Long-acting Insulin Analogue Pregnancy: Can be considered during pregnancy if clinically needed; intensified blood-glucose control and monitoring recommended (insulin requirements usually fall in the first trimester and rise during the second and third).

Insulin Detemir

Brand names: Levemir

Insulin detemir is a long-acting basal insulin analogue used once or twice daily to provide background insulin cover in type 1 and type 2 diabetes.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Individualised. With oral antidiabetics or added to a GLP-1 receptor agonist: once daily, initial dose 0.1-0.2 units/kg or 10 units in adults, then titrated to target. As part of a basal-bolus regimen: once or twice daily, individually adjusted

Route: Subcutaneous only (abdominal wall, thigh, upper arm, deltoid or gluteal region) - must NOT be given intravenously (risk of severe hypoglycaemia) or intramuscularly, and must not be used in insulin infusion pumps

Frequency: Once or twice daily depending on need; when twice daily, the evening dose may be given in the evening or at bedtime; give at the same time each day

Long-acting basal insulin analogue; 1 unit detemir = 1 international unit human insulin. May be used alone as the basal insulin or with bolus insulin, oral antidiabetics and/or GLP-1 receptor agonists. When a GLP-1 receptor agonist is added, reduce the Levemir dose by 20% to minimise hypoglycaemia. The SPC provides pre-breakfast self-monitored plasma glucose titration tables for type 2 diabetes. Elderly and renal/hepatic impairment: intensify glucose monitoring and individualise the dose (impairment may reduce requirements). Can be used in adolescents and children from 1 year of age; safety and efficacy below 1 year not established. FlexPen delivers 1-60 units in 1-unit increments (subcutaneous only).

Dose adjustments

Renal

Renal or hepatic impairment may reduce insulin requirements; intensify glucose monitoring and adjust the dose on an individual basis.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to insulin detemir or to any excipient

Side effects

Hypoglycaemia (most frequently reported; major hypoglycaemia in approximately 6% of treated patients)
Injection-site reactions (pain, redness, hives, inflammation, bruising, swelling, itching) - more frequent than with human insulin, usually minor and transient
Lipodystrophy and cutaneous amyloidosis at injection sites
Transient refraction anomalies and oedema at the start of treatment
Acute painful neuropathy and temporary worsening of diabetic retinopathy with rapid improvement in glycaemic control

Interactions

Drugs that may increase hypoglycaemia risk: antidiabetic agents, ACE inhibitors, angiotensin II receptor blockers, disopyramide, fibrates, fluoxetine, MAO inhibitors, pentoxifylline, pramlintide, salicylates, octreotide, sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors
Drugs that may reduce the glucose-lowering effect: atypical antipsychotics (olanzapine, clozapine), corticosteroids, danazol, diuretics, oestrogens, oral contraceptives, glucagon, isoniazid, niacin, phenothiazines, protease inhibitors, growth hormone (somatropin), sympathomimetics, thyroid hormones

Clinical monograph

How it works

Acylation with a fatty-acid side chain promotes albumin binding and self-association, prolonging and smoothing its glucose-lowering action.

Prescribing in practice

Hypoglycaemia is the principal risk, and as a high-alert medicine the dose should be prescribed in units in words with the product specified.
Some patients require twice-daily administration to achieve full basal cover.
Adjust the regimen with changes in diet, activity or intercurrent illness and review concurrent therapy in current prescribing references.

Monitoring

Monitor fasting and pre-meal blood glucose and HbA1c to guide titration and detect hypoglycaemia.

Counselling the patient

Take it at the same time(s) each day as directed.
Recognise and treat hypoglycaemia and carry fast-acting carbohydrate.
Rotate injection sites and do not share pens or needles.

Evidence & guidelines

Long-acting basal analogues reduce hypoglycaemia compared with NPH insulin and are supported within NICE diabetes guidance.

Reference: NICE NG17 (Type 1 DM); NICE NG28 (Type 2 DM); MHRA Insulin Safety Alert; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways