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1 High Alert with pioglitazone or rosiglitazone (qrisk of fluid retention and worsening HF); OB:
Pregnancy may temporarily alter insulin requirements; Pedi: Children ⬍2 yr (safety
PDF Page #1
insulin detemir (in-su-lin de-te-mir) not established).
Levemir Adverse Reactions/Side Effects
Classification Endo: HYPOGLYCEMIA. Local: lipodystrophy, pruritis, erythema, swelling. Misc: al-
Therapeutic: antidiabetics, hormones lergic reactions including ANAPHYLAXIS.
Pharmacologic: pancreatics Interactions
Pregnancy Category B Drug-Drug: Beta blockers, clonidine, and reserpine may mask some of the
signs and symptoms of hypoglycemia. Corticosteroids, thyroid supplements, es-
Indications trogens, isoniazid, niacin, phenothiazines, and rifampin mayqinsulin re-
Control of hyperglycemia in patients with type 1 (IDDM) and type 2 (NIDDM) diabe- quirements. Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypo-
tes mellitus. glycemic agents, and salicylates, maypinsulin requirements. Concurrent use with
pioglitazone or rosiglitazone mayqrisk of fluid retention and worsening HF.
Action Drug-Natural Products: Glucosamine may worsen blood glucose control.
Lower blood glucose by : stimulating glucose uptake in skeletal muscle and fat, inhib- Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic
iting hepatic glucose production. Other actions of insulin: inhibition of lipolysis and effects.
proteolysis, enhanced protein synthesis. Therapeutic Effects: Control of hyper-
glycemia in diabetic patients. Route/Dosage
Dose depends on blood glucose, response, and many other factors.
Pharmacokinetics Subcut (Adults and Children ⬎ 2 yr): Type 2 diabetes patients who are insulin-
Absorption: Delayed and prolonged. naive— 0.1– 0.2 units/kg once daily in the evening (or divided into a twice daily reg-
Distribution: Identical to endogenous insulin. imen) or 10 units once daily in the evening (or divided into a twice daily regimen).
Metabolism and Excretion: Metabolized by liver, spleen, kidney, and muscle. Patients with type 1 or 2 diabetes receiving basal insulin or basal bolus ther-
Half-life: 5– 7 hr (dose-dependent). apy— may substitute on an equivalent unit-per-unit basis.
TIME/ACTION PROFILE ( hypoglycemic effect) NURSING IMPLICATIONS
ROUTE ONSET PEAK DURATION Assessment
Subcut 3–4 hr 3–14 hr† 6–24 hr‡ ● Assess patient for signs and symptoms of hypoglycemia (anxiety; rest-
†Small amounts of insulin detemir are slowly released resulting in a relatively constant effect over lessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; con-
time. fusion; cool, pale skin; difficulty in concentration; drowsiness; night-
‡Duration is dose dependent; duration increases as dose increases. mares or trouble sleeping; excessive hunger; headache; irritability;
nausea; nervousness; tachycardia; tremor; weakness; unsteady gait) and
Contraindications/Precautions hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor;
Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to a particular type rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; unusual thirst)
of insulin, preservatives, or other additives. periodically during therapy.
Use Cautiously in: Stress and infection may temporarily alter insulin require- ● Monitor body weight periodically. Changes in weight may necessitate changes in
ments; Renal/hepatic impairment (maypinsulin requirements); Concomitant use insulin dose.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 Patient/Family Teaching
● Instruct patient on proper technique for administration. Include type of insulin,
● Lab Test Considerations: Monitor blood glucose every 6 hr during therapy, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard PDF Page #2
more frequently in ketoacidosis and times of stress. Hemoglobin A1C may be moni- syringes. Discuss the importance of not changing brands of insulin or syringes, se-
tored every 3– 6 mo to determine effectiveness. lection and rotation of injection sites, and compliance with therapeutic regimen.
● Toxicity and Overdose: Overdose is manifested by symptoms of hypo- Patients taking insulin detemir should be given the Patient Information circular
glycemia. Mild hypoglycemia may be treated by ingestion of oral glucose.
Severe hypoglycemia is a life-threatening emergency; treatment consists for this product.
of IV glucose, glucagon, or epinephrine. Recovery from hypoglycemia ● Explain to patient that this medication controls hyperglycemia but does not cure
may be delayed due to the prolonged effect of subcut insulin detemir. diabetes. Therapy is long term.
● Instruct patient in proper testing of serum glucose and ketones. These tests should
Potential Nursing Diagnoses be closely monitored during periods of stress or illness and health care profes-
Noncompliance (Patient/Family Teaching) sional notified of significant changes.
● Emphasize the importance of compliance with nutritional guidelines and regular
Implementation exercise as directed by health care professional.
● High Alert: Insulin-related medication errors have resulted in patient harm and
death. Clarify ambiguous orders; do not accept orders using the abbreviation “u” ● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
for units, (can be misread as a zero or the numeral 4; has resulted in tenfold over- tamins, or herbal products being taken and to consult health care professional be-
doses). Insulins are available in different types, strengths. Check type, dose, and fore taking other Rx, OTC, herbal products, or alcohol.
expiration date with another licensed nurse. Do not interchange insulins without ● Advise patient to notify health care professional of medication regimen prior to
consulting physician or other health care professional. treatment or surgery.
● Do not confuse Levemir (insulin detemir) with Lovenox (enoxaparin). ● Advise patient to notify health care professional if nausea, vomiting, or fever devel-
● Use only insulin syringes to draw up dose. The unit markings on the insulin sy- ops, if unable to eat regular diet, or if blood glucose levels are not controlled.
ringe must match the insulin’s units/mL. Special syringes for doses ⬍50 units are ● Instruct patient on signs and symptoms of hypoglycemia and hyperglyce-
available. Prior to withdrawing dose, rotate vial between palms to ensure uniform mia and what to do if they occur.
solution; do not shake. ● Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel)
● High Alert: Do not mix insulin detemir with any other insulin or solution, or use and identification describing their disease and treatment regimen at all times.
syringes containing any other medicinal product or residue. If giving with a short ● Advise patient to notify health care professional if pregnancy is planned or sus-
acting insulin, use separate syringes and different injection sites. Solution should
be clear and colorless with no particulate matter. pected or if breast feeding or planning to breast feed.
● Do not use if cloudy, discolored, or unusually viscous. Store unopened vials and ● Emphasize the importance of regular follow-up, especially during first few weeks
cartridges of insulin detemir in the refrigerator; do not freeze. After initial use vi- of therapy.
als of insulin detemir cartridges (PenFill) or a prefilled syringe may be stored in a
cool place for 42 days. Do not store in-use cartridges and pre-filled syringes in re- Evaluation/Desired Outcomes
frigerator or with needle in place. Keep away from direct heat and sunlight. ● Control of blood glucose levels in diabetic patients without the appearance of hy-
● Subcut: Rotate injection sites. poglycemic or hyperglycemic episodes.
● Administer daily insulin detemir with evening meal or at bedtime. Administer
twice daily insulin detemir evening dose with evening meal, at bedtime, or 12 Why was this drug prescribed for your patient?
hrs after morning dose.
● Not for IV administration or use with insulin pumps.
䉷 2015 F.A. Davis Company