INSULIN DETEMIR

INSULIN DETEMIR
(in'su-lyn det'e-mir)
Levemir
Classifications: hormone; antidiabetic agent; insulin, long-acting;
Therapeutic: antidiabetic; insulin

Prototype: Insulin injection
Pregnancy Category: C

Availability

100 units/mL available in 10 mL multidose vials and 3 mL prefilled syringes

Action

Insulin detemir, a long-acting insulin, exerts its action by binding to insulin receptors. Receptor-bound insulin lowers blood glucose by facilitating cellular uptake of glucose into skeletal muscle and fat, and inhibiting the output of glucose from the liver.

Therapeutic Effect

Insulin detemir is effective as a glucose-lowering agent, with glycemic control equivalent to that of NPH insulin.

Uses

Treatment of type 1 and type 2 diabetes mellitus.

Contraindications

Hypersensitivity to insulin detemir, or cresol; use in insulin infusion pumps; diabetic ketoacidosis, coma, hyperosmolar hyperglycemic state, hypoglycemia; pregnancy C. Safe and effective use in children with type 2 diabetes has not been established.

Cautious Use

Renal and hepatic impairment; older adults; cardiac disease, CHF, concurrent use of beta-blocking agent(s); lactation.

Route & Dosage

Diabetes
Adult/Child: SC Insulin-na?ve patients: 0.1–0.2 units/kg q.d. in evening or 10 units q.d. or b.i.d. in evenly spaced doses. For those taking a basal insulin product (i.e., NPH insulin, insulin glargine), a unit-to-unit dose conversion can be used.

Administration

Subcutaneous
  • Once-daily injections should be given with the evening meal or at bedtime. With twice-daily dosing, the evening dose may be given with the evening meal, at bedtime, or 12 h after the morning dose.
  • Do not administer IV or IM. With thin patients, inject at a 45-degree angle into a pinched fold of skin to avoid IM injection.
  • Do not mix with any other type of insulin. Do not use with an insulin infusion pump.
  • Store unopened vials under refrigeration at 2°–8° C (36°–46° F). Once removed from refrigeration, pens, cartridges, and other delivery devices must be kept at room temperature (not to exceed 30° C or 85° F) and either used within 42 d or discarded.

INCOMPATIBILITIES Solution/additive: Insulin detemir should not be mixed with any other insulin preparations.

Adverse Effects (≥1%)

[See INSULIN (REGULAR)] Body as a Whole: Allergic reactions. Metabolic: Hypoglycemia, weight gain. Skin: Lipodystrophy, pruritus, rash.

Diagnostic Test Interference

See INSULIN INJECTION (REGULAR).

Interactions

Drug: See INSULIN INJECTION (REGULAR). Herbal: Garlic and green tea may potentiate hypoglycemic effects.

Pharmacokinetics

Absorption: Slow, prolonged absorption over 24 h. Peak: 6–8 h. Distribution: 98–99% protein bound. Half-Life: 5–7 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of hypoglycemia (see Appendix F), especially after changes in insulin dose or type.
  • Lab tests: Periodic fasting blood glucose and HbA1C; periodic serum potassium with concurrent potassium-lowering drugs.
  • Monitor weight periodically.

Patient & Family Education

  • Follow directions for taking the drug (see Administration). Rotate injection sites and never inject into an area with redness, swelling, itching, or dimpling.
  • Know parameters for withholding drug. Check blood sugar as prescribed; notify physician of fasting blood glucose below 80 or above 120 mg/dL.
  • Ingest some form of sugar (e.g., orange juice, dissolved table sugar, honey) if symptoms of hypoglycemia develop; and seek medical assistance.
  • Notify the physician of any of the following: fever, infection, trauma, diarrhea, nausea, or vomiting.
  • Do not take any other medication unless approved by physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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