ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Long-acting Insulin Analogue Pregnancy: May be used in pregnancy — NICE NG3 recommends human insulin (isophane/soluble) as first choice; detemir used where established pre-pregnancy. Close monitoring required.

Insulin Detemir

Brand names: Levemir

Adult dose

Dose: Type 1 DM: 0.2–0.4 units/kg OD or BD; Type 2 DM: 10 units OD at bedtime initially, titrated to fasting glucose 4–7 mmol/L
Route: Subcutaneous injection
Frequency: Once or twice daily
Max: Individualised — no absolute maximum; titrate to glycaemic target
MHRA safety requirement: always prescribe by brand name (Levemir) to avoid dispensing errors. Administer in abdomen, thigh, or upper arm — rotate sites. Duration of action 16–24 hours. BD dosing often required in Type 1 DM.

Paediatric dose

Dose: 0.2 units/kg
Route: Subcutaneous injection
Frequency: Once or twice daily
Max: Individualised per glycaemic target
BNFc: Licensed from age 2 years. Starting dose 0.2–0.4 units/kg OD; adjust based on fasting glucose. Seek specialist paediatric endocrinology opinion for initial insulin regimen.

Dose adjustments

Renal

Insulin requirements may decrease in renal impairment (reduced insulin clearance) — monitor glucose closely and reduce dose as needed.

Hepatic

Insulin requirements may decrease in hepatic impairment — monitor closely.

Paediatric weight-based calculator

BNFc: Licensed from age 2 years. Starting dose 0.2–0.4 units/kg OD; adjust based on fasting glucose. Seek specialist paediatric endocrinology opinion for initial insulin regimen.

Clinical pearls

  • Always prescribe by brand name (MHRA requirement) — insulin errors are a Never Event
  • Antidote for hypoglycaemia: if conscious — 15–20g fast-acting carbohydrate (Lucozade, glucose tablets); if unconscious — IM glucagon 1mg (GlucaGen) OR IV dextrose 10% 150–200mL
  • Detemir has a flatter, more reproducible PK profile than NPH — less nocturnal hypoglycaemia
  • Unlike glargine, detemir is soluble (clear) in vial — do not confuse with rapid-acting insulins (also clear)

Contraindications

  • Hypoglycaemia
  • Hypersensitivity to insulin detemir or any excipient

Side effects

  • Hypoglycaemia (most common)
  • Injection site reactions (lipohypertrophy, lipoatrophy)
  • Oedema (particularly at initiation)
  • Weight gain
  • Hypersensitivity reactions

Interactions

  • Alcohol — potentiates hypoglycaemia
  • Beta-blockers — mask hypoglycaemia symptoms (except sweating)
  • Corticosteroids, thiazides — antagonise glucose-lowering effect
  • ACE inhibitors, salicylates — may enhance hypoglycaemic effect

Monitoring

  • Fasting blood glucose (target 4–7 mmol/L)
  • HbA1c every 3 months initially then 6-monthly
  • Injection site assessment
  • Renal and hepatic function

Reference: BNFc; BNF 90; NICE NG17 (Type 1 DM); NICE NG28 (Type 2 DM); MHRA Insulin Safety Alert. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways