insulin detemir
Brand: Levemir
ISMP High Alert Prototype: insulin-glargine
Drug Class: insulin
Drug Family: insulin
Subclass: long-acting basal insulin analog
Organ Systems: endocrine
Mechanism of Action
Acylated insulin analog with a fatty acid (C14) chain that enables reversible albumin binding, prolonging absorption from the subcutaneous depot. Activates the insulin receptor, promoting glucose uptake in muscle and adipose, inhibiting hepatic glucose output, and suppressing lipolysis.
insulin receptor (IR)
Indications
- type 1 diabetes mellitus
- type 2 diabetes mellitus
Contraindications
- hypoglycemic episodes
- hypersensitivity to insulin detemir
Adverse Effects
Common
- hypoglycemia
- injection site reactions
- weight gain
- lipodystrophy
Serious
- severe hypoglycemia
- hypokalemia
- anaphylaxis
Pharmacokinetics (ADME)
| Absorption | subcutaneous only; slow absorption from depot due to albumin binding |
| Distribution | albumin-bound in plasma |
| Metabolism | proteolytic degradation |
| Excretion | proteolytic |
| Half-life | 5–7 hours; duration 16–24 hours |
| Onset | 1–2 hours |
| Peak | relatively flat (less pronounced than NPH) |
| Duration | 16–24 hours (shorter than glargine at low doses) |
| Protein Binding | albumin ~98% |
| Vd | low (0.1 L/kg) |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| beta-blockers | mask tachycardia of hypoglycemia; may prolong hypoglycemia | moderate |
| corticosteroids | increase insulin resistance; higher doses may be required | moderate |
| ACE inhibitors | may enhance insulin sensitivity; monitor for hypoglycemia | minor |
Nursing Considerations
- Administer subcutaneously once or twice daily (at the same time each day); do NOT administer IV.
- Rotate injection sites (abdomen, thigh, upper arm) to prevent lipodystrophy; document site used.
- Dose may need to be twice daily in type 1 patients; monitor fasting and pre-meal glucose values to assess adequacy.
- Educate patients to recognize and treat hypoglycemia (15 g rapid-acting carbohydrates); recheck glucose in 15 minutes.
Clinical Pearls
- Insulin detemir causes less weight gain than NPH or insulin glargine and may be preferred in patients where weight management is a concern.
- At lower doses, duration of action is only 16–18 hours, sometimes necessitating twice-daily dosing in type 1 diabetes — an important distinction from glargine and degludec.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.