Indications
Insulin detemir is a long acting (basal) insulin used to control blood sugar in adults, adolescents and children aged 1 year and above with diabetes mellitus. It is used in type 1 diabetes, together with mealtime insulin, and in type 2 diabetes, alone or with tablets such as Metformin or with mealtime insulin.
How It Works
Insulin detemir is a modified form of human insulin. After injection under the skin, its molecules cling together and bind to albumin (a blood protein), so they are released slowly and steadily over many hours. This gives a background level of insulin that helps the body move sugar from the blood into cells and stops the liver from releasing too much sugar between meals and overnight.
Dosage and Administration
The dose is individual and is set by your doctor according to blood sugar readings, weight, diet and activity. It is usually injected under the skin of the thigh, abdomen or upper arm once or twice a day, at the same time(s) each day. Change the injection spot each time to avoid lumps under the skin. Never inject into a vein or muscle, never mix it with other insulins in the same syringe, and never share pens, even with a new needle.
Interactions
- Medicines that can lower blood sugar further include other diabetes medicines, ACE inhibitors such as Enalapril, some antidepressants, salicylates and alcohol.
- Medicines that can raise blood sugar include steroids such as Prednisolone, thiazide diuretics, thyroid hormones, oral contraceptives and some antipsychotics.
- Beta blockers such as Propranolol can hide the warning signs of low blood sugar.
- Pioglitazone used with insulin may increase the risk of fluid retention and heart failure.
Contraindications
- Allergy to insulin detemir or any ingredient of the injection.
- It must not be used during an episode of low blood sugar (hypoglycaemia).
Side Effects
The most common side effect is low blood sugar, causing shakiness, sweating, hunger, a fast heartbeat, headache, confusion or irritability. Other effects include redness, swelling or itching at the injection site, thickening or hollowing of the skin where injections are repeated, mild weight gain and ankle swelling when starting. Rare: generalised allergic reactions, temporary changes in vision.
Get urgent medical help if blood sugar is very low and the person is confused, drowsy, unable to swallow, having a seizure or unconscious (do not give food or drink by mouth if they cannot swallow), or if there is swelling of the face or throat or difficulty breathing.
Pregnancy and Lactation
Insulin detemir can be used during pregnancy and breastfeeding. Good blood sugar control is very important for the baby, and insulin needs usually change during pregnancy and after delivery, so close monitoring and dose adjustments by the doctor are needed.
Precautions and Warnings
Check blood sugar regularly, especially when changing the dose, during illness, extra exercise, fasting such as during Ramadan, or travel across time zones. Always carry glucose or sweets. Do not stop insulin in type 1 diabetes, as this can cause diabetic ketoacidosis. Be careful when driving if you are at risk of low blood sugar. Kidney or liver disease may reduce insulin needs. Check the label every time to avoid mixing up insulins.
Overdose
Too much insulin causes low blood sugar. For mild symptoms, take glucose tablets, sugar, juice or sweets, then a snack. Severe low blood sugar needs emergency treatment, such as a glucagon injection or intravenous glucose given by a health professional.
Therapeutic Class
Antidiabetic, long acting insulin analogue
Storage
Store unopened pens or vials in a refrigerator at 2 to 8°C; do not freeze and keep away from the freezer compartment. Once in use, keep below 30°C and use within the period stated on the pack (usually 6 weeks). Protect from heat and light and keep out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.