From the Guidelines
Long-acting insulins that can be used with diabetic patients on levofloxacin include insulin glargine (Lantus, Toujeo), insulin detemir (Levemir), and insulin degludec (Tresiba). There are no significant drug interactions between levofloxacin and these long-acting insulins that would contraindicate their concurrent use 1. However, it's essential to monitor blood glucose levels more closely when patients are on antibiotics like levofloxacin, as infections and antibiotics can both affect glycemic control. Infections typically increase insulin resistance and may raise blood glucose levels, while resolution of infection can lower glucose levels.
The dosing of long-acting insulin should be individualized based on the patient's usual insulin requirements, glycemic targets, and current clinical status. If the patient is experiencing significant changes in oral intake due to illness, insulin doses may need adjustment. Some key considerations for insulin dosing include:
- Starting with a basal insulin dose of 10 units, or 0.1 to 0.2 units/kg of body weight, per day and adjusting as needed 1
- Using a safe and simple approach to increase the dose by 10% to 15%, or 2 to 4 units, once or twice weekly until the fasting blood glucose target is met
- Considering cost and affordability when selecting an insulin product, particularly for patients with limited resources
Additionally, ensure the patient understands the importance of consistent carbohydrate intake and regular blood glucose monitoring while on both medications to maintain optimal glycemic control. Proper insulin injection technique is also crucial to optimize glucose control and insulin use safety, including injecting into appropriate body areas, injection site rotation, and avoiding intramuscular delivery 1.
From the Research
Long-Acting Insulin Options
- Insulin isophane (NPH) is the standard long-acting human insulin for patients with type 1 and type 2 diabetes 2.
- Long-acting human insulin analogues are also available: insulin glargine and insulin detemir 2.
- Insulin degludec is another long-acting human insulin analogue, approved in the EU for patients with type 1 and type 2 diabetes 2.
Efficacy and Safety of Long-Acting Insulin Analogues
- Insulin glargine has a steady time-action profile over 24 hours without a pronounced peak, and its efficacy is similar to NPH insulin 3.
- Insulin degludec has been shown to have a significantly decreased fasting plasma glucose (FPG) and lower prevalences of overall and nocturnal hypoglycemia compared to insulin glargine or insulin detemir 4.
- A systematic review and meta-analysis found no significant differences in the reductions in glycosylated hemoglobin between insulin degludec and other long-acting basal insulin analogues 4.
Considerations for Patients on Levofloxacin
- There is no direct evidence in the provided studies regarding the interaction between levofloxacin and long-acting insulin analogues.
- However, the choice of long-acting insulin analogue can be based on the patient's individual needs and medical history, taking into account the efficacy and safety profiles of the different options 2, 3, 4, 5, 6.
Special Considerations
- Insulin degludec has been shown to be suitable for managing hyperglycemia in hospitalized patients, with benefits including stable and predictable glycemic control, low glycemic variability, and a low risk of hypoglycemia 6.
- The ultralong duration of action, ability to be titrated daily, and flexibility in dosing make insulin degludec suitable for noncritical care settings with difficult-to-maintain rigid insulin schedules 6.