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Administrating Insulin and Insulin Analogues

Insulin Detemir (LevemirR)

Why do we need basal insulin?

A low level of background or basal insulin is needed to maintain blood glucose levels at a ‘normal’ level. If you do not have this background level of insulin your blood sugar concentrations would start to rise 4 hours after a meal when the short-acting insulin starts to wear off.

Traditional basal insulins have had a duration of action which is variable, depending on absorption usually lasting about 12 hours.

What is Detemir?

Detemir is a new basal (long acting) insulin analogue which was launched in the UK in June 2004. It is a soluble (clear in solution unlike isophane insulin which is cloudy) and is designed to provide a smooth, prolonged effect.

Long-acting human insulin analogues (insulin glargine and insulin detemir) are made by altering the chemical structure of insulin to allow more consistent release during the day, thereby mimicking natural basal insulin release.

See insulin glargine for more information.

How is it used?

Detemir is used in combination with meal-time short acting insulin administered either twice daily or once daily as part of a ‘basal-bolus regime. It is given as a subcutaneous injection similar to conventional insulins.

A basal-bolus regimen describes the use of a short-acting insulin before each meal (the ‘bolus’ or mealtime dose), and long-acting insulin at bedtime (the ‘basal’ dose).

How does it differ from Human Insulin?

Insulin Detemir is a ‘man-made’ insulin which has been engineered in the laboratory. It is ‘clear’ in appearance, unlike commonly used long acting insulin (isophane insulin) which is cloudy.

Data has shown that when administered twice daily, insulin detemir has a lower risk of causing hypoglycaemia when compared to isophane insulin.

How long does its effect last after injection?

The action of Insulin Detemir has been shown to last for about 20 hours which is considerably longer than the action of Human Insulatard which lasts for about 12 hours.

What advantages does Detemir offer when compared with Isophane insulin (InsulatardR) ?

  • Glucose lowering is more predictable than with Isophane Insulin (InsulatardR) in people with Type 1 diabetes.
  • Fewer nocturnal hypoglycaemic events when compared with insulatard. One study showed that the risk of nighttime hypoglycaemia was 36 percent lower with insulin detemir when compared to isophane insulin.
  • Better overall control of blood sugar when used in place of insulatard with insulin aspart (Novorapid) with a basal bolus regime.
  • Less likely to cause weight gain than Isophane insulin (InsulatardR).

What preparations are available?

Levemir FlexPenR prefilled disposable pen injection device

3 ml cartridges for use with NovoPenR devices

Each cartridge or pen device contains 3 ml of insulin detemir (100 Units/ml)

How much does it cost the NHS?

At the time of writing the cost of 5 pre-filled FlexPen devices (5x300 units) is 39 (NHS price)

 

Dr Nishan Wijenaike
Consultant Diabetologist
November 2004