Home Drug Guide Insulin Detemir

Drug Guide

Generic Name

Insulin Detemir

Brand Names Levemir, Levemir Flexpen, Levemir Innolet, Levemir Penfill, Levemir Flextouch

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Long-acting insulin

FDA Approved Indications

Treatment of diabetes mellitus in adults, adolescents, and children for blood glucose control.

Mechanism of Action

Insulin Detemir lowers blood glucose by facilitating cellular glucose uptake, inhibiting hepatic glucose production, and promoting storage of glucose as glycogen in liver and muscle tissues. Its long-acting formulation provides a steady level of insulin over 24 hours.

Dosage and Administration

Adult: Typically, 0.2–0.4 units/kg once daily or divided into two doses. Dosage individualized based on blood glucose monitoring.

Pediatric: Dosing based on weight and blood glucose levels, often starting at 0.2 units/kg once daily.

Geriatric: Start with lower doses due to increased risk of hypoglycemia; titrate carefully.

Renal Impairment: Adjust dose based on response; renal impairment may prolong insulin action.

Hepatic Impairment: Use with caution; no specific adjustment guidelines established.

Pharmacokinetics

Absorption: Absorbed slowly from subcutaneous tissue, providing a steady insulin level.

Distribution: Distributed throughout the extracellular fluid; predominantly bound to insulin receptors.

Metabolism: Metabolized via insulin degradation pathways.

Excretion: Excreted primarily as insulin metabolites.

Half Life: Approximate terminal half-life of 2–3 hours; depot effect prolongs action to 24 hours.

Contraindications

Hypoglycemia
Allergy to insulin or any component of the formulation

Precautions

Risk of hypoglycemia; adjust doses during illness; monitor blood glucose regularly. Caution in hepatic or renal impairment.

Adverse Reactions - Common

Hypoglycemia (Common)
Injection site reactions (lipodystrophy, redness, swelling) (Common)

Adverse Reactions - Serious

Severe hypoglycemia (Serious)
Allergic reactions (rash, anaphylaxis) (Serious)

Drug-Drug Interactions

Other hypoglycemic agents, corticosteroids, beta-blockers

Drug-Food Interactions

Alcohol may alter blood glucose levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly; assess injection sites for reactions.

Diagnoses:

Risk for unstable blood glucose levels
Risk for hypoglycemia or hyperglycemia

Implementation: Administer subcutaneously at prescribed times; rotate injection sites.

Evaluation: Assess blood glucose levels, HbA1c, and for signs of adverse reactions.

Patient/Family Teaching

Inject insulin as prescribed, at the same times daily.
Recognize signs of hypoglycemia and hyperglycemia.
Carry quick-acting carbohydrate for hypoglycemia episodes.
Maintain consistent diet and exercise routines.

Special Considerations

Black Box Warnings:

Hypoglycemia is life-threatening if not recognized and treated.

Genetic Factors: Genetic variants may influence insulin response, but routine testing is not standard.

Lab Test Interference: Insulin levels in blood tests may affect interpretation of glucose-related labs.

Overdose Management

Signs/Symptoms: Severe hypoglycemia: tremors, sweating, confusion, seizures, unconsciousness.

Treatment: Administer glucose orally or via IV if unconscious; in severe cases, administer glucagon or IV dextrose under medical supervision.

Storage and Handling

Storage: Store unopened vials, pens, and cartridges refrigerated (36-46°F or 2-8°C). After opening, vials and pens may be kept at room temperature up to 77°F (25°C) for up to 28 days.

Stability: Stable until expiration date when unopened; once opened, use within specified period.