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Insulin Detemir

Brand names: Levemir®



Insulin Detemir injection

What is Insulin Detemir injection?

INSULIN DETEMIR (Levemir®) is a human-made form of insulin. Insulin is a hormone produced naturally by the pancreas. Insulin lowers the amount of sugar in your blood. Keeping your blood sugar close to normal prevents or reduces long-term complications of diabetes including damage to the blood vessels, eyes, kidneys, or nerves. Insulin detemir is a long-acting insulin that is usually given once or twice a day. The time-course of action of insulin may vary in different people and at different times in the same person. The time-course of action of insulin may also vary depending on the place where the insulin is injected, your body temperature, and your physical activity. A prescription from you health care provider is needed to buy insulin detemir. A prescription to obtain insulin syringes may or may not be required in the state where you live. Generic insulin detemir is not yet available.

There are different types of insulin available. Each type has a different onset of action and a different duration of action in the body. You should learn which types you take and how you should administer them, and how each type acts in your body. Insulin is obtained from beef, pork, or human sources. Beef insulin is no longer made in the US because of concerns of cow tissues spreading certain infections.

Do not change the type of insulin you are taking without talking to your prescriber. If you must switch the type of insulin you use, you should realize that you may need to monitor your blood sugar more frequently and that dosage adjustments may be needed before you are stabilized on the new type. Take care to learn and recognize the symptoms of hypoglycemia (low blood sugar) and know how you should treat these reactions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• adrenal or pituitary gland problems
• diarrhea
• fever or infection
• injury or trauma
• kidney disease
• liver disease
• nausea, vomiting
• recent surgery
• thyroid disease
• an unusual or allergic reaction to insulin, metacresol, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should this medicine be used?

Insulin is for injection under the skin. Use exactly as directed. Do not use more insulin than prescribed. Do not use more or less often than prescribed. It is important to follow the directions given to you by your health care professional or prescriber. Your health care professional or prescriber will teach you how to give yourself insulin injections. If you utilize an insulin injector device, you will be taught how to use it, prime it, and how to refill the device with the insulin cartridges.

You will be taught how to administer doses for meals You will also be taught how to adjust doses for activities and illness.
Always check the appearance of insulin detemir before using it. Do not use if it is cloudy or has solid particles in it.

Do not mix insulin detemir with any other injection, including other insulins. If you are injecting more than one type of insulin at the same time as insulin detemir, you must use different syringes.

What drug(s) may interact with Insulin Detemir?

• other medicines for diabetes

Many medications may cause changes (increase or decrease) in blood sugar, these include:
• alcohol containing beverages
• angiotensin converting enzyme inhibitors (ACE inhibitors), often used for high blood pressure or heart problems (examples include captopril, enalapril, lisinopril)
• antiretroviral protease inhibitors (examples include indinavir, ritonavir, saquinavir)
• aspirin and aspirin-like drugs
• beta-blockers, often used for high blood pressure or heart problems (examples include atenolol, metoprolol, propranolol)
• certain medicines used for mental depression, emotional, or psychotic disturbances
• chromium
• cisapride
• clonidine
• cyclosporine
• danazol
• diazoxide
• disopyramide
• epinephrine
• female hormones, such as estrogens, progestins, or contraceptive pills
• fenofibrate
• gemfibrozil
• glucagon
• growth hormone (somatropin)
• guanethidine
• isoniazid
• lithium
• metoclopramide
• male hormones or anabolic steroids
• medications to suppress appetite or for weight loss
• medicines for allergies, asthma, cold, or cough
• niacin
• nicotine (including nicotine found in patches and gum)
• pentamidine
• pentoxifylline
• phenytoin
• propoxyphene
• quinolone antibiotics, medicines used for infections (examples include ciprofloxacin, levofloxacin, norfloxacin)
• some herbal dietary supplements
• steroid medicines such as prednisone or cortisone
• sulfonamides, medicines for infection ( examples include Azulfidine®, Bactrim®, Gantrisin® Septra®)
• tacrolimus
• thyroid hormones
• water pills (diuretics)

Some medications can hide the warning symptoms of low blood sugar (hypoglycemia). You may need to monitor your blood sugar more closely if you are taking one of these medications. These include:
• beta-blockers, often used for high blood pressure or heart problems (examples include atenolol, metoprolol, propranolol)
• clonidine
• guanethidine
• reserpine

Tell your health care provider about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care provider before stopping or starting any of your medicines.

What should I watch for while taking Insulin Detemir?

Visit your health care professional or prescriber for regular checks on your progress. To control your diabetes properly you must use insulin regularly and follow a regular diet and exercise schedule. Diabetes cannot be cured. Careful, daily control of blood sugar can postpone or prevent many of the long-term complications of diabetes.

Dangerously high or low blood sugar can occur when meals and insulin are not spaced properly. Checking and recording your blood glucose and urine ketone levels regularly is important. Sometimes it is hard to tell the difference between low and high blood sugar (see side effects). Use a glucometer (blood glucose or sugar measuring device), whenever possible, before you treat high or low blood sugar.

Always carry a quick-source of sugar with you in case you have symptoms of low blood sugar (hypoglycemia). Examples include hard sugar candy or glucose tablets.

Make sure that you have the right kind of syringe for the type of insulin you use. Try not to change the brand and type of insulin syringe unless your health care professional or prescriber tells you to. Use a syringe one time only. Throw away syringe and needle in a closed container to prevent accidental needle sticks.

Do not switch brands or types of insulin without consulting your health care professional or prescriber. Switching insulin brand or type can cause dangerously high or low blood sugar.

Always keep an extra supply of insulin, syringes, and needles on hand.

Wear a Medic Alert bracelet or necklace and/or carry an identification card with your name and address, condition, medication, and prescriber's name and address.

If you develop a cold, diarrhea, vomiting, or other infection or illness, you should contact your health care professional or prescriber. 'Sick-days' may require changes to your insulin dosage. Or your illness may need to be evaluated. Ask your health care professional or prescriber what you should do if you become ill. Do not stop taking your insulin; check with your health care professional or prescriber for advice.

If you are a long time smoker and suddenly stop, you may need a change in insulin dose. Talk to your health care professional or prescriber first.

Many nonprescription cough and cold products contain sugar or alcohol. These can affect diabetes control or can alter the results of tests used to monitor blood sugar. Avoid alcohol. Avoid products that contain alcohol or sugar.

If you are going to have surgery, make sure you tell the health care professionals that you take insulin.

What side effects may I notice from receiving Insulin Detemir?

Learn how and when you should monitor your blood sugar, and what you should do if high or low blood sugar occurs. Side effects that you should report to your health care professional or prescriber as soon as possible:

Symptoms of hypoglycemia (low blood glucose):
• anxiety or nervousness, confusion, difficulty concentrating, hunger, pale skin, nausea, fatigue, sweating, headache, palpitations, numbness of the mouth, tingling in the fingers, tremors, muscle weakness, blurred vision, cold sensations, uncontrolled yawning, irritability, rapid heartbeat, shallow breathing, and loss of consciousness. You should learn to recognize your own symptoms of hypoglycemia. Your symptoms may be different than others. If you are uncertain about your symptoms of hypoglycemia, check your blood sugar often to help you learn to recognize the symptoms. Hypoglycemia may cause you to not be aware of your actions or surroundings if it is severe, so you should let others know what to do if you cannot help yourself in a severe reaction. Your health care professional or prescriber will teach you how to treat hypoglycemia. Always carry a quick source of sugar such as candies or glucose tablets with you.

Symptoms of high blood sugar (hyperglycemia):
• dizziness, dry mouth, flushed dry-skin, fruit-like breath odor, loss of appetite, nausea, stomach ache, unusual thirst, frequent passing of urine

Insulin also can cause rare but serious allergic reactions in some patients, including:
• severe skin rash and itching (hives)
• difficulty breathing

Side effects that usually do not require medical attention (report to your health care professional or prescriber if they continue or are bothersome):
• increase or decrease in fatty tissue under the skin, through overuse of a particular injection site
• itching, burning, swelling, or rash at the injection site

Where can I keep my medicine?

Keep out of the reach of children.

Store unopened cartridges, FlexPen®s, or Levemir® Innolet® systems in a refrigerator between 2—8 degrees C (36—46 degrees F.) Do not freeze or use if the insulin has been frozen. Once opened, the Levemir® Innolet® system, FlexPen®, and cartridges that are inserted into pens should be kept at room temperature, approximately 25 degrees C (77 degrees F) or cooler. Do not store in the refrigerator once opened. Once opened, the insulin can be used for 42 days. After 42 days, the cartridge, Levemir® Innolet® system or FlexPen® should be thrown away.

Store unopened insulin vials in a refrigerator between 2—8 degrees C (36—46 degrees F). Do not freeze or use if the insulin has been frozen. Opened vials (vials currently in use) may be stored in the refrigerator or at room temperature, at approximately 30 degrees C (86 degrees F) or cooler. Keeping your insulin at room temperature decreases the amount of pain during injection. Once opened, your insulin can be used for 42 days. After 42 days, the vial of insulin should be thrown away.

Protect from light and excessive heat. Throw away any unused medicine after the expiration date has passed.

Last updated: 2/18/2005 3:00:00 PM

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

 
 
Wikipedia: insulin detemir
Levemir1.gif
Insulin detemir
Systematic (IUPAC) name
 ?
Identifiers
CAS number 169148-63-4
ATC code A10AE05
PubChem  ?
Chemical data
Formula C267H402N64O76S6 
Mol. mass 5913
Pharmacokinetic data
Bioavailability 60% (when administered s.c.)
Metabolism  ?
Half life 5-7 hours
Excretion  ?
Therapeutic considerations
Pregnancy cat.

?

Legal status
Routes  ?

Insulin detemir is a long-lasting human insulin analogue for maintaining the basal level of insulin. Novo Nordisk markets it under the trade name Levemir. It is an insulin analogue in which to the lysine amino acid at position B29 a fatty acid (myristic acid) is bound. It is quickly resorbed after which in the blood it binds to albumin through the fat acid at position B29. It then slowly dissociates from this complex.

In a clinical study (see ref 2) which compared the efficacy and safety of using Levemir for the treatment of patients with type 2 diabetes who had suboptimal glycemic control while receiving maximally tolerated doses of metformin and sulfonylurea (common tablet therapies for type 2 diabetes), it was found that, "At 24 weeks, A1C (glycosylated hemoglobin) had decreased by 1.8 and 1.9% (from 8.6 to 6.8 and from 8.5 to 6.6%) for detemir and NPH, respectively (NS). In both groups, 70% of participants achieved an A1C of 7.0%, but the proportion achieving this without hypoglycemia was higher with insulin detemir than with NPH insulin (26 vs. 16%, P = 0.008). Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001). Mean weight gain was 1.2 kg with insulin detemir and 2.8 kg with NPH insulin (P < 0.001), and the difference in baseline-adjusted final weight was –1.58 (P < 0.001)."

In short, it was found that insulin detemir reduced Hemoglobin A1C to target levels of 7.0% for 70% of patients, similar to human basal insulin NPH, but without the same risk of hypoglycemia (low blood sugar) and with much lower weight gain.

Similar results have been seen in type 1 diabetes (see ref 3.)

References

    1. http://content.nejm.org/cgi/content/full/NEJMoa075392, Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes; Rury R. Holman, M.B., Ch.B., F.R.C.P., Kerensa I. Thorne, M.Sc., Andrew J. Farmer, D.M., F.R.C.G.P., Melanie J. Davies, M.D., F.R.C.P., Joanne F. Keenan, B.A., Sanjoy Paul, Ph.D., Jonathan C. Levy, M.D., F.R.C.P., for the 4-T Study Group

    2. http://care.diabetesjournals.org/cgi/content/abstract/29/6/1269?ijkey=2e8d412f27ded6ae0a205b3bfd4d3608ed9b64b5&keytype2=tf_ipsecsha , A 26-Week, Randomized, Parallel, Treat-to-Target Trial Comparing Insulin Detemir With NPH Insulin as Add-On Therapy to Oral Glucose-Lowering Drugs in Insulin-Naïve People With Type 2 Diabetes, Kjeld Hermansen, MD1, Melanie Davies, MD2, Taudeusz Derezinski, MD3, Gabrielle Martinez Ravn4, Per Clauson4, Philip Home, DM, DPHIL5 on behalf of the Levemir Treat-to-Target Study Group

    3. http://www.springerlink.com/content/6lktug1r2exurq0j/?p=af5e2f613a0f4c6690f8fdc920f48bd6&pi=5 , Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with Type 1 diabetes, Journal Diabetologia, Issue Volume 47, Number 4 / April, 2004.


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