Updated June 15, 2006

Insulin Detemir

A new, long-acting insulin analog (modified, synthetic form of insulin) that acts in the bloodstream for up to 24 hours. Marketed under the brand name Levemir, detemir is approved for adults and children with Type 1 diabetes and for adults with Type 2 diabetes. It is meant to be injected once or twice daily. Detemir can be used with a rapid-acting insulin as part of a basal–bolus insulin regimen or in combination with oral medicines. However, it should not be mixed in the same syringe with other insulins or used in insulin pumps.

A healthy pancreas secretes a little bit of insulin all the time (so-called “basal” secretion) and also delivers extra insulin when food is consumed to cover any ingested carbohydrate. The traditionally used injected insulin preparations, such as Regular and NPH, do not mimic this action all that well.

Insulin analogs are synthetic forms of insulin in which the molecular structure has been altered to create certain effects, such as a shorter or longer activity profile. The first insulin analogs on the market were the rapid-acting insulin analogs (lispro and aspart), which more closely mimic the natural insulin spike at mealtimes than Regular insulin.

Insulin glargine (brand name Lantus), which became available in the year 2000, was the first long-acting insulin analog to reach the market. Unlike NPH (which is composed of nonanalog insulin and a protein additive to make it last longer), there is no significant peak in insulin glargine’s action, so it mimics the basal insulin secretion by the pancreas more closely than NPH does.

The FDA approved insulin detemir for marketing in the United States in June 2005. Several clinical trials have found that insulin detemir has a flatter activity profile than NPH. A study published in the June 2004 issue of the journal Diabetes showed that insulin detemir had a significantly more predictable blood-glucose-lowering pattern than either NPH or insulin glargine in people with Type 1 diabetes. Use of detemir may also be associated with less weight gain than NPH.

Novo Nordisk began shipping Levemir to pharmacies on March 7, 2006. It is available in vials and prefilled insulin pens. For more information, visit www.levemir-us.com.

This article was written by Robert S. Dinsmoor, a Contributing Editor of Diabetes Self-Management.

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