insulin detemir


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insulin detemir

(in-su-lin de-te-mir) ,

Levemir

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: pancreatics
Pregnancy Category: B

Indications

Control of hyperglycemia in patients with type 1 (IDDM) and type 2 (NIDDM) diabetes mellitus.

Action

Lower blood glucose by :
  • stimulating glucose uptake in skeletal muscle and fat,
  • inhibiting hepatic glucose production.
Other actions of insulin:
  • inhibition of lipolysis and proteolysis,
  • enhanced protein synthesis.

Therapeutic effects

Control of hyperglycemia in diabetic patients.

Pharmacokinetics

Absorption: Delayed and prolonged.
Distribution: Identical to endogenous insulin.
Metabolism and Excretion: Metabolized by liver, spleen, kidney, and muscle.
Half-life: 5–7 hr (dose-dependent).

Time/action profile ( hypoglycemic effect)

ROUTEONSETPEAKDURATION
Subcut3–4 hr3–14 hr†6–24 hr‡
†Small amounts of insulin detemir are slowly released resulting in a relatively constant effect over time.‡Duration is dose dependent; duration increases as dose increases.

Contraindications/Precautions

Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to a particular type of insulin, preservatives, or other additives.
Use Cautiously in: Stress and infection may temporarily alter insulin requirements; Renal/hepatic impairment (may ↓ insulin requirements); Concomitant use with pioglitazone or rosiglitazone (↑ risk of fluid retention and worsening HF) Obstetric: Pregnancy may temporarily alter insulin requirements; Pediatric: Children <2 yr (safety not established)..

Adverse Reactions/Side Effects

Endocrinologic

  • hypoglycemia (life-threatening)

Local

  • lipodystrophy
  • pruritis
  • erythema
  • swelling

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Beta blockers, clonidine, and reserpine may mask some of the signs and symptoms of hypoglycemia.Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin,phenothiazines,, and rifampin may ↑ insulin requirements.Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may ↓ insulin requirements.Concurrent use with pioglitazone or rosiglitazone may ↑ risk of fluid retention and worsening HF.Glucosamine may worsen blood glucose control.Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

Route/Dosage

Dose depends on blood glucose, response, and many other factors.
Subcutaneous (Adults and Children > 2 yr) Type 2 diabetes patients who are insulin-naive–0.1–0.2 units/kg once daily in the evening (or divided into a twice daily regimen) or 10 units once daily in the evening (or divided into a twice daily regimen). Patients with type 1 or 2 diabetes receiving basal insulin or basal bolus therapy—may substitute on an equivalent unit-per-unit basis.

Availability

Solution for injection: 100 units/mL in 10–mL vials and 3–mL cartridges

Nursing implications

Nursing assessment

  • Assess patient for signs and symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; unusual thirst) periodically during therapy.
  • Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.
  • Lab Test Considerations: Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. Hemoglobin A1C may be monitored every 3–6 mo to determine effectiveness.
  • Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine. Recovery from hypoglycemia may be delayed due to the prolonged effect of subcut insulin detemir.

Potential Nursing Diagnoses

Noncompliance (Patient/Family Teaching)

Implementation

  • high alert: Insulin-related medication errors have resulted in patient harm and death. Clarify ambiguous orders; do not accept orders using the abbreviation “u” for units, (can be misread as a zero or the numeral 4; has resulted in tenfold overdoses). Insulins are available in different types, strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.
  • Do not confuse Levemir (insulin detemir) with Lovenox (enoxaparin).
  • Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin’s units/mL. Special syringes for doses <50 units are available. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.
    • high alert: Do not mix insulin detemir with any other insulin or solution, or use syringes containing any other medicinal product or residue. If giving with a short acting insulin, use separate syringes and different injection sites. Solution should be clear and colorless with no particulate matter.
    • Do not use if cloudy, discolored, or unusually viscous. Store unopened vials and cartridges of insulin detemir in the refrigerator; do not freeze. After initial use vials of insulin detemir cartridges (PenFill) or a prefilled syringe may be stored in a cool place for 42 days. Do not store in-use cartridges and pre-filled syringes in refrigerator or with needle in place. Keep away from direct heat and sunlight.
  • Subcutaneous: Rotate injection sites.
    • Administer daily insulin detemir with evening meal or at bedtime. Administer twice daily insulin detemir evening dose with evening meal, at bedtime, or 12 hrs after morning dose.
  • Not for IV administration or use with insulin pumps.

Patient/Family Teaching

  • Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Patients taking insulin detemir should be given the Patient Information circular for this product.
  • Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
  • Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
  • Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, herbal products, or alcohol.
  • Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled.
  • Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
  • Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed.
  • Emphasize the importance of regular follow-up, especially during first few weeks of therapy.

Evaluation/Desired Outcomes

  • Control of blood glucose levels in diabetic patients without the appearance of hypoglycemic or hyperglycemic episodes.

insulin detemir

(dĕt′ə-mîr′)
n.
A long-acting insulin analog whose structure differs from that of human insulin by the attachment of the fatty acid myristic acid at the end of the B chain in place of the amino acid threonine, used in the treatment of type 1 and type 2 diabetes.
References in periodicals archive ?
It is known that patients who have received treatment with insulin detemir, in particular, should be given two doses daily to achieve fasting glycemic control (4).
Once-daily initiation of basal insulin as add-on to metformin: a 26-week, randomized, treat-to-target trial comparing insulin detemir with insulin glargine in patients with type 2 diabetes.
Spending on drugs used by patients with diabetes, 2015 Billions of dollars Insulin glargine 1 Rosuvastatin 2 Atorvastatin 4 Insulin aspart 7 Sitagliptin 8 Insulin isophane (NPH) 9 Pregabalin 10 Gabapentin 11 Insulin detemir 12 Metformin 14 Insulin lispro 16 Metformin-sitagliptin 20 The number in each bar represents the drug's place in the top 20 for spending for all drugs.
Ribel et al., "The mechanism of protraction of insulin detemir, a long-acting, acylated analog of human insulin,"
Shehadeh et al,5 through an open label, prospective, controlled multicenter cluster non-inferiority randomized study, assessed the use of insulin detemir and BIAsp 30 during Ramadan.
Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with type 1 diabetes.
[160] reported that insulin replacement therapy could be associated with increased EAT mass, as shown by their open label interventional study comparing insulin detemir with insulin glargine.
* The major global barrier for the T1Dmarket will be the biosimilar erosion of the leading insulin brands for T1D treatment, such as Lantus (insulin glargine), Levemir (insulin detemir), Humalog (insulin lispro), and NovoLog (insulin aspart).
Researchers randomly assigned 60 people with mild cognitive impairment (MCI) or mild to moderate Alzheimer's disease to get either a placebo or one of two intranasal doses (20 or 40 IU a day) of a long-acting type of insulin (insulin detemir).
Similarly, Novo Nordisk last summer debuted the prefilled insulin delivery device Levemir FlexTouch (insulin detemir [rDNA origin] injection) in the United States.
Those who received larger doses of the insulin detemir drug showed more improvement than those who had less or a placebo.