Insulin Detemir

Insulin, Long-acting insulin analog, Basal insulin

Insulin detemir

Levemir, Levemir FlexTouch (US discontinuation announced 2024)

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Titration strategies

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Summary

Classes

Insulin, Long-acting insulin analog, Basal insulin

Common uses

Type 1 diabetes mellitus▲0▼, Type 2 diabetes basal coverage▲0▼

Pharmacy

Starting dose

~10 units SC at the same time daily, or 0.1-0.2 units/kg/d; titrate by fasting glucose. Frequently dosed BID at moderate-to-high doses

Preparations

100 U/mL FlexTouch pen, vial

US FDA Max

Titrated to glucose

Pharmacology

Routes

Subcutaneous

Onset

1-2 hours

Duration

~12-24 hours (dose-dependent; BID dosing often needed at higher doses)

Half-life

~7 hours apparent

Bioavailability

~60% from subcutaneous depot (reduced by reversible albumin binding via the myristic acid side chain that also extends duration)

Pregnancy

One of the better-studied basal insulin analogs in pregnancy; reassuring data.^{[citation needed]}

Legal status

Rx-only in US

Purported mechanism

Insulin detemir has a 14-carbon myristic fatty acid attached to LysB29 that binds reversibly to plasma and tissue albumin; the slow albumin dissociation prolongs the apparent half-life and produces a less peaked basal profile than NPH.▲0▼ Generally associated with less weight gain than glargine, possibly via central appetite effects. Novo Nordisk announced US discontinuation in 2024 as part of basal-insulin portfolio rationalization (degludec, glargine biosimilars remain).