From the Guidelines
Insulin detemir (Levemir) can be substituted with other long-acting insulin options such as insulin glargine (Lantus, Basaglar, Toujeo), insulin degludec (Tresiba), or NPH insulin (Humulin N, Novolin N), with the most direct substitute being insulin glargine, which has similar duration of action and can often be used at the same total daily dose as Levemir, as supported by the latest guidelines 1. When considering a substitute for Levemir, it's essential to consider the individual patient's factors, such as insulin sensitivity, meal patterns, and activity levels, which affect insulin requirements.
- The most recent guidelines suggest that long-acting basal analogs, such as U-100 glargine or detemir, have been demonstrated to reduce the risk of symptomatic and nocturnal hypoglycemia compared with NPH insulin 1.
- Longer-acting basal analogs, such as U-300 glargine or degludec, may convey a lower hypoglycemia risk compared with U-100 glargine when used in combination with oral agents 1.
- Clinicians should be aware of the potential for overbasalization with insulin therapy and consider cost as an important component of effective management, as the cost of insulin has been rising steadily over the past two decades 1. Some key points to consider when substituting Levemir include:
- Monitoring blood glucose more frequently during the transition period to ensure proper glycemic control and to make any necessary dose adjustments.
- Working with a healthcare provider to determine the appropriate alternative and dosing.
- Considering the use of human insulin (NPH and regular) as a cost-effective option for many individuals with type 2 diabetes, especially those with relaxed A1C goals, low rates of hypoglycemia, and prominent insulin resistance, as well as those with cost concerns 1.
From the Research
Substitutes for Levemir
- Insulin detemir is a long-acting insulin analogue that can be used as a substitute for Levemir 2, 3.
- It has a lower within-subject variability of fasting plasma glucose levels compared to NPH insulin and insulin glargine, which may decrease hypoglycemic events and contribute to a decreased incidence of weight gain 2.
- Insulin detemir is well tolerated, with common adverse effects including hypoglycemia, headache, dizziness, and injection-site reactions 2.
Comparison with Other Insulins
- Insulin detemir has been compared to NPH insulin in several studies, with similar glycemic control and a lower risk of severe hypoglycemia 2, 4.
- A cost-utility analysis found that insulin detemir was more effective than NPH insulin, but also more expensive 5.
- Insulin detemir has also been compared to insulin glargine, with some studies suggesting that detemir may have a lower risk of severe hypoglycemia 4.
Clinical Use
- Insulin detemir can be used as part of a basal-bolus insulin therapy regimen, with once or twice daily dosing 2, 6.
- It has been shown to be effective in improving glycemic control in patients with type 1 and type 2 diabetes mellitus 2, 6.
- Insulin detemir may be a suitable substitute for Levemir in patients who require a long-acting insulin analogue 2, 3.