Is Levemir (insulin glargine) a long‑acting basal insulin?

Is Levemir Long-Acting?

Yes, Levemir (insulin detemir) is a long-acting basal insulin analog with a duration of action up to 24 hours, though it often requires twice-daily dosing unlike insulin glargine which typically provides full 24-hour coverage with once-daily administration. 1, 2

Pharmacokinetic Profile of Levemir

• Insulin detemir is a soluble long-acting human insulin analog acylated with a 14-carbon fatty acid that reversibly binds to albumin (98-99% albumin bound), providing slow absorption and a prolonged metabolic effect. 1, 2
• The duration of action reaches nearly 24 hours at a dose of 0.4 units/kg, though many patients require twice-daily administration for optimal 24-hour basal coverage. 2
• Insulin detemir has a more predictable, protracted, and consistent glucose-lowering effect than NPH insulin, with less intrapatient variability in glycemic control compared with NPH insulin or insulin glargine. 1

Clinical Comparison: Levemir vs. Glargine (Lantus)

Key distinction: While both are long-acting insulins, insulin glargine (Lantus) has a true peakless profile over 24 hours with once-daily dosing, whereas insulin detemir may require twice-daily dosing when once-daily administration fails to provide 24-hour coverage. 3, 4

Insulin Glargine Characteristics

• Insulin glargine has an onset of action of approximately 1 hour with no pronounced peak action time, providing a relatively constant concentration profile over 24 hours. 4, 5
• The peakless profile of glargine results from its precipitation in subcutaneous tissue at physiologic pH, allowing slow, steady release from a depot. 5, 6
• Glargine is typically administered once daily at any time of day (though at the same time every day), making it more convenient than detemir. 7, 4

Insulin Detemir Characteristics

• Insulin detemir and insulin glargine may require twice-daily dosing when once-daily administration fails to provide 24-hour coverage, as explicitly recognized in the 2022 ADA Standards of Care. 3
• At the dose of 0.4 units/kg, detemir's duration reaches nearly 24 hours, but this is dose-dependent and may not be sufficient for all patients. 2

Clinical Efficacy and Safety

• Both detemir and glargine reduce the risk for severe hypoglycemia compared to NPH insulin, but only the reduction with detemir was statistically significant in type 1 diabetes trials. 8
• Insulin detemir provides at least equivalent glycemic control to NPH insulin with a similar or lower risk of hypoglycemia, especially nocturnal hypoglycemia. 1, 2
• Detemir has been associated with no appreciable bodyweight gain in type 1 diabetes and less bodyweight gain than NPH insulin in type 2 diabetes, which is a distinct clinical advantage. 1, 2
• The incidence of nocturnal hypoglycemia can be reduced by up to 50% with detemir compared to NPH insulin. 2

WHO Guideline Perspective on Long-Acting Analogs

• The World Health Organization recommends human insulin (including NPH) as first-line insulin therapy, with long-acting insulin analogs like detemir and glargine considered for those who experience frequent severe hypoglycemia with human insulin, due to cost considerations. 8
• Although there was moderate-quality evidence of reduced risk for severe hypoglycemia with long-acting detemir and glargine insulin analogs in both type 1 and type 2 diabetes, the WHO expert panel concluded that the relatively modest overall benefit was outweighed by the large price difference between human insulin and insulin analogs. 8
• Universal use of long-acting detemir and glargine insulin analogs is not recommended by WHO, although it can be justified in some circumstances, such as unexplained and frequent severe hypoglycemic events. 8

Practical Dosing Considerations

• Insulin detemir is most often injected once per day at bedtime and seems to be the ideal basal insulin in basal-prandial therapy for type 1 diabetic patients when combined with rapid-acting insulin for meals. 2
• When converting from glargine to detemir, the total daily dose of detemir should be approximately 38% higher than the total daily dose of glargine to achieve equivalent glycemic control. 3
• In labile type 1 diabetes or obese insulin-resistant patients, detemir (like glargine) may be most effective given as two daily injections due to high insulin requirements or inadequate 24-hour coverage. 9