insulin detemir: clinical use

Prescribing considerations

• UK discontinuation is under way; do not initiate new patients on the selected Levemir products and arrange supervised, individualised switches for existing users.
• Verify the insulin brand, device and strength. Assess device compatibility, dexterity, vision, injection technique and self-management ability before switching.
• Use subcutaneously only; not intravenously, intramuscularly, in infusion pumps or mixed with other products.
• Illness, physical activity, diet, endocrine disease and switching insulins may alter requirements or hypoglycaemia awareness.

Contraindications and cautions

• Hypersensitivity to insulin detemir or any product excipient.
• Do not administer during current or suspected hypoglycaemia.

Monitoring

• Blood glucose and hypoglycaemia frequency or awareness, especially during illness, pregnancy and insulin switches.
• Injection sites for lipodystrophy, cutaneous amyloidosis and local reactions.
• Closer glucose monitoring in older people and those with renal or hepatic impairment.
• Oedema, weight gain and heart-failure symptoms with pioglitazone.

Clinical pharmacology

A recombinant, soluble long-acting insulin analogue. Protraction results from self-association after injection and albumin binding through its fatty-acid side chain. Receptor activation increases peripheral glucose uptake and suppresses hepatic glucose output.

Formulation and product differences

• Penfill is a cartridge for compatible Novo Nordisk reusable insulin delivery systems.
• FlexPen is a disposable pre-filled multidose pen.
• During use, Penfill cartridges should not be refrigerated; FlexPen may be refrigerated or kept below 30°C. Protect both from freezing and light.
• Neither cartridge nor pre-filled pen may be refilled or shared.

Injection

Route: Parenteral

Strengths: 100 units/mL