(in' su lin) (de' te mir)
P / L : Caution during pregnancy and lactation
|| See TERMINOLOGY & ABBREVIATIONS ||
|Indication(s) & Dosage||Subcutaneous
Adult: In insulin-naive patients with type 2 DM who are not well controlled on oral antidiabetic drugs: Initial dosage of 0.1-0.2 units/kg given once daily in the evening or 10 units given once or twice daily, with subsequent dosage adjusted based on glycaemic control. In patients on basal insulin only: Insulin detemir may be substituted on a unit-for-unit basis for the basal insulin currently in use, adjust dose to achieve glycaemic targets. Inj may be given once daily at evening meal or at bedtime or twice daily in the morning and the second dose admin after the evening meal, at bedtime, or 12 hr after the morning dose.
Renal impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Incompatibility: Do not mix with other insulin preparations.
|Administration||Should be taken on an empty stomach. Take before meals.
|Overdosage||Symptoms: Hypoglycaemia. Management: In mild hypoglycaemic episodes, treat with oral glucose. In severe hypoglycaemic episodes, where the patient has become unconscious, treat with IM/subcutaneous glucagon (0.5-1 mg) or IV glucose. If the patient does not respond to glucagon within 10-15 minutes, IV glucose must be given. Once consciousness is regained, admin oral carbohydrates to prevent a relapse.|
|Contraindications||Do not admin by IV, IM or via insulin infusion pump.|
|Special Precautions||Renal or hepatic impairment. Regular monitoring of blood glucose and HbA1c. Continuous rotation of the inj site within a given area to reduce inj site reactions. Pregnancy, lactation|
|Adverse Drug Reaction(s)||Hypoglycaemia, lipodystrophy, pruritus, rash, wt gain, sodium retention and oedema. Inj site reactions e.g. pain, itching, hives, swelling and inflammation.|
|Drug Interactions||Possible absence of hypoglycaemic warning symptoms with Î²-blockers. Increased blood sugar with thiazide diuretics, corticosteriods, chlorpromazine, tibolone, isoniazid, niacin, some calcium-channel blockers such as diltiazem or nifedipine, diazoxide, lithium and thyroid hormones. Increased risk of hypoglycemia with disopyramide, larges doses of aspirin, gatifloxacin, MAOIs, mebanazine, nandrolone, pegvisomant, testosterone. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.
|Pregnancy Category (FDA)||Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1sttrimester (and there is no evidence of a risk in later trimesters).|
|Storage||Subcutaneous: Unopened preparation: Store between 2-8Â°C (36-46Â° F). Do not freeze. Once opened, the vial should be kept in refrigerator (do not freeze) or at room temperature, below 30Â°C (86Â°F) for up to 42 days. Once opened, cartridge or a prefilled syringe to be stored at room temperature, below 30Â°C (86Â°F) up to 42 days (do not refrigerate).|
|Pharmacology||Insulin detemir is a recombinant human insulin analogue which is long-acting. It is prepared using recombinant DNA technology and genetically modified cultures of Saccharomyces cerevisiae. Slow systemic absorption and reversible binding to albumin may account for the prolonged duration of action of insulin detemir.
Duration: 24 hr
Absorption: Max plasma concentration: 6-8 hr (SC admin). Absolute bioavailability: 60%.
Distribution: Protein binding: 98% (albumin). Volume of distribution: 0.1 L/kg. Terminal half-life: 5-7 hr (after SC admin).
|ATC Classification||A10AE05 - insulin detemir.|
Why is Insulin detemir prescribed?
Insulin detemir is used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). It is also used to treat people with type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood) who need insulin to control their diabetes. In patients with type 1 diabetes, insulin detemir may be used with another type of insulin (a short-acting insulin). In patients with type 2 diabetes, insulin detemir also may be used with another type of insulin or with oral medication(s) for diabetes. Insulin detemir is a long-acting, man-made version of human insulin. Insulin detemir works by replacing the insulin that is normally produced by the body and by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar.
How to use Insulin detemir?
Insulin detemir comes as a solution (liquid) to inject subcutaneously (under the skin). It is usually injected once a day, with the evening meal or at bedtime.Sometimes insulin detemir may be injected twice a day, in the morning before breakfast and in the evening with the evening meal or at bedtime about 12 hours later. Inject insulin detemir at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor to explain any part you do not understand. Use insulin detemir exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Never use insulin detemir when you have symptoms of hypoglycemia (low blood sugar) or if you have checked your blood sugar and found it to be low. Do not inject insulin into a skin area that is red, swollen, itchy, or thickened.
Insulin detemir should not be used in an external insulin pump.
Insulin detemir should not be diluted or mixed with other insulin products.
Insulin detemir controls diabetes but does not cure it. Continue to use insulin detemir even if you feel well. Do not stop using insulin detemir without talking to your doctor. Do not switch to another brand or type of insulin or change the dose of any type of insulin you are using without talking to your doctor.
Insulin detemir comes in vials and in dosing pens that contain cartridges of medication. Be sure you know what type of container your insulin detemir comes in and what other supplies, such as needles, syringes, or pens, you will need to inject your medication.
If your insulin detemir comes in vials, you will need to use syringes to inject your dose. Ask your doctor to show you how to inject insulin detemir using a syringe. Ask your doctor if you have questions about the type of syringe you should use.
If your insulin detemir comes in pens, be sure to read and understand the manufacturer's instructions. Ask your doctor to show you how to use the pen. Follow the directions carefully, and always prime the pen before use.
Never reuse needles or syringes and never share needles, syringes, or pens. If you are using an insulin pen, always remove the needle right after you inject your dose. Throw away needles and syringes in a puncture-resistant container.
Always look at your insulin detemir before you inject it. It should be as clear and colorless. Do not use your insulin detemir if it is colored, cloudy, thickened, or contains solid particles, or if the expiration date on the bottle has passed.
You can inject your insulin detemir in your upper arm, thigh, or stomach. Never inject insulin detemir into a vein or muscle. Change (rotate) the injection site within the chosen area with each dose; try to avoid injecting the same site more often than once every 1 to 2 weeks.
Carefully read the manufacturer's information for the patient.
Other uses for Insulin detemir
Insulin detemir may be prescribed for other uses; ask your doctor for more information.
What special precautions to follow?
Before using insulin detemir,
- inform your doctor if you are allergic to insulin (Humulin, Novolin, others), any of the ingredients of insulin detemir, or any other medications. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
- inform your doctor what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril; beta blockers such as atenolol, labetalol, metoprolol, nadolol, and propranolol; certain cholesterol-lowering medications such as fenofibrate and gemfibrozil; clonidine; danazol; disopyramide; diuretics; fluoxetine; hormone replacement therapy; isoniazid; lithium; medications for asthma and colds; medications for mental illness and nausea; monoamine oxidase inhibitors, including isocarboxazid, phenelzine, selegiline, and tranylcypromine; octreotide; oral contraceptives; oral medications for diabetes; oral steroids such as dexamethasone, methylprednisolone, and prednisone; pentamidine; reserpine; salicylate pain relievers such as aspirin, choline magnesium trisalicylate, choline salicylate, diflunisal, magnesium salicylate, and salsalate; somatropin; sulfa antibiotics; and thyroid medications. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- inform your doctor if you have or have ever had nerve damage caused by your diabetes or any other medical conditions, including kidney or liver disease.
- inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using insulin detemir, call your doctor.
- if you are having surgery, including dental surgery, inform the doctor or dentist that you are using insulin detemir.
- alcohol may cause a change in blood sugar. Ask your doctor about the safe use of alcoholic beverages while you are using insulin detemir.
- ask your doctor what to do if you get sick, experience unusual stress, or change your diet, exercise, or activity schedule. These changes can affect your dosing schedule and the amount of insulin you will need.
- ask your doctor how often you should check your blood sugar. Be aware that hypoglycemia may affect your ability to perform tasks such as driving and ask your doctor if you need to check your blood sugar before driving or operating machinery.
What special dietary instructions to follow?
Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet and to eat about the same amounts of the same kinds of food at about the same times each day. Skipping or delaying meals or changing the amount or kind of food you eat can cause problems with your blood sugar control.
What to do if I forget a dose?
If you remember your dose shortly after the time you were supposed to use it, inject the missed dose as soon as you remember it. If some time has passed since your regular dosing time, follow the directions provided by your doctor or call your doctor to find out whether you tonject the missed dose. Do not inject a double dose to make up for a missed one.
What side effects can Insulin detemir cause?
Insulin detemir may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms.
Insulin detemir injection may cause side effects. inform your doctor if any of these symptoms are severe or do not go away
redness, swelling, or itching at the site of the injection
changes in the feel of your skin, skin thickening (fat build-up), or a little depression in the skin (fat breakdown)
swelling of the hands, feet, ankles, or lower legs
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency treatment:
rash and/or itching over the whole body
shortness of breath
low blood pressure
Insulin detemir may cause other side effects. Call your doctor if you have any unusual problems while using Insulin detemir.
What to know about storage and disposal of Insulin detemir
Store unopened insulin detemir vials and pens in the original carton in the refrigerator. Do not freeze. Do not use insulin detemir if it has been frozen. Unopened refrigerated insulin detemir can be stored until the date shown on the company's label.
If no refrigerator is available (for example, when on vacation), store the vials, or pens at room temperature and away from direct heat and light. Unrefrigerated vials and pens can be used within 42 days or after that time they must be thrown away. Opened vials can be stored for 42 days at room temperature or in the refrigerator. Opened pens may be stored at room temperature for up to 42 days; do not refrigerate them. Throw away any insulin detemir that has been exposed to extreme heat or cold.
Throw away any medication that is outdated or no longer needed.
In case of emergency/overdose
In case of overdose, consult your doctor. If the victim has collapsed or is not breathing, consult local medical emergency services.
Insulin detemir overdose can occur if you use too much insulin detemir or if you use the right amount of insulin detemir but eat less than usual or exercise more than usual. Insulin detemir overdose can cause hypoglycemia. If you have symptoms of hypoglycemia, follow your doctor's instructions for what you should do if you develop hypoglycemia. Other symptoms of overdose:
- loss of consciousness
What other information to know?
Keep all appointments with your doctor and the laboratory. Your blood sugar and glycosylated hemoglobin (HbA1c) should be checked regularly to determine your response to insulin detemir. Your doctor will also inform you how to check your response to insulin by measuring your blood sugar levels at home. Follow these instructions carefully.
You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Insulin detemir may cause other side effects. Consult your doctor if you have any unusual problems while taking this.
Ref: MedlinePlus, U.S. Natl. Library of Medicine
This information is provided for reference only and not a replacement for and should only be used in conjunction with full consultation with a registered medical practitioner. It may not contain all the available information you require and cannot substitute professional medical care, nor does it take into account all individual circumstances. Although great effort has been made to ensure content accuracy, mph-bd shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise.