High-Alert Medications - Levemir (insulin detemir)

Learn More About High-Alert Medications
Download this Safety Information: Levemir (insulin detemir)

Extra care is needed because Levemir is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Levemir

When taking your medicine
1.	Know your insulin. Levemir is a long-acting insulin that should be injected below the skin once or twice daily. (When taken in smaller doses, Levemir may be considered an intermediate-acting insulin.) When Levemir is taken once daily, inject the insulin with the evening meal or at bedtime. When taken twice daily, the evening dose should be taken with the evening meal, at bedtime, or 12 hours following the morning dose.
2.	Prepare your insulin. A rapid- or short-acting insulin is often prescribed with Levemir. However, Levemir should never be mixed in the same syringe with other insulins before injection. Do not vigorously shake insulin before use.
3.	Don't reuse or recycle. Discard used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Don't reuse or recycle syringes, needles, or lancets.
4.	Don't share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV.
To avoid serious side effects
5.	t Avoid mix-ups. If you use more than one type of insulin, make sure each vial, pen, or cartridge looks different. If insulins look similar, put a rubber band around one type to help avoid mix-ups.
6.	Check your medicine. There are dozens of different insulins on the market, many in similar looking vials, cartons, or pens. When you pick up your insulin at the pharmacy, be sure it's the right type of insulin.
7.	Treat low blood sugar (hypoglycemia). Carry a quick source of sugar, such as glucose tablets, candy, or juice, to treat low blood sugar. Signs of low blood sugar are listed below.
8.	Test your blood sugar level. Ask your doctor how often you should test your blood sugar level. Keep a log of your blood sugar levels and how much insulin you take each day. Bring the log with you each time you visit your doctor.
9.	Get a periodic lab test. You should have a hemoglobin A1c test at least twice a year to determine how well your diabetes is being controlled. The test shows an average of your blood sugar control over a 6- to 12-week period. Your goal is a hemoglobin A1c of 7% or less.
When you should call your doctor
10.	Call for illness or changes in habits. Your insulin needs may change because of illness, stress, changes in eating habits or physical activity, and other medicines you take. Call your doctor if you experience these conditions. Never change your insulin dose unless advised by your doctor.

Signs of hypoglycemia (low blood sugar)

hunger
feeling shaky
fast heartbeat

lightheadedness
dizziness
sweating

headache
confusion
irritability

Hypoglycemia is caused by too much insulin or increased work or exercise without eating. Symptoms of hypoglycemia may be different for each person and can change from time to time. Hypoglycemia can affect your ability to think and react quickly, so driving a car could be risky. Severe hypoglycemia can lead to loss of consciousness, seizures, brain damage, or even death. Know the symptoms of hypoglycemia and treat it quickly by drinking juice or a sugar-containing beverage, or eating sugar or candy. Talk to your doctor if hypoglycemia is a problem for you.

Topics	Fast Facts
Generic name	insulin detemir (pronounced IN soo lin DE te mir) (no generic available)
Common brand names	Levemir, Levemir FlexPen (prefilled pen)
Type of insulin, onset, duration	Intermediate- to long-acting; begins working in 3 to 4 hours and lasts 6 to 23 hours Duration of effects depends on the dose; higher doses last longer than lower doses
Uses	Treatment of type 1 and type 2 diabetes mellitus to improve control of blood glucose
When to take the insulin	Inject Levemir under the skin once or twice daily as directed by your doctor When taken once daily, inject the insulin with the evening meal or at bedtime; when taken twice daily, the evening dose should be taken with the evening meal, at bedtime, or 12 hours following the morning dose Inject Levemir at the same time(s) each day
Usual dose	The dose and frequency of administering insulin are unique to each individual Daily doses of insulin are based upon body weight, diet, activity level, age, individual sensitivity to insulin, type of diabetes (1 or 2)
Injecting the insulin	Do not mix Levemir with other insulins Ask your doctor, nurse, or pharmacist to show you how to draw your dose of insulin into a syringe and inject it, or select the dose on a pen device and inject the insulin Do not use Levemir with an external insulin pump Before injecting a dose, take the chill off refrigerated insulin by gently rolling the vial or pen between the palm of both hands (do not shake the insulin vigorously) Inject the insulin below the skin (not in the muscle) in the upper thighs, upper arms, buttocks, or abdomen; the injection site should be changed (rotated) with each dose Don't use Levemir if the insulin appears cloudy instead of clear and colorless
Special instructions and precautions	Follow the diet prescribed by your doctor; keep your eating habits and exercise regular Tell the doctor who prescribes insulin about any new medicines you are taking Do not share insulin pens or syringes/needles with others
Safety during pregnancy/breastfeeding	Talk to your doctor about managing your diabetes during pregnancy and breastfeeding
Storage and disposal	Store unopened vials and pens in the refrigerator until first use (do not freeze) or at room temperature for 42 days After first use, store vials in the refrigerator or at room temperature; discard after 42 days After first use, store insulin pens at room temperature (do not refrigerate); discard after 42 days Safely discard used syringes, needles, pens, and lancets (safety tip #3, other side)
Most common side effects	Hypoglycemia (low blood sugar); see signs and treatment of hypoglycemia above Low potassium blood levels, fast heart rate, fatigue, headache, hunger, weight gain
Other conditions to report to your doctor	Chest pain or palpitations, persistent fatigue, confusion, numbness of mouth, lips, or tongue, muscle weakness, tremors, vision changes, swelling of feet, flu-like symptoms Swelling, itching, redness, warmth, or pain at the injection site
Herbals that should not be taken with Levemir	These herbals can lower your blood glucose: chromium, garlic, gymnema
Prescription medicines that should not be taken with Levemir	Many prescription medicines can affect your blood sugar levels and insulin needs Tell your doctor about all the medicines you take, particularly new medicines
Special tests your doctor may prescribe	Patients are often asked to test their own blood glucose using home testing equipment, test their urine for sugar and acetone, and take their blood pressure regularly To monitor your diabetes, your doctor may periodically test your blood levels for hemoglobin A1c, potassium, cholesterol, and substances that measure kidney function

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

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