • Insulin detemir is a clear and colorless insulin. Before each injection, check the vial or pen. Make sure that there are no floating particles in the solution, and that the solution hasn’t changed color. Don’t use insulin detemir if it’s thick, cloudy, or colored.
  • Don’t mix insulin detemir with other insulins or solutions.
  • Take this medication at the same time every day.

In addition to the medication, you’ll also need:

  • needles
  • syringes (if using insulin detemir vials)
  • a safe needle disposal container
  • alcohol swabs
  • lancets to prick your finger to test your blood sugar
  • blood sugar test strips
  • a blood glucose monitor to test your blood sugar at home

Storage

Insulin detemir must be stored at the right temperature.

Unopened insulin detemir:

  • Store in the refrigerator at a temperature between36°F and 46°F (2°C and 8°C).
    • Don’t store it next to the cooling component in the refrigerator.
    • You can keep unopened insulin detemir in the refrigerator until the expiration date on the vial.
  • If you can’t refrigerate this drug, you can store it at room temperature below 86°F (30°C) for up to 42 days.
    • Keep it as cool as possible and away from heat.
    • After 42 days at room temperature, insulin detemir should be thrown out.
  • Don’t freeze insulin detemir.
    • If insulin detemir was frozen, don’t use it.
  • Keep insulin detemir vial in the carton that it comes with to protect it from light.

Opened insulin detemir vial:

  • Store insulin detemir vial in the refrigerator at a temperature between36°F and 46°F (2°C and 8°C).
  • If you can’t refrigerate this drug, you can store it at room temperature below 86°F (30°C) away from heat and light for up to 42 days.
  • Throw away the insulin detemir vial after 42 days, even if there is some insulin left.

Opened insulin detemir pen:

  • Store it at room temperature below 86°F (30°C) for up to 42 days.
  • Don’t store an opened, used pen in the refrigerator.
  • Remove the needle after every injection. Use a new needle every time.
  • Don’t store insulin detemir with the needle attached to it. Storing it without the needle decreases the chance of contamination, infection, or leakage, and will help you get the correct dose.
  • Keep insulin detemir pens away from direct light and heat.
  • Throw away the pen after 42 days even if there is some insulin left in it.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Unopened medication needs to be refrigerated. You may need to use an insulated bag with a cold pack to maintain the temperature. Follow the storage instructions mentioned on the medication guide.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
  • Needles and syringes are used to take this medicine. Check for special rules about traveling with medicine, needles, and syringes.

Clinical monitoring

Your doctor may do blood tests before and during your treatment with insulin detemir to make sure it’s safe for you to take. These tests include:

  • blood sugar levels
  • glycosylated hemoglobin (A1C) levels. This test measures your blood sugar control over the last 2–3 months.
  • liver function test
  • kidney function test
  • blood potassium levels

Your doctor may need to adjust your dosage of insulin detemir based on other medications you’re taking, as well as your:

  • blood sugar levels
  • kidney function
  • liver function
  • exercise habits
  • eating habits

Your doctor may also do other tests to check for complications of diabetes, such as the following:

  • eye exam
  • foot exam
  • dental exam
  • tests for nerve damage
  • cholesterol level test
  • blood pressure and heart rate checks

Your diet

Follow the nutrition plan that your doctor, registered dietitian, or diabetes educator prescribed for you.

Hidden costs

In addition to the medication, you’ll also need:

  • needles
  • syringes (if using insulin detemir vials)
  • a safe needle disposal container
  • alcohol swabs
  • lancets to prick your finger to test your blood sugar
  • blood sugar test strips
  • a blood glucose monitor to test your blood sugar at home

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

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Alternatives

Are there any alternatives?

There are other medicines available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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