• Levemir is a brand name for a type of long-acting insulin prefilled pen that contains insulin detemir.
• Levemir (insulin detemir) is a biosynthetic human insulin analog of DNA origin that has been made using genetic engineering technology. Although it resembles human insulin in most of its structure, the amino acid threonine in position B30 has been omitted, and a C14 fatty acid chain has been attached to the amino acid B29. This makes it long-acting (up to 24 hours in duration).
• Levemir works by allowing cells throughout the body to uptake glucose (sugar) and convert it into a form that can be used by these cells for energy.
• Levemir belongs to the class of medicines known as long-acting insulins. It may also be called a long-acting recombinant human insulin analog.

• May be used for the treatment of type 1 diabetes in adults and children over the age of two who require long-acting insulin for their diabetes control.
• May be used to control blood sugar levels in adults and children with type 2 diabetes who require long-acting insulin when other medications are no longer effective at improving blood sugar levels.
• Levemir is available as a prefilled FlexTouch pen and a 10mL multidose vial. Both contain insulin detemir (at a concentration of 100U/mL).
• The prefilled FlexTouch pen is for single-patient use. This 3mL pen contains 300 units of insulin detemir (at a concentration of 100U/mL). Units can be increased by 1 unit at a time by moving the dial on the pen. The even unit numbers are printed on the dial and the odd numbers are shown as lines. The maximum dosage that can be given with one injection is 80 units. FlexTouch can be used with NovoFine or NovoTwist disposable needles.
• Although human insulin products are transferred into human breast milk, no adverse effects have been noted on a nursing infant; however, the risks versus benefits of breastfeeding should be taken into consideration.
• Research has not found any difference in the efficacy of Levemir versus Lantus, another long-acting insulin; however, weight gain and night-time hypoglycemia (low blood sugar levels) appear to be less with Levemir.
• May be given once or twice a day.
• Provides relatively constant levels of insulin detemir in the body with no pronounced peak.
• May be administered without regard to meals.
• Has a long duration of action (up to 24 hours).
• May be used with short or rapid-acting insulins but should not be used with another long-acting insulin such as Lantus.
• Levemir is better at mimicking a person without diabetes's normal physiological basal insulin release than some other long-acting insulins.
• Lower risk of night-time hypoglycemia compared with NPH.
• Slightly less weight gain has been reported with Levemir compared with Lantus (3.0kg vs 3.9kg) when used as add-on therapy for people with type 2 diabetes.
• Significant drug interactions are unlikely.
• If converting from insulin glargine to Levemir, the change may be done on a unit-to-unit basis. If changing from NPH insulin to Levemir, the change is usually done on a unit-to-unit basis; however, some people with type 2 diabetes may require more Levemir than NPH insulin.

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Low blood sugar levels (hypoglycemia) are the most common side effect of Levemir. The risk of hypoglycemia increases with tighter blood sugar controls, changes in meal patterns, certain coadministered medications, and changes in physical activity levels. People with liver or kidney disease may be at a higher risk of hypoglycemia.
• All insulins can cause potassium levels to go low (this is called hypokalemia). Insulin may also cause sodium retention, weight gain, fluid retention, and swelling, itching, redness, or lumps around the injection site. There is a risk of infection if a Levemir pen is shared.
• Other side effects reported include upper respiratory tract infections, headache, pharyngitis, influenza-like illness, gastroenteritis, and back, or abdominal pain.
• The dosage of Levemir may need to be reduced for liver or kidney disease. Blood glucose levels should be carefully monitored in people with these conditions.
• Seniors may be more susceptible to the side effects of long-acting insulin, such as insulin detemir. The dosage of Levemir in elderly people should be conservative.
• Levemir must be given by subcutaneous (under the skin) injection. It should not be given by IV, IM, or via an infusion pump.
• Levemir is not suitable for the treatment of diabetic ketoacidosis. Short-acting insulins should be used to treat this condition. Do not use it during a hypoglycemic episode or in people with hypersensitivity to Levemir.
• Seniors may have more difficulty using the Levemir FlexTouch pen due to poor vision or dexterity problems, or if they are unable to hear the audible clicks when they dial their dose. This may make it difficult to dial the correct dosage or inject the insulin under their skin.
• Levemir may cause more injection site reactions compared with Lantus; however, Lantus may have more of a detrimental effect on mitochondria. More people are likely to discontinue treatment with Levemir compared with Lantus (21% versus 13%).
• Research has not shown a clear association between insulin use during pregnancy and adverse developmental outcomes in the fetus. There is limited data on the presence of Levemir in breast milk and its effects on a nursing infant.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

• Tell your doctor if you have ever had an allergic reaction to any type of insulin before you start using Levemir.
• Children are especially sensitive to the effects of insulin, particularly around puberty.
• There are so many different types of insulin that medication errors are common. Always check the label on your insulin to make sure it is the brand you have been prescribed and it is the correct strength. Talk to your doctor or pharmacist if you are unsure. Always make sure you dial up the correct dose of Levemir for you.
• The dosage of Levemir needs to be individualized. This may take time, so ensure you monitor your blood sugars regularly when titrating the dosage of Levemir and tell your doctor the results.
• Levemir may be administered once or twice daily. If administered once daily, administer the dose with the evening meal or at bedtime.
• Never share your Levemir FlexTouch pen with other people. Store your pens as recommended on the label.
• Inject your insulin exactly as directed by your doctor. Take all other medications as prescribed.
• Your insulin requirements may change if you become unwell, develop an infection, or have other medical conditions. Surgery, injury, mental stress, diet, and how much exercise you do can also affect how much insulin you need. Puberty, pregnancy, and menopause can also affect insulin requirements. Conditions that delay food absorption or stomach emptying can slow down the time it takes to break down and absorb food which can change how much insulin you need.
• Be alert for symptoms of hypoglycemia which may include a headache, sweating, trembling, anxiety, confusion, irritability, rapid breathing, or a fast heartbeat. People with hypoglycemia may also faint and severe hypoglycemia that is left untreated may be fatal. Tell your family, friends, and caregivers to give you some fast-acting sugar (such as some jellybeans, fruit juice, or honey) if they notice you have symptoms of hypoglycemia, and then follow it up with a more substantial meal or glucagon injection if you are unconscious.
• Insulin is easily broken down by extreme temperatures, which means you need to be careful if you live in a part of the U.S. that gets very hot in summer, or very cold in winter.
• Levemir that has been opened may be kept at room temperature (below 86 degrees Fahrenheit [30 degrees Celcius]) for up to 42 days. If unopened, keep in a refrigerator at (36 to 46 degrees Fahrenheit [2-8 degrees Celcius]). Do not freeze any insulin. Throw insulin out that has been mistakenly frozen. Keep insulin away from direct sunlight or heat
• Levemir is a clear solution; discard it if it looks cloudy.
• If you are going out in the sun, always use an insulated bag protected by a cool pack to ensure your Levemir doesn't heat up; but avoid freezing it. During cold weather, keep your Levemir close to your skin so your body heat keeps it at a more even temperature. Discard any Levemir FlexTouch pens that you think may have inadvertently got too hot or too cold. The expiry date on Levemir applies to unopened, refrigerated insulin.
• Levemir FlexTouch can be used with NovoFine or NovoTwist disposable needles.
• Talk to your doctor if you think you might be pregnant when you start Levemir. During pregnancy, your insulin requirements change and you must monitor your blood sugar levels regularly. Tell your doctor if you inadvertently become pregnant. Although small amounts of Levemir pass into breastmilk it is uncertain what effect this has on a breastfeeding infant.

• The duration of effect is mediated by slowed systemic absorption of Levemir (insulin detemir) from the injection site because of the self-association of the drug molecules. The distribution is also slowed because of the binding of insulin detemir to albumin.
• Research has shown that the average time between an injection of Levemir and the duration of effect ranged from 7.6 hours to more than 24 hours depending on the dosage.
• Starts to work within 60 to 180 minutes after injection.
• Has no pronounced peak but full blood sugar-lowering effects can take one to three hours to develop after administration
• Keeps working for up to 24 to 36 hours
• Some studies dosed Levemir twice daily; however, at least one study has found this makes no difference to HbA1c control and concluded that Levemir was just as effective if dosed once daily.
• The effects of Levemir are dependent on the initial dosage given. Dosages of 0.1 units per kg may last only six hours whereas dosages equal to or greater than 0.8 units/kg last approximately 22 to 24 hours. Levemir has a relatively peakless profile but may be more slowly absorbed from the thigh compared to the deltoid (arm) and the abdomen after subcutaneous administration.

Medicines that interact with Levemir may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Levemir. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Levemir include:

• antibiotics, such as doxycycline and minocycline
• antidepressants such as SSRIs (eg, fluoxetine, sertraline), monoamine oxidase inhibitors (MAOI) such as selegiline, isocarboxazid, and phenelzine
• antiepileptics, such as fosphenytoin and phenytoin
• antipsychotics, such as aripiprazole, chlorpromazine
• antivirals such as amprenavir, atazanavir, and fosamprenavir
• aspirin
• beta-blockers, such as acebutolol, atenolol, or timolol
• cyclosporine
• diuretics, such as furosemide, chlorthalidone, or hydrochlorothiazide
• fluoroquinolone antibiotics, such as ciprofloxacin or norfloxacin
• gemfibrozil
• heart medications such as captopril, candesartan, or clonidine
• hormones, such as estradiol, estrone, and norethindrone
• lithium
• niacin
• pentamidine
• salmeterol
• steroids, such as cortisone, dexamethasone, fludrocortisone, or prednisone
• sucralfate
• tacrolimus or pimecrolimus
• topiramate
• turmeric
• aloe vera
• other insulins
• other medications that affect blood sugar levels or are used for diabetes, such as chlorpropamide, glimepiride, or glipizide.

Any medication that may increase the risk of low blood sugar levels, decrease the blood glucose-lowering effect of Levemir, or blunt the signs or symptoms of hypoglycemia may interact with Levemir.

Alcohol may also interact with Levemir by blocking the production of glucose by the liver, causing hypoglycemia.

Note that this list is not all-inclusive and includes only common medications that may interact with Levemir. You should refer to the prescribing information for Levemir for a complete list of interactions.