Generic Name

Insulin Detemir

Mechanism

• Insulin Detemir is a long‑acting basal insulin analogue that mimics endogenous basal insulin secretion.
• It contains a fatty‑acid (myristic acid) side‑chain that binds to albumin in the plasma, producing a slow, stable release of insulin over ≥24 h.
• By competing with glucagon and inhibiting hepatic gluconeogenesis, it lowers fasting glucose, while peripheral tissues (muscle, adipose) uptake glucose via the insulin receptor tyrosine‑kinase pathway.
• The albumin‑binding property gives Insulin Detemir a predictable, flat insulin curve with a lower peak‑to‑trough variability compared to older basal analogues.

Pharmacokinetics

• Food interaction: Large meals delay absorption by ~1 h; adjust carbohydrate counts accordingly.

Indications

• Type 1 diabetes mellitus requiring basal insulin to maintain fasting glycaemic control.
• Type 2 diabetes mellitus in patients needing basal insulin component of multiple daily injection (MDI) or basal‑bolus regimens.
• Gestational diabetes when long‑acting insulin is needed (use with caution; local guidelines preferred).

Contraindications

Contraindications
• Known hypersensitivity to insulin or detemir components.

Warnings
• Hypoglycaemia: Occasional asymptomatic episodes; caution in elderly, renal impairment, hepatic disease, or with concomitant sulfonylureas.
• Renal/Hepatic impairment: Use with caution; monitor for altered glucose homeostasis.
• Pregnancy: Use only if benefits outweigh risks; prefer human insulin analogues with more pregnancy data.
• Severe hepatic disease: May alter metabolism; start at low dose.

Dosing

• Initiation: 0.2 IU/kg/day (≈10 IU) once daily; dose adjusted to fasting capillary glucose 4–7 mmol/L (70–125 mg/dL).
• Adjustment: 2–4 IU increments every 2–3 days; aim for fasting glucose 5–7 mmol/L (90–125 mg/dL).
• Route: Subcutaneous injection; preferred sites: abdomen, thigh, or upper arm (avoid injection sites with lipohypertrophy).
• Timing: Administer at the same time each day; consistent with bedtime or waking routine.
• Special populations:
• *Elderly:* Titrate slower; watch for hypoglycemia.
• *Renal/hepatic impairment:* Start lower (≈0.1 IU/kg/day) and titrate cautiously.

Monitoring

• Self‑monitoring of blood glucose (SMBG): fasting, pre‑prandial, and bedtime.
• HbA1c: every 3–6 months or sooner if dose changes >10 %.
• Renal/hepatic panels: baseline and annually (or sooner if clinical concern).
• Weight: every visit (document changes >5 % as potential therapy issue).
• Electrolytes & serum insulin: if unexplained hypoglycaemia.

Clinical Pearls

• “Flat‑curve” advantage: Because Insulin Detemir has minimal peak action, it’s especially useful for patients prone to nocturnal hypoglycaemia; consider bedtime dosing.
• Albumin dependence: In hypoalbuminemia (e.g., nephrotic syndrome), the drug may dissociate more rapidly, shortening duration – monitor glucose closely.
• Combination with long‑acting GLP‑1 agonists: Can blunt weight gain; useful in obese type 2 patients when basal insulin alone is insufficient.
• Switching strategy: When transitioning from human basal insulin, maintain the same dose‑per‑day and titrate with a 1‑1 split between previous and detemir doses initially.
• Patient education: Encourage patients to note the exact time of injection; inconsistent timing can increase variability in glucose control.

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• *This drug card is intended for educational use by medical students and healthcare professionals and reflects current evidence-based practice as of 2026.*