Treatment and Prevention

Insulin Detemir: instructions for use

Insulin Detemir is the equivalent of human insulin. The drug is intended for hypoglycemic treatment of patients with diabetes. It is characterized by prolonged action and a reduced likelihood of developing hypoglycemia at night.

International non-proprietary name

The INN of this tool is Insulin detemir. Trade names are Levemere Flekspen and Levemere Penfill.

ATX

It is a hypoglycemic drug belonging to the pharmacological group of insulins. Its ATC code is A10AE05.

Forms of release and composition

The drug is available in the form of an injection solution intended for administration under the skin. Other dosage forms, including tablets, are not made. This is due to the fact that in the digestive tract insulin is split into amino acids and cannot perform its functions.

Insulin Detemir is the equivalent of human insulin.

The active ingredient here is insulin detemir. Its content in 1 ml of solution is 14.2 mg, or 100 U. Additional composition includes:

  • sodium chloride;
  • glycerol;
  • hydroxybenzene;
  • metacresol;
  • sodium hydrophosphate dihydrate;
  • zinc acetate;
  • dilute hydrochloric acid / sodium hydroxide;
  • injection water.

It looks like a clear, uncolored, homogeneous solution. It is distributed in 3 ml cartridges (Penfill) or pen syringes (Flekspen). Outer carton. Instructions attached.

pharmachologic effect

The drug is a product of genetic engineering. It is obtained by creating rDNA in Baker's yeast. For this, plasmid fragments are replaced by genes that determine the biosynthesis of insulin precursors. These modified DNA plasmids are inserted into Saccharomyces cerevisiae cells, and they begin to produce insulin.

When using this drug, the risk of nocturnal hypoglycemia is reduced by 65% ​​(compared with other drugs).

The considered agent is an analogue of the hormone secreted by the islets of Langerhans in the human body. It is characterized by an extended time of action and an even release without marked jumps in the concentration of the active substance in the plasma.

Insulin molecules form associations at the injection site and also bind to albumin. Due to this, the drug is absorbed and enters the target tissue at the periphery slowly, which makes it more effective and safe than other insulin preparations (Glargin, Isofan). In comparison, the risk of hypoglycemia at night is reduced to 65%.

By acting on cellular receptors, the active ingredient of the drug triggers a number of intracellular processes, including the synthesis of important enzymes such as glycogen synthetase, pyruvate and hexokinase. Reducing the level of glucose in plasma is provided by:

  • suppressing its production in the liver;
  • enhance intracellular transport;
  • activation of absorption in the tissues;
  • stimulate the processing of glycogen and fatty acids.

The pharmacological effects of the drug are proportional to the dose administered. The duration of exposure depends on the place of injection, dosage, body temperature, speed of blood flow, physical activity. It can reach 24 hours, so injections are made 1-2 times a day.

The state of the kidneys does not affect the process of metabolism of the substance.

In the course of the studies, no genotoxicity of the solution, carcinogenic effects, or pronounced effects on cell growth and reproductive functions were detected.

Pharmacokinetics

To obtain the maximum plasma concentration from the time of administration, 6-8 hours should pass. Bioavailability is about 60%. The equilibrium concentration at two times the introduction is determined after 2-3 injections. The volume of distribution is on average 0.1 l / kg. The main part of the injected insulin circulates with the blood stream. The drug does not interact with fatty acids and pharmacological agents that bind to proteins.

Metabolization is not different from the processing of natural insulin. The half-life is from 5 to 7 hours (in accordance with the dose used). Pharmacokinetics does not depend on gender and age of the patient. The condition of the kidneys and liver also does not affect these indicators.

Indications for use

The drug is designed to combat hyperglycemia in the presence of diabetes mellitus type 1 and 2.

Insulin is designed to combat hyperglycemia in the presence of type 1 and type 2 diabetes.

Contraindications

This tool is not prescribed for hypersensitivity to the action of the insulin component or intolerance to excipients. The age limit is 2 years.

How to take Insulin Detemir

The solution is used for subcutaneous administration, intravenous infusion can cause severe hypoglycemia. It is not injected intramuscularly and not used in insulin pumps. Injections can be administered to the area:

  • shoulder (deltoid muscle);
  • hips;
  • anterior wall of the peritoneum;
  • buttocks.

The injection site must be constantly changed to reduce the likelihood of the appearance of signs of lipodystrophy.

Dosing regimen is selected strictly individually. Doses depend on plasma glucose, determined on an empty stomach. Correction of dosages may be needed during exercise, changes in diet, concomitant diseases.

The drug is introduced into various places, including the anterior wall of the peritoneum.

The use of the drug is allowed:

  • independently;
  • together with bolus injections of insulin;
  • in addition to Lyraglutide;
  • with oral antidiabetic agents.

In case of complex hypoglycemic therapy, it is recommended to inject the medicine once a day. You need to choose any convenient time and stick to it when performing daily injections. If there is a need to use the solution 2 times a day, the first dose is administered in the morning, and the second - with an interval of 12 hours, with dinner or before bedtime.

After subcutaneous dose injection, the button of the syringe handle is kept pressed, and the needle is left in the skin for at least 6 seconds.

When switching from other insulin preparations to Detemir-insulin in the first weeks, strict control of the glycemic indicator is needed. It may be necessary to change the treatment regimen, dosages and time of admission of antidiabetic drugs, including oral.

It is necessary to carefully monitor the level of sugar and adjust dosages in the elderly in a timely manner.

It is necessary to carefully control the level of sugar and timely adjust the dosage in the elderly and patients with renal-hepatic pathologies.

Side Effects of Insulin Detemir

This pharmacological agent is well tolerated. Possible adverse reactions are associated with the pharmacological effects of insulin.

On the part of the organ of vision

Anomalies of refraction are sometimes observed (blurring of the image, causing headaches and drying of the ocular surface). Diabetic retinopathy is possible. The risk of its progression increases with intensive insulin therapy.

Musculoskeletal and connective tissue

During treatment, lipodystrophy may develop, which is expressed both in atrophy and in hypertrophy of adipose tissue.

central nervous system

Sometimes peripheral neuropathy develops. In most cases, it is reversible. Most often, its symptoms appear with a sharp normalization of the glycemic indicator.

The drug can cause blurring, accompanied by headache and dry eyes.
Attentiveness and speed of response may be impaired with hypo-or hyperglycemia.
Tachycardia is possible as a manifestation of generalized allergy.

Metabolism

Often there is a reduced concentration of sugar in the blood. Severe hypoglycemia develops in only 6% of patients. It can cause convulsive manifestations, fainting, impaired brain function, or death.

Allergies

Sometimes there is a reaction at the injection site. This may cause itching, redness of the skin, rash, swelling. Changing the place of insulin injection may reduce or eliminate these manifestations, the rejection of the drug is required in rare cases. Possible generalized allergies (intestinal disorder, difficulty breathing, arterial hypotension, blanching of integument, sweating, tachycardia, anaphylaxis).

Influence on ability to operate mechanisms

Attentiveness and speed of response may be impaired with hypo-or hyperglycemia. It is necessary to prevent the occurrence of these conditions during the performance of potentially dangerous work and driving a car.

special instructions

The probability of falling sugar levels at night is reduced in comparison with similar drugs, which allows to intensify the process of normalizing the glycemic indicators of patients. These measures do not lead to a strong increase in body weight (unlike other insulin solutions), but can change the primary hypoglycemic symptoms.

The termination of insulin therapy or the use of insufficient dosages can cause hyperglycemia.

Termination of insulin therapy or the use of insufficient dosages can cause hyperglycemia or provoke ketoacidosis, including fatalities. Particularly high risks in insulin-dependent type of diabetes. Symptoms of increased sugar concentration:

  • thirst;
  • lack of appetite;
  • frequent urination;
  • bouts of nausea;
  • vomiting reflex;
  • dryness of the oral mucosa;
  • dryness and itching of the integument;
  • hyperemia;
  • sensation of acetone smell;
  • drowsiness.

The need for insulin increases with unplanned physical activity, deviation from the meal schedule, infectious lesion, fever. The need to change the time zone requires prior medical consultation.

The drug can not be used:

  1. Intravenous, intramuscularly, in infusion pumps.
  2. When the color and transparency of the liquid has changed.
  3. If the expiration date has expired, the solution was stored in improper conditions or was frozen.
  4. After dropping or squeezing the cartridge / syringe.

Insulin detemir is forbidden to be administered intravenously.

Use in old age

In elderly patients, plasma glucose concentrations should be monitored with particular care. If necessary, adjust the initial dose.

Appointment to children

Clinical experience with the drug for children of the younger age group (up to 2 years) is absent. Children and adolescent doses should be carefully selected.

Use during pregnancy and lactation

When conducting research, negative consequences for children whose mothers used the drug during pregnancy were not identified. However, it should be used with care when carrying a child. In the initial period of pregnancy, the woman's need for insulin is somewhat reduced, and later increases.

No data is available on whether insulin is released into breast milk. Its oral intake on the infant should not be reflected negatively, since the drug in the gastrointestinal tract quickly disintegrates and is absorbed by the body in the form of amino acids. A nursing mother may need a dose adjustment and a change in diet.

Clinical experience with the drug for children of the younger age group (up to 2 years) is absent.
In violation of the function of the liver requires strict control of sugar levels and a corresponding change in the input dosages.
When conducting research, negative consequences for children whose mothers used the drug during pregnancy were not identified.

Use in violation of kidney function

Dosage is determined individually. The need for the drug may be somewhat reduced if the patient has impaired renal function.

Use in violation of the liver

Requires strict control of the level of sugar and a corresponding change in the dosages.

Overdose of Insulin Detemir

There are no clearly indicated doses that can lead to an overdose of the drug. If the amount injected is far in excess of the required individual dosage, hypoglycemic signs may appear gradually. Disturbing symptoms:

  • blanching covers;
  • cold sweat;
  • headache;
  • hunger;
  • weakness, fatigue, drowsiness;
  • bouts of nausea;
  • anxiety, distraction;
  • feeling of heartbeat;
  • visual abnormalities.

A small decrease in the glycemic index is eliminated by the use of glucose, sugar, etc.

A small decrease in the glycemic index is eliminated by the use of glucose, sugar, carbohydrate-saturated food or drinks, which the diabetic should always carry with them (cookies, candy, refined sugar, etc.). In severe hypoglycemia, an unconscious patient is injected into the muscle with either glucagon under the skin or intravenous glucose / dextrose infusion. If the patient does not wake up 15 minutes after the injection of glucagon, he needs to introduce a solution of glucose.

Interaction with other drugs

The composition should not be mixed with various medicinal liquids and infusion solutions. Thiols and sulfites cause the destruction of the structure of the funds in question.

The effect of the drug increases with parallel use:

  • Clofibrate;
  • Fenfluramine;
  • Pyridoxine;
  • Bromocriptine;
  • Cyclophosphamide;
  • Mebendazole;
  • Ketoconazole;
  • Theophylline;
  • antidiabetic oral medications;
  • ACE inhibitors;
  • antidepressants of the MAOI group;
  • non-selective beta-blockers;
  • inhibitors of carbonic anhydrase activity;
  • lithium preparations;
  • sulfonamides;
  • salicylic acid derivatives;
  • tetracyclines;
  • anabolic steroids.

In combination with Heparin, Somatotropin, Danazol, Phenytoin, Clonidine, Morphine, corticosteroids, thyroid hormones, sympathomimetics, calcium antagonists, thiazide diuretics, TCA, oral contraceptives, nicotine, insulin efficacy decreases.

It is recommended to refrain from drinking alcohol.

Under the influence of Lanreotide and Octreotide, the effectiveness of the drug can both decrease and increase. The use of beta-blockers leads to smoothing the manifestations of hypoglycemia and inhibits the restoration of glucose levels.

Compatibility with alcohol

It is recommended to refrain from drinking alcohol. The effect of ethanol is difficult to predict, because it can both strengthen and weaken the hypoglycemic effect of the drug.

Analogs

Full analogues of Detemir-insulin are Levemir FlexPen and Penfill. After the consultation with a doctor, other insulins (glargine, Insulin-isophan, etc.) can be used as a substitute for the drug.

Pharmacy vacation terms

Access to medication is limited.

Can I buy without a prescription

Prescription drug is released.

Insulin prolonged action Levemir
Insulin LEVEMIR: reviews, instructions, price

Price

The cost of injection solution Levemir Penfill - from 2154 rubles. for 5 cartridges.

Drug storage conditions

Insulin is stored in a package at a temperature of + 2 ... + 8 ° C, avoiding freezing. The used syringe-pen with the preparation is protected from the action of excessive heat (temperature up to + 30 ° C) and light.

Shelf life

The drug can be stored for 30 months from the date of manufacture. The shelf life of the used solution is 4 weeks.

Manufacturer

The drug is manufactured by the Danish pharmaceutical company Novo Nordisk.

Reviews

Nikolay, 52 years old, Nizhny Novgorod

I use this insulin for the third year. It effectively reduces sugar, runs longer and is better than previous injections.

Galina, 31, Yekaterinburg

When the diet did not help, I had to cope with gestational diabetes during pregnancy with this drug. The drug is well tolerated, injections, if done correctly, painless.

Watch the video: How to Use an Insulin Pen - Mayo Clinic Patient Education (December 2019).

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