Insulin detemir

Together with glargine and degludec (Haak 2018), insulin detemir belongs to the group of long-acting insulin analogues and is therefore a basal insulin (Kasper 2015).

Insulin detemir was the second representative of the long-acting insulin analogues after insulin glargine (Schwabe 2005) and was approved in Europe in 2004 under the trade name Levemir (Hürter 2005).

The therapy costs are EUR 1.91 for a dose of 40 IU. This is almost twice as high as for NPH insulin, for example (Schwabe 2005).

Pharmacodynamics

Insulin detemir is shortened by one amino acid at the B-chain and additionally carries the fatty acid side chain myristic acid (Kasper 2015 / Hien 2013).

After injection, detemir binds to albumin via a fatty acid. This results in slow absorption and a prolonged metabolic effect (Philips 2006).

Detemir has a lower metabolic potency than human insulin because it dissociates from the insulin receptor twice as fast in vitro. Therefore, the drug is designed at a concentration four times higher than human insulin (Philips 2006).

Compared with NPH insulins, detemir has a lower interindividual variance. The titration rules are independent of age. A higher mitogenic potency could not be proven in studies (Hürter 2005).

Indication

Insulin detemir can be used in basal therapy in children, adolescents and adults with type 1 or type 2 diabetes (Philips 2006).

It can be used in the type 2 diabetic along with oral antidiabetic agents such as metformin and GLP1- agonists such as liraglutide (Keating 2012).

Dosage and route of administration

Insulin detemir is administered using a pen (Hien 2013). Detemir is not suitable for insulin pump therapy, as are all other long-acting insulins (Dellas 2018).

Insulin detemir can be injected s. c. or intracutaneously. However, it should not be given i. v., as with all other delay insulins (Herold 2022).

Injection should be into the abdominal wall (more rapid absorption) or into the front or outer thigh (slower absorption) (Schubert 2009).

To avoid lipohypertrophy, the injection sites should be changed constantly (Marischler 2020).

Detemir is usually administered 1 x / d, preferably before bedtime. Patients whose target blood glucose level cannot be optimized before dinner should be switched to insulin administration twice: in the morning as well as in the evening before bedtime or before dinner (Philips 2006).

Advantages

• the number of hypoglycemicevents, especially at night, is reduced in type 1 diabetics (the number of hypoglycemic events was 37.1 with detemir and 48.2 with NPH insulin per person-year in studies (the number of nocturnal hypoglycemic events was 4.0 and 9.2, respectively). Similarly, the number of severe hypoglycemias also decreased by 0.51 episodes per patient-year (Haak 2018).
• HbA1c is marginally improved
• Weight gain:

No significant weight gain is found in type 1 diabetics and a smaller increase in type 2 diabetics than with NPH- insulin.

• Good tolerability
• Detemir can also be used in patients with renal or hepatic dysfunction (Philips 2006).

Adverse effects

The following adverse effects have been reported in isolated cases:

• Type III allergy (Darmon 2005)
• severe reaction at the injection site (Blumer 2006)

Contraindication

Absolute contraindications:

• Hypoglycemia
• Insulinoma (Flake 2021)

Insulin detemir has not been studied in pregnant women (Philips 2006).

Preparations

• Detemir, trade name Levemir (Herold 2022)

Onset of action occurs after 1 h, duration of action is 19 - 26 h (Haak 2018). A maximum effect is hardly reached (Dellas 2018). Detemir is rather characterized - compared to other delay insulins - by a very constant effective rate (Hien 2013).

Insulin detemir should not be mixed with other insulins (Kasper 2015). It does not need to be swished before an injection (Herold 2022).

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