Insulin Detemir (Subcutaneous)

Overview

When patients consume a form of sugar known as glucose, insulin is required in order to metabolize the substance. If patients are unable to produce enough insulin or if their insulin does not work effectively, the amount of sugar in the patient's blood increases to an abnormal level. As a result, additional pressure is placed on the patient's organs and they can suffer a range of symptoms.

High blood sugar, or hyperglycemia, is associated with feelings of fatigue, increased thirst, increased urination, blurred vision, nausea and, in extreme cases, loss of consciousness. If the patient is unable to control their blood sugar with their natural stores of insulin, diabetes mellitus will occur.

In cases of type 1 diabetes, the patient's body is unable to produce insulin naturally, whereas patients with type 2 diabetes are able to produce insulin but it does not work effectively.

This condition is linked to a number of serious health problems. Patients with type 2 diabetes are more at risk of suffering cardiac events, such as heart attacks and strokes. In addition to this, patients may develop diabetic retinopathy which can result in blindness. Patients can also experience blood circulation problems due to diabetes mellitus and, if the condition is not controlled properly, the patient may require amputations of the extremities.

When patients are diagnosed with type 2 diabetes, they may be able to control the condition by changing their lifestyle and dietary habits. If patients are currently consuming too much sugar, for example, their natural level of insulin may simply be unable to cope with processing the excess of amount sugar. By reducing their sugar intake, patients may find that their natural levels of insulin are enough to metabolize the substance and prevent the symptoms from occurring.

However, if the patient's blood sugar cannot be regulated by dietary and/or lifestyle modifications, they may be prescribed Insulin Detemir. Administered via subcutaneous injection, this medicine effectively increases the amount of insulin-like substances in the patient's system and enables them to process the glucose in their body.

As type 1 diabetes is an autoimmune disease, it cannot normally be fully controlled with diet and lifestyle changes. Although patients with type 1 diabetes can reduce their symptoms and manage their condition more effectively if they follow their physician's dietary advice, they will normally require medication as well.

Whilst Insulin Detemir can often be used in isolation, it may also be prescribed alongside other diabetes medications. In some cases, physicians may supplement the patient's treatment by prescribing oral diabetes medicines or additional subcutaneous medications.

By using the appropriate amount of Insulin Detemir, patients can control their blood sugar levels and ensure that they remain within a safe range. In doing so, patients can reduce their symptoms and reduce their risk of suffering additional health problems as a result of diabetes mellitus.

Conditions Treated

  • Diabetes Mellitus

Type Of Medicine

  • Long-acting human insulin analog

Side Effects

Even when medications are effective in treating a specific condition, they can cause patients to experience some side-effects. Although patients may be more likely to experience side-effects when they first starting using a medication, these may diminish over time.

When patients first start using Insulin Detemir, for example, they may exhibit any of the following side-effects:

  • Coldness, blistering, bleeding, stinging, tenderness or ulceration at injection site
  • Warmth, feeling of pressure, infection, hives, tingling or swelling at injection site
  • Discoloration of the skin, burning, lumps, itching, rash or soreness at injection site
  • Scarring, redness, pain, numbness or inflammation at injection site
  • Decrease in the amount of urine
  • Rattling, noisy breathing
  • Weight gain
  • Trouble breathing at rest
  • Accumulation or redistribution of body fat
  • Swelling of the hands, lower legs, feet or fingers

If the above side-effects are not troublesome to the patient and are relieved over time, they may not need to access medical assistance. However, if the patient experiences severe side-effects or prolonged adverse effects, they should obtain medical advice.

Furthermore, patients will need to obtain immediate medical assistance if they experience the following side-effects when using Insulin Detemir:

  • Anxiety
  • Itching
  • Blurred vision
  • Irritation
  • Chills
  • Increased hunger
  • Cold sweats
  • Hoarseness
  • Confusion
  • Pale, cool skin
  • Hives
  • Cough
  • Headache
  • Depression
  • Nightmares
  • Difficulty swallowing
  • Nausea
  • Dizziness
  • Swelling of the face, hands, lips, feet or of the eyelids
  • Joint pain
  • Swelling or stiffness
  • Fast heartbeat
  • Seizures
  • Fever
  • Swelling or puffiness of the eyelids or around the face, tongue, lips or eyes
  • Redness of the skin
  • Unusual weakness or tiredness
  • Shakiness
  • Chest tightness
  • Trouble breathing
  • Slurred speech
  • Rash on the skin

Patients should also seek medical help if they experience any other adverse effects when using Insulin Detemir.

Dosage

When patients are treated with Insulin Detemir, their dose of medication will depend on their existing blood sugar levels. Regardless of whether patients are being treated for type 1 or 2 diabetes, their up-to-date blood sugar levels will be used to determine what dose of Insulin Detemir they need.

Insulin Detemir must be administered via a subcutaneous injection. As this involves an injection under the skin, patients may be given this medication by a healthcare practitioner at first. However, it can be more convenient for patients if they are taught to prepare and administer the medicine themselves. Patients can also be taught how to monitor and check their blood sugar levels so that they're able to calculate the appropriate dose of Insulin Detemir.

Prior to using Insulin Detemir, patients should always check the dose they're about to administer and the concentration of the medication.

Insulin Detemir can normally be injected into various parts of the body, such as the upper arm, thigh, stomach or abdomen. However, patients should choose a different area to inject into every time they use this medicine. Patients should not inject Insulin Detemir into an area which is swollen, painful or has broken skin.

Before using Insulin Detemir, patients should check that the solution is colorless and clear. If the solution appears to have particles in it, is thickened or cloudy, patients should not administer it. Instead, they should choose another vial of medicine to use or contact their physician to obtain additional medication.

Patients should not attempt to dilute this medicine or mix Insulin Detemir with any other medications. If patients are prescribed additional diabetes medicines, they will be shown how to administer them and should not attempt to inject them alongside Insulin Detemir.

Generally, patients are advised to use Insulin Detemir once or twice per day. If patients are instructed to administer one dose of medicine per day, they will usually be told to use the medicine with their evening meal or when they go to bed. If patients are advised to use the medication twice per day, they will usually be advised to administer it in the morning and evening, with twelve hours between each dose.

Patients should keep an accurate record of when they administered their medication, how much they used and their most recent blood sugar levels. Treating diabetes mellitus with Insulin Detemir requires adherence to a regular medication schedule. If patients forget to use Insulin Detemir, they should contact their physician for advice.

Potential Drug Interactions

As some medications can interact with each other, patients may be advised not to use certain medicines whilst they are being treated with Insulin Detemir.

For example, using Insulin Detemir alongside the following medications is not usually advisable:

  • Balofloxacin
  • Pasireotide
  • Besifloxacin
  • Lanreotide
  • Ciprofloxacin
  • Gemifloxacin
  • Liraglutide
  • Enoxacin
  • Pramlintide
  • Levofloxacin
  • Fleroxacin
  • Pazufloxacin
  • Flumequine
  • Pefloxacin
  • Gatifloxacin
  • Prulifloxacin
  • Lomefloxacin
  • Pioglitazone
  • Metreleptin
  • Sparfloxacin
  • Moxifloxacin
  • Rufloxacin
  • Nadifloxacin
  • Rosiglitazone
  • Norfloxacin
  • Tosufloxacin
  • Octreotide
  • Thioctic Acid
  • Ofloxacin

Whilst patients are not usually prescribed the above medicines in conjunction with Insulin Detemir, their doctor may feel it is beneficial to the patient in some cases. If so, the patient may be advised to take their medication at a certain time or their dose may be modified in order to reduce the risk of a drug interaction occurring.

Similarly, patients may be more likely to exhibit side-effects if they take the following medicines at the same time as using Insulin Detemir:

  • Acebutolol
  • Metoprolol
  • Albiglutide
  • Nebivolol
  • Atenolol
  • Moclobemide
  • Betaxolol
  • Phenelzine
  • Bisoprolol
  • Pindolol
  • Carteolol
  • Penbutolol
  • Carvedilol
  • Metipranolol
  • Celiprolol
  • Oxprenolol
  • Dulaglutide
  • Methylene Blue
  • Esmolol
  • Practolol
  • Exenatide
  • Nialamide
  • Furazolidone
  • Procarbazine
  • Iproniazid
  • Rasagiline
  • Isocarboxazid
  • Selegiline
  • Labetalol
  • Propranolol
  • Levobunolol
  • Safinamide
  • Linezolid
  • Sotalol
  • Lixisenatide
  • Timolol
  • Nadolol
  • Tranylcypromine

Insulin Detemir can also interact with certain foods, drinks, over-the-counter medicines, vitamins and supplements. For example, patients are usually advised not to consume ethanol (alcohol) whilst they are being treated with this medicine.

Patients should inform their physician if they are using any over-the-counter medicines, supplements or vitamins prior to using Insulin Detemir. In addition to this, patients should obtain medical advice before they start using any new medicines, supplements or vitamins once they have started using Insulin Detemir.

Warnings

If patients have any existing health problems, it could affect their treatment for diabetes mellitus. Similarly, any historic medical problems may affect what medication they're prescribed. It's important, therefore, that patients disclose their medical history and current health problems to their physician before they are treated with this medicine. The following conditions can be particularly relevant if treatment with Insulin Detemir is being considered:

  • Liver disease
  • Kidney disease
  • Low blood sugar (Hypoglycemia)
  • Stress
  • Illness
  • Emotional disturbance
  • Diabetic ketoacidosis

Insulin Detemir may be used to treat type 1 diabetes in pediatric patients who are over the age of two years. However, studies have not confirmed what effect this medication has on patients with type 1 diabetes who are under the age of two years. Due to this, Insulin Detemir is not normally used to treat patients with type 1 diabetes who are less than two years old. Similarly, Insulin Detemir is not normally used to treat type 2 diabetes in pediatric patients.

Patients should never share Insulin Detemir pens, cartridges or needles with any other individual. Doing so could result in blood-borne illnesses and/or viruses being transmitted.

When patients are diagnosed with diabetes mellitus, their physician may advise them to make some lifestyle changes. Patients may be advised:

  • To keep a copy of their prescriptions, medical history and their medication with them when they travel
  • Not to drink alcohol as it can have an impact on their blood sugar
  • To engage in counseling in order to make successful lifestyle changes
  • Not to take any other medicines unless they have been approved by a doctor. This applies to all medicines but particularly to allergy medicines, aspirin, sinus medicines, cold and flu remedies, cough medicine, asthma medications and appetite control supplements or medicines.

When patients are being treated with Insulin Detemir, they should have regular consultations with their physician. Similarly, regular urine and blood tests should be carried out. This will enable the patient's physician to check the medication is working effectively and that they aren't suffering any harmful effects due to the treatment.

After administering Insulin Detemir, patients may notice some swelling, itching, skin redness or itching at the injection site. If this is severe or does not go away, patients should obtain medical advice.

Once patients have been diagnosed with diabetes mellitus, they may be advised to wear a medical identification bracelet and to carry a medical identification card. This will inform relevant healthcare practitioners of the patient's condition and their treatment in the event of an emergency.

Patients should keep additional medical supplies on hand in case they are needed. Having extra Insulin Detemir and needles ensures that patients can administer additional medication if it is required.

As well as being prescribed Insulin Detemir, patients should be given a glucagon kit. This is medicine which can be administered if the patient's blood sugar levels drop to a very low level. Although this should only be used in an emergency, patients should ensure that they have it with them at all times in case it is needed.

If patients are advised to use Insulin Detemir in conjunction with other diabetes medications, they may be at risk of developing fluid retention (edema) and/or serious heart problems. If patients experience the following symptoms, they will need to access urgent medical care:

  • Chest discomfort or pain
  • Rapid weight gain
  • Extreme weakness or tiredness
  • Trouble breathing
  • Excessive swelling of the wrists, ankles, feet and/or hands
  • Shortness of breath
  • Uneven heartbeat

If patients use too much Insulin Detemir or administer it too often, they may experience hypoglycemia (low blood sugar). Similarly, if patients miss a meal, drink alcohol, do more exercise than usual or use Insulin Detemir in conjunction with other diabetes medicines, they may experience an episode of low blood sugar. Symptoms caused by low blood sugar can include:

  • Confusion
  • Blurred vision
  • Anxiety
  • Nightmares
  • Restless sleep
  • Headache
  • Fast heartbeat
  • Excessive hunger
  • Drowsiness
  • Lightheadedness or dizziness
  • Difficulty thinking
  • Shakiness
  • Cold sweats
  • Abnormal behavior, such as appearing drunk
  • Tingling in the feet, lips, hands or tongue
  • Slurred speech

However, people can experience different symptoms when their blood sugar is low. Patients should learn to recognize their symptoms of low blood sugar so that they can react to an episode of hypoglycemia quickly.

If patients are experiencing low blood sugar, they can increase their blood sugar levels by doing one or more of the following:

  • Consuming honey
  • Drinking a non-diet soft drink
  • Drinking fruit juice
  • Consuming a glucose gel or tablet
  • Drinking sugar dissolved in water
  • Eating sugar cubes

If the above actions don't relieve the symptoms of low blood sugar, patients should visit their nearest medical clinic or hospital and obtain urgent help. If patients begin to experience more extreme symptoms of low blood sugar, such as convulsions or unconsciousness, they will require emergency medical care. Patients should ensure they have a glucagon kit available for these instances and that family members are aware of how to administer this medication in the event of an emergency.

When patients experience an episode of low blood sugar, they may feel drowsy, dizzy, lightheaded and less alert than usual. Patients should not operate machinery, drive or perform any tasks which may be dangerous until they have fully recovered.

If patients forget to administer Insulin Detemir, eat excessively, avoid taking additional diabetes medicines or fail to follow the lifestyle advice given to them by their doctor, they may experience episodes of high blood sugar (hyperglycemia). During these times, patients may experience the following symptoms:

  • Dry mouth
  • Fruit-like breath odor
  • Dry, flushed skin
  • Blurred vision
  • Drowsiness
  • Tiredness
  • Ketones in the urine
  • Unusual thirst
  • Loss of appetite
  • Increased urination
  • Loss of consciousness
  • Trouble breathing, may be rapid and deep
  • Nausea or vomiting
  • Stomach ache or stomach pain

If patients begin to experience symptoms of hyperglycemia (high blood sugar), they should check their blood sugar levels. Following this, they should contact their physician for advice.

Patients with diabetes can experience complications during pregnancy. Whilst people without diabetes can develop gestational diabetes when pregnant, patients who have already been diagnosed with diabetes can find it more difficult to manage their condition whilst they are pregnant.

Due to this, patients should consult their physician if they plan to become pregnant so that a treatment regime can be planned in advance.

Insulin Detemir has been classed as a category B drug by the Food and Drug Administration. Although this medicine is not thought to pose a significant risk to the unborn baby if used by the expectant mother, it cannot be ruled out.

If patients become pregnant whilst using Insulin Detemir, they should inform their physician immediately. If patients with diabetes mellitus become pregnant, their blood sugar levels may need to be monitored more closely. As pregnancy can have an impact on blood sugar levels, the patient's dose of medication may need to be changed more than usual.

If patients take or use medication whilst breastfeeding, it may be passed on to the infant. It is not known whether Insulin Detemir can be transferred in this way or, if so, whether it would cause harm to the infant. Due to this, patients are normally advised not to breastfeed whilst using Insulin Detemir and should assess the potential risks before doing so. If patients are considering breastfeeding after receiving treatment with Insulin Detemir, they should obtain medical advice.

Before patients use Insulin Detemir, they should tell their physician if they have any existing allergies or if they have ever experienced an allergic reaction before. In some cases, Insulin Detemir can cause patients to develop a serious allergic reaction and this may include anaphylaxis. The symptoms of this type of reaction can include:

  • Itching
  • Rash on the skin
  • Shortness of breath
  • Chest pain
  • Trouble breathing
  • Wheezing
  • Difficulty swallowing
  • Hoarseness
  • Swelling of the throat, tongue, face, mouth and/or hands

As this type of allergic reaction can be life-threatening, patients will need emergency medical assistance if they display the above symptoms.

Storage

As patients are usually advised to administer Insulin Detemir once or twice per day, they will need to keep an adequate store of medicine with them. When keeping medicine at home, it's important that patients store it in a secure location and that children and/or pets cannot gain access to it.

In order to store Insulin Detemir safely, patients should follow the manufacturer's guidelines. Generally, unused pens and vials can be kept in the refrigerator but should not be frozen. Patients should only keep Insulin Detemir in a refrigerator for as long as the medication guide states.

Alternatively, Insulin Detemir vials and pens can usually be kept at room temperature for up to forty-two days (or less if the expiration date will run out within this timeframe). However, Insulin Detemir will need to be kept as cool as possible and protected from light and heat.

Patients should not dispose of Insulin Detemir or medical equipment, such as needles, with normal household waste. Instead, patients should contact their physician's office or pharmacist and use a designated medicine disposal service.

Summary

If left untreated, diabetes mellitus can have serious health complications and may be fatal. It is essential, therefore, that patients are able to control their blood sugar levels using lifestyle changes and appropriate medications.

By using Insulin Detemir, patients can successfully regulate their basal level of insulin and keep their blood sugar within an appropriate range. This will help to relieve the patient's symptoms and reduce the frequency of hyperglycemic and hypoglycemic episodes. In addition to this, patients may be able to reduce their risk of suffering further health problems by keeping their blood sugar levels within a normal range and managing their condition successfully.