Generic
Insulin Detemir
1 brands available in the market
At a glance
Insulin Detemir is a long-acting human insulin analog used to improve glycemic control in adults and children with diabetes mellitus.
Description
Insulin Detemir is a long-acting recombinant human insulin analog produced by recombinant DNA technology using genetically modified cultures of Saccharomyces cerevisiae. Slow systemic absorption and reversible binding to albumin account for the prolonged duration of action. It binds to insulin receptors to regulate glucose metabolism, facilitating glucose uptake in muscle and fat cells and inhibiting glucose output from the liver.
Indications
- Improvement of glycemic control in adults and children with diabetes mellitus
Therapeutic class
Long Acting Insulin
Pharmacological class
Long-acting Insulin Analog
Pharmacology
The primary activity of insulin detemir is the regulation of glucose metabolism. Insulins exert their specific action through binding to insulin receptors. Receptor-bound insulin lowers blood glucose by facilitating cellular uptake of glucose into skeletal muscle and adipose tissue and by inhibiting the output of glucose from the liver. Insulin inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis.
Mechanism of action
Lowers blood glucose by binding to insulin receptors, facilitating glucose uptake in muscle and fat cells, and inhibiting glucose output from the liver.
Dosage
Adult Dose (Subcutaneous):
- Type 1 or 2 Diabetes (once daily): Administer SC with evening meal or at bedtime
- Type 1 or 2 Diabetes (twice daily): Administer SC with morning meal and either with evening meal, at bedtime, or 12 hours after morning dose
- Insulin-naïve Type 2: 10 units/day (or 0.1-0.2 units/kg/day) in evening or divided q12hr
- Conversion from other insulins (glargine or NPH): Unit-to-unit basis; type 2 patients may require more insulin detemir than NPH
- Dose adjustments: Based on blood glucose measurements; look for consistent pattern in blood sugars for >3 days
Child Dose (Type 1, ≥2 years): Approximately one-third of total daily insulin requirements; adolescents <1.2 units/kg/day during growth spurts
Administration
Administer as subcutaneous injection at the same time every day in upper arm, thigh or abdominal wall; abdominal wall injection results in faster absorption; rotate injection sites; do not use IV, IM or in insulin pumps.
Missed dose
If you miss a dose, take it as soon as possible; if it is almost time for your next dose, skip the missed dose and go back to regular schedule; do not double the dose.
Side effects
Side Effects:
- Hypoglycemia
- Lipodystrophy
- Pruritus
- Rash
- Weight gain
- Sodium retention and edema
- Injection site reactions (pain, itching, hives, swelling, inflammation)
- Influenza-like symptoms
- Pallor, Palpitation, Tachycardia, Mental confusion, Weakness, Blurred vision, Itching, Hunger, Nausea
Precautions & warnings
Precautions:
- Caution in renal or hepatic impairment (dosage requirements may be reduced)
- Regular monitoring of blood glucose and HbA1c
- Continuous rotation of injection site within a given area to reduce injection site reactions
- Caution in pregnancy and lactation
- Dose adjustment: Look for consistent pattern in blood sugars for >3 days
- Dosage must be individualized based on clinical response
Contraindications
Contraindications:
- Hypersensitivity to Insulin Detemir or any excipients (including anaphylaxis)
Drug interactions
Drug Interactions:
- Possible absence of hypoglycemic warning symptoms with beta-blockers
- Increased blood sugar with thiazide diuretics, corticosteroids, chlorpromazine, tibolone, isoniazid, niacin, some calcium-channel blockers (diltiazem, nifedipine), diazoxide, lithium, thyroid hormones
- Increased risk of hypoglycemia with disopyramide, large doses of aspirin, gatifloxacin, MAOIs, mebanazine, nandrolone, pegvisomant, testosterone
- Octreotide and lanreotide decrease insulin resistance
- Pioglitazone, rosiglitazone increase risk of weight gain and peripheral edema
Food interactions
Food Interactions: It is unsafe to consume alcohol with Insulin Detemir.
Use in pregnancy
Use in Pregnancy: Category B; generally considered safe; animal studies show low or no adverse effects; limited human studies.
Pregnancy Category: B — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Safe during breastfeeding; does not pass into breastmilk in significant amount and is not harmful to baby; lactating women may require adjustments of insulin doses.
Pediatric use
Safety and effectiveness established in pediatric patients (6 to 17 years) with type 1 diabetes; not studied in patients <6 years with type 1 diabetes or in patients with type 2 diabetes.
Geriatric use
No overall differences in safety or effectiveness observed between elderly (≥65 years) and younger patients; hypoglycemia may be difficult to recognize in the elderly.
Renal / hepatic impairment
Renal Impairment: Dose adjustments may be needed; regular monitoring of blood glucose recommended; caution required.
Hepatic Impairment: Dose adjustments may be needed; regular monitoring of blood glucose recommended; caution required.
Overdose effects
Overdose: Excess insulin relative to food intake or energy expenditure may lead to severe and sometimes prolonged life-threatening hypoglycemia; mild episodes treated with oral glucose; severe episodes (coma, seizure, neurologic impairment) treated with IM/SC glucagon or IV glucose.
Storage conditions
Unopened insulin detemir: Store in refrigerator at 2°C-8°C; do not freeze; protect from light; if refrigeration not possible, can be kept at room temperature (below 30°C) for 42 days.
Chemical structure
Insulin Detemir