Adult Dosing
Diabetes Mellitus
Levemir
- Dosing individualized to patient’s needs, generally used in combination with short or rapid acting insulins
- 30%-50% of total insulin requirements may be provided by long-acting insulin
- Exhibits a flat action without a peak and with immediate onset; lasting almost 24 hours (dose dependent; lower doses may last only 6 hours)
- Start with 0.1-0.2 U/kg SC every evening. Alternatively, 10 units (adults) daily or twice-daily, if required
- Increase dose gradually until fasting blood glucose meets the desired goal
- Usual final dose (after gradual upward titration): 0.3-0.5 units/kg/day SC; give dose with evening meal or at bedtime for once-daily regimen
- If changing from basal insulin to insulin detemir, change on a unit-to-unit basis (some recommend starting at 20% fewer units then adjusting as needed)
- Monitor blood glucose level during the initial week of therapy to allow dose adjustment and concurrent rapid- or short-acting insulin given before each meal
Pediatric Dosing
Diabetes Mellitus-Children 
6 years
Levemir
- Dosing individualized to patient’s needs, generally used in combination with short or rapid acting insulins
- 30%-50% of total insulin requirements may be provided by long-acting insulin
- Exhibits a flat action without a peak and with immediate onset; lasting almost 24 hours (dose dependent; lower doses may last only 6 hours)
- Start with 0.1-0.2 U/kg SC every evening. Alternatively, 10 units (adults) daily or twice-daily, if required
- Increase dose gradually until fasting blood glucose meets the desired goal
- Usual final dose (after gradual upward titration): 0.3-0.5 units/kg/day SC; give dose with evening meal or at bedtime for once-daily regimen
- If changing from basal insulin to insulin detemir, change on a unit-to-unit basis (some recommend starting at 20% fewer units then adjusting as needed)
- Monitor blood glucose level during the initial week of therapy to allow dose adjustment and concurrent rapid- or short-acting insulin given before each meal
[Outline]
See Supplemental Patient Information
- Hypoglycemia, lipodystrophy and hypersensitivity are adverse events associated with use of all insulin therapy. Monitor glucose level in patient with diabetes mellitus
- Do not administer insulin detemir intravenously or via an insulin pump. Do not dilute or mix with any other insulin or solution
- Change in dose should be made cautiously under medical supervision. Changes in insulin strength, timing of dosing, manufacturer, type (eg, regular, NPH, or insulin analogs), species (animal, human), or method of manufacture (rDNA versus animal-source insulin) may require a change in dosage
- Adjust the concomitant oral antidiabetic drug. Do not shared needles and flexpen
- Hyperglycemia has occurred in patients with type 1 diabetes, diabetic ketoacidosis due to inadequate dosing, and discontinuation of therapy
- Symptoms of hyperglycemia include nausea, vomiting, drowsiness, flushed dry skin, dry mouth, increased urination, thirst and loss of appetite as well as acetone breath
- Hypoglycemia depends on the action profile of the insulin. Dose adjustment is recommended if patient changes their physical activity or their usual meal plan
- In patients being switched from other intermediate or long-acting insulin preparations to once- or twice-daily insulin detemir , dosages can be prescribed on a unit-to-unit basis; however, as with all insulin preparations, dose and timing of administration may need to be adjusted to reduce the risk of hypoglycemia
- Dose adjustment is recommended in renal and hepatic impairment
- Concomitant use of thiazolidinediones can cause dose related fluid retention, which may lead to or exacerbate heart failure, therefore monitor for signs and symptoms of heart failure and treat accordingly or consider discontinuation or dose reduction
Cautions: Use cautiously in patients with
Supplemental Patient Information
- Do not mix with other insulins in same syringe
Pregnancy Category:B
Breastfeeding: Probably safe. No specific information available for insulin detemir during breastfeeding; however no adverse reactions have been reported due to insulin in breastmilk. This drug may be considered compatible and safe with breastfeeding based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 January 2011). Manufacturer advises caution. Insulin detemir is compatible with breastfeeding, but women with diabetes who are lactating may require dose adjustments.
Pricing data from www.DrugStore.com in U.S.A.
- Levemir 100 UNIT/ML SOLN [Vial] (NOVO NORDISK)
10 ml = $136
30 ml = $378.82 - Levemir FlexPen 100 UNIT/ML SOLN [Pen] (NOVO NORDISK)
15 ml = $242.99
45 ml = $684.94
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
