Home Drug Guide Insulin Detemir

Drug Guide

Generic Name

Insulin Detemir

Brand Names Levemir, Levemir Flexpen, Levemir Innolet, Levemir Penfill, Levemir Flextouch

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Long-acting insulin

FDA Approved Indications

  • Treatment of diabetes mellitus in adults, adolescents, and children for blood glucose control.

Mechanism of Action

Insulin Detemir lowers blood glucose by facilitating cellular glucose uptake, inhibiting hepatic glucose production, and promoting storage of glucose as glycogen in liver and muscle tissues. Its long-acting formulation provides a steady level of insulin over 24 hours.

Dosage and Administration

Adult: Typically, 0.2–0.4 units/kg once daily or divided into two doses. Dosage individualized based on blood glucose monitoring.

Pediatric: Dosing based on weight and blood glucose levels, often starting at 0.2 units/kg once daily.

Geriatric: Start with lower doses due to increased risk of hypoglycemia; titrate carefully.

Renal Impairment: Adjust dose based on response; renal impairment may prolong insulin action.

Hepatic Impairment: Use with caution; no specific adjustment guidelines established.

Pharmacokinetics

Absorption: Absorbed slowly from subcutaneous tissue, providing a steady insulin level.

Distribution: Distributed throughout the extracellular fluid; predominantly bound to insulin receptors.

Metabolism: Metabolized via insulin degradation pathways.

Excretion: Excreted primarily as insulin metabolites.

Half Life: Approximate terminal half-life of 2–3 hours; depot effect prolongs action to 24 hours.

Contraindications

  • Hypoglycemia
  • Allergy to insulin or any component of the formulation

Precautions

  • Risk of hypoglycemia; adjust doses during illness; monitor blood glucose regularly. Caution in hepatic or renal impairment.

Adverse Reactions - Common

  • Hypoglycemia (Common)
  • Injection site reactions (lipodystrophy, redness, swelling) (Common)

Adverse Reactions - Serious

  • Severe hypoglycemia (Serious)
  • Allergic reactions (rash, anaphylaxis) (Serious)

Drug-Drug Interactions

  • Other hypoglycemic agents, corticosteroids, beta-blockers

Drug-Food Interactions

  • Alcohol may alter blood glucose levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly; assess injection sites for reactions.

Diagnoses:

  • Risk for unstable blood glucose levels
  • Risk for hypoglycemia or hyperglycemia

Implementation: Administer subcutaneously at prescribed times; rotate injection sites.

Evaluation: Assess blood glucose levels, HbA1c, and for signs of adverse reactions.

Patient/Family Teaching

  • Inject insulin as prescribed, at the same times daily.
  • Recognize signs of hypoglycemia and hyperglycemia.
  • Carry quick-acting carbohydrate for hypoglycemia episodes.
  • Maintain consistent diet and exercise routines.

Special Considerations

Black Box Warnings:

  • Hypoglycemia is life-threatening if not recognized and treated.

Genetic Factors: Genetic variants may influence insulin response, but routine testing is not standard.

Lab Test Interference: Insulin levels in blood tests may affect interpretation of glucose-related labs.

Overdose Management

Signs/Symptoms: Severe hypoglycemia: tremors, sweating, confusion, seizures, unconsciousness.

Treatment: Administer glucose orally or via IV if unconscious; in severe cases, administer glucagon or IV dextrose under medical supervision.

Storage and Handling

Storage: Store unopened vials, pens, and cartridges refrigerated (36-46°F or 2-8°C). After opening, vials and pens may be kept at room temperature up to 77°F (25°C) for up to 28 days.

Stability: Stable until expiration date when unopened; once opened, use within specified period.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.