From the Guidelines
Using Levemir (insulin detemir) and Gliazide (gliclazide) together is generally acceptable, but caution is required due to the increased risk of hypoglycemia, particularly in patients with severe renal impairment or those at risk of hypoglycemia. When considering the use of Levemir and Gliazide together, it's essential to evaluate the patient's individual risk factors, such as renal function, history of hypoglycemia, and pancreatic beta cell function. According to the most recent guidelines, including the 2022 consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) 1, there are no absolute contraindications to using these medications together. However, relative contraindications include:
- Severe hypoglycemic episodes
- Impaired awareness of hypoglycemia
- Severe renal or hepatic impairment
- Allergy to either medication The combination of Levemir and Gliazide works through complementary mechanisms, with Levemir providing long-acting basal insulin and Gliazide stimulating insulin release from the pancreas and potentially improving insulin sensitivity. Key considerations when using these medications together include:
- Monitoring blood glucose frequently, especially when initiating therapy or adjusting doses
- Educating patients about recognizing and managing hypoglycemia symptoms
- Starting with lower doses of both medications and titrating based on blood glucose readings
- Being cautious in patients with severe renal impairment, as the risk of hypoglycemia may be increased, and dose adjustments may be necessary, as recommended in the 2022 ADA and KDIGO consensus report 1.
From the Research
Contraindications to Using Levemir and Gliazide Together
- The use of Levemir (insulin detemir) and Gliazide (gliclazide) together may increase the risk of hypoglycaemia, particularly in patients with renal impairment 2, 3, 4.
- Patients with a glomerular filtration rate (GFR) of less than 30 mL/min/1.73 m(2) are at a higher risk of hypoglycaemia when using sulphonylureas, such as gliclazide 3, 4.
- The risk of hypoglycaemia is also increased in patients aged 65 years or older, and those receiving concurrent intermediate- or long-acting insulin 4.
- Renal insufficiency can lead to the accumulation of sulphonylureas, such as gliclazide, and increase the risk of hypoglycaemia 5.
- However, gliclazide is considered to be one of the sulphonylureas that is less likely to cause hypoglycaemia, as its metabolites are either inactive or have minimal hypoglycaemic potency 5.
- Impaired renal function does not significantly modify the risk of hypoglycaemia associated with gliclazide use, but it does modify the risk associated with insulin use 6.