SubcutaneousDiabetes mellitusAdult: 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.
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Dose adjustment may be needed.
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Dose adjustment may be needed.
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May be taken with or without food. For patients treated w/ once daily regimen, administer w/ evening meal or at bedtime. For patients who need twice daily dosing, the evening dose can be administered either w/ the evening meal or at bedtime or 12 hr after the morning dose.
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Do not mix with other insulin preparations.
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Do not admin by IV, IM or via insulin infusion pump.
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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
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Hypoglycaemia, lipodystrophy, pruritus, rash, wt gain, sodium retention and oedema. Inj site reactions e.g. pain, itching, hives, swelling and inflammation.
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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.
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Possible absence of hypoglycaemic warning symptoms with β-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.
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Description: 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
Pharmacokinetics:
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).
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Unopened preparation: Store between 2-8°C (36-46° F). Do not freeze. Once opened, the vial should be kept in refrigerator (do not freeze) or at room temperature, below 30°C (86°F) for up to 42 days. Once opened, cartridge or a prefilled syringe to be stored at room temperature, below 30°C (86°F) up to 42 days (do not refrigerate).
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