Indications for: LEVEMIR
Type 1 diabetes (in adults and children) and type 2 diabetes (in adults) when basal (long-acting) insulin is needed.
Limitations of Use:
Not for treatment of diabetic ketoacidosis.
Adults and Children:
May be given once daily with evening meal or at bedtime or twice-daily (in the AM and PM). SC inj only into thigh, abdominal wall, or upper arm. <2yrs: not recommended. ≥2yrs, type 1 diabetes: starting dose should be ⅓ - ½ of total daily insulin requirements; short-acting, pre-meal insulin should be used to satisfy remainder of daily insulin requirements. Insulin-naive, type 2 diabetic adults inadequately controlled on oral antidiabetics: initially 10 Units (or 0.1–0.2 Units/kg) once daily in the evening or divided into twice daily regimen; inadequately controlled on GLP-1 receptor agonist: initially 10 Units once daily in the evening. Switching from another basal insulin: dose should be the same on a unit-to-unit basis; may need more insulin detemir when switching from NPH (see full labeling).
During episodes of hypoglycemia.
Instruct patients on diet, exercise, blood or urine testing, proper administration of insulin, change in species of origin, type or purity of insulin, and management of hypoglycemia. Do not reuse or share pens, needles, or syringes between patients, even if the needle is changed. Do not inject into areas of lipodystrophy or localized cutaneous amyloidosis. Increased risk of hyperglycemia of hypoglycemia if changes in physical activity, meal patterns, concomitant medications, renal or hepatic function, insulin regimen, administration site, and if acute illness occurs: monitor glucose more frequently and may need to adjust dose. Dosage increase may be required during infection, illness, stress, trauma, and pregnancy. Monitor potassium levels in patients at risk for hypokalemia (eg, concomitant K+-lowering or K+-sensitive drugs). Discontinue and treat if hypersensitivity reactions occur. Renal or hepatic impairment: may need dose adjustment. Pregnancy. Nursing mothers.
Do not mix or dilute with other insulins. Concomitant thiazolidinediones (TZDs) may cause fluid retention and heart failure; consider dose reduction or discontinue TZDs. Potentiated by oral antidiabetic agents, ARBs, pramlintide, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, salicylates, somatostatin analog, GLP-1 receptor agonists, sulfonamide antibiotics, DPP-4 inhibitors, SGLT-2 inhibitors. Antagonized by corticosteroids, isoniazid, niacin, danazol, diuretics, thiazides, phenothiazines, sympathomimetics, somatropin, thyroid hormones, estrogens, progestogens, atypical antipsychotics. Variable effects with β-blockers, clonidine, lithium salts, alcohol, pentamidine.
Hypoglycemia, hypokalemia, local or systemic allergy, lipodystrophy, edema.
Half-life: 5–7 hours.
Vials (10mL)—1; FlexPen (3mL)—1; FlexTouch (3mL)—1