Diabetes treatment is carried out in the form of replacement therapy. Since insulin of its own cannot help the absorption of glucose from the blood, its artificial analogue is introduced. With type 1 diabetes, this is the only way to preserve the health of patients.
Currently, indications for treatment with insulin preparations have been expanded, since with their help it is possible to achieve a decrease in the level of sugar in severe type 2 diabetes, with concomitant diseases, pregnancy and surgical interventions.
Insulin therapy should be similar to the natural production and release of insulin from the pancreas. For this purpose, not only short-acting insulins are used, but also medium duration, as well as long insulin.
Insulin Therapy Rules
With normal insulin secretion, it is constantly present in the blood as a basal (background) level. It is designed to reduce the action of glucagon, which is also without a break, produce alpha cells. Background secretion is small - about 0.5 or 1 unit every hour.
In order for diabetic patients to create such a basal level of insulin, long-acting drugs are used. These include insulin Levemir, Lantus, Protafan, Tresiba and others. Introduction of long-acting insulin is performed once or twice a day. With a double injection interval is 12 hours.
The dose of the drug is chosen individually, as the need for insulin may be higher at night, then the evening dose increases, if there is a need for a better decrease in the daytime, then a large dose is transferred to the morning hours. The total dose of the drug administered depends on weight, diet, exercise.
In addition to the background secretion, insulin is produced for food intake. When the blood glucose level rises, the active synthesis and secretion of insulin begins to absorb carbohydrates. Normally, 12 grams of carbohydrate requires 1-2 U of insulin.
As a substitute for "food" insulin, which reduces hyperglycemia after a meal, short-acting drugs (Actrapid) and ultrashort (Novorapid) are used. Such insulins are administered 3-4 times daily before each main meal.
Short insulin requires a snack after 2 hours for a peak period of action. That is, with a 3-time introduction, you need to eat 3 more times. Ultrashort preparations of such intermediate food intake do not require. Their peak of action allows you to assimilate carbohydrates that came with the main meal, after which their action ceases.
The main schemes of insulin administration include:
- Traditional - the insulin dose is first calculated, and then the food, carbohydrates in it, and exercise are adjusted to it. Fully painted day by the hour. Nothing can be changed in it (amount of food, type of food, time of reception).
- Intensified - insulin adjusts to the daily regimen and gives you the freedom to schedule insulin intake and food intake.
With an intensive insulin therapy scheme, it is used as a background - extended insulin once or twice a day, and short (ultrashort) before each meal.
Levemir FlexPen - properties and features of the application
Levemir FlexPen is produced by the pharmaceutical company Novo Nordisk. The release form - colorless liquid which is intended only for a hypodermic injection.
The composition of insulin Levemir FlexPen (analogue of human insulin) is the active ingredient -demir. The drug was produced by genetic engineering, which makes it possible to prescribe it to patients with allergies to insulin of animal origin.
1 ml of Levemir insulin contains 100 U, the solution is placed in a syringe pen, which contains 3 ml, that is 300 U. In the package of 5 plastic disposable pens. The price of Levemir FlekPen is slightly higher than the drugs produced in cartridges or vials.
Instructions for use Levemira indicates that this insulin can be used by patients with the first and second type of diabetes, as well as that it is good for replacement therapy in pregnant women with diabetes.
Studies of the effect of the drug on the degree of weight gain of patients. With the introduction once a day after 20 weeks, the weight of the patients increased by 700 g, and the comparison group that received insulin-isophane (Protafan, Insulim), the corresponding increase was 1600 g.
All insulins are divided into groups according to the time of action:
- With ultrashort sugar-lowering effect - onset of action in 10-15 minutes. Aspart, Lispro, Hmumulin R.
- Short action - start after 30 minutes, peak after 2 hours, total time - 4-6 hours. Aktrapid, Farmasulin N.
- The average duration of action - after 1.5 hours begins to lower blood sugar, reaches a peak in 4-11 hours, the effect lasts from 12 to 18 hours. Insuman Rapid, Protafan, Vozlim.
- Combined action - the activity is manifested after 30 minutes, peak concentrations from 2 to 8 hours from the moment of administration, it lasts 20 hours. Mixard, Novomiks, Farmasulin 30/70.
- Prolonged action onset after 4-6 hours, peak - 10-18 hours, the total duration of action up to a day. This group includes Levemir, Protamine.
- Ultra-long insulin works 36-42 hours - Tresiba insulin.
Levemir is a long acting insulin with a flat profile. The action profile of the drug is less variable compared to isophane insulin or glargine. The prolonged action of Levemir is due to the fact that its molecules form complexes at the injection site and also bind to albumin. Therefore, this insulin is slower to target tissues.
Isophane-insulin was chosen as an example for comparison, and it was proved that Levemir has a more uniform flow into the blood, which ensures the constancy of action throughout the day. The mechanism of the lowering action on glucose level is associated with the formation of an insulin-receptor complex on the cell membrane.
Levemir has such an influence on metabolic processes:
- Accelerates the synthesis of enzymes inside the cell, including for the formation of glycogen - glycogen synthetase.
- Activates the movement of glucose into the cell.
- Accelerates the absorption of glucose molecules from circulating blood by tissues.
- Stimulates the formation of fat and glycogen.
- Inhibits glucose synthesis in the liver.
Due to the lack of data on the safety of Levemir, it is not recommended for children under 2 years of age. When used in pregnant women, no negative effect on the course of pregnancy, the health of the newborn, or the appearance of malformations was detected.
There are no data on the effect on infants during breastfeeding, but since it belongs to a group of proteins that are easily destroyed in the digestive tract and are absorbed through the intestines, it can be assumed that it does not penetrate into breast milk.
How to apply Levemir FlexPen?
The advantage of Levemir is the constant concentration of the drug in the blood throughout the entire period of action. If doses of 0.2-0.4 IU are administered per kg of patient weight, then the maximum effect occurs after 3-4 hours, reaches a plateau and lasts up to 14 hours after administration. The total duration of stay in the blood is 24 hours.
The advantage of Levemir is that it does not have a pronounced peak of action. Therefore, when administered, there is no risk of excessively low blood sugar levels. It is established that the risk of hypoglycemia during the day occurs less frequently by 70%, and nocturnal attacks by 47%. Studies were conducted over 2 years in patients.
Despite the fact that Levemir acts during the day, it is recommended to inject it twice to lower and keep the blood sugar level stable. If insulin is used for combination with short insulin, it is administered in the morning and evening (or before bedtime) with a break of 12 hours.
For the treatment of type 2 diabetes, Levemir can be administered once and at the same time you take tablets with a hypoglycemic effect. The initial dose for such patients is 0.1–0.2 U per 1 kg of body weight. Dosages for each patient are selected individually, based on the glycemic level.
Levemir is administered under the skin of the anterior surface of the thigh, shoulder, or abdomen. The injection site must be changed every time. For the introduction of the drug should:
- Dose selector to select the desired number of units.
- Insert the needle into the fold of the skin.
- Click the "Start" button.
- Wait 6 - 8 seconds
- Remove the needle.
Dose adjustment may be necessary for older patients with reduced kidney or liver function, with the addition of concomitant infections, changes in dietary habits, or with increased physical activity. If the patient is transferred to Levemir from other insulins, then a new dose selection and regular glycemic control is necessary.
The administration of long-acting insulin, which includes Levemir, is not administered intravenously due to the risk of the occurrence of severe forms of hypoglycemia. With the introduction of intramuscular injection, the onset of Levemir is manifested earlier than with subcutaneous injection.
For use in insulin pumps the drug is not intended.
Adverse Reactions with Levemir FlexPen
Side effects in patients using Levemir FlexPen are mainly dose-dependent and develop as a result of the pharmacological action of insulin. Hypoglycemia among them occurs most frequently. It is usually associated with improper selection of a dose of the drug or malnutrition.
So the mechanism of hypoglycemic insulin action in Levemir is lower than that of similar drugs. If, however, a reduced concentration of glucose in the blood occurs, then this is accompanied by dizziness, an increased feeling of hunger, and unusual weakness. The increase in symptoms can manifest itself in impaired consciousness and the development of hypoglycemic coma.
Local reactions occur at the injection site and are temporary. Often there is redness and swelling, itchy skin. Failure to administer the drug and frequent injections at the same place can cause lipodystrophy.
General reactions to the use of Levemir occur less frequently and are a manifestation of individual hypersensitivity. These include:
- Edema in the first days of drug administration.
- Urticaria, skin rash.
- Gastrointestinal disorders.
- Difficulty breathing.
- Common itching of the skin.
If the dose is lower than the insulin requirement, then an increase in blood sugar can lead to the development of diabetic ketoacidosis.
Symptoms increase gradually over several hours or days: thirst, nausea, increased urine output, drowsiness, redness of the skin, and the smell of acetone from the mouth.
Combined use of Levemir with other drugs
Anti-diabetic tablets, Tetracycline, Ketoconazole, Pyridoxine, Clofibrate, Cyclophosphamide are among the drugs that increase the lowering properties of Levemir on blood sugar levels.
Hypoglycemic effect is enhanced by the joint appointment of certain antihypertensive drugs, anabolic steroids, medicines, which contain ethyl alcohol. Also, alcohol in diabetes mellitus can cause an uncontrolled, prolonged increase in the decrease in blood sugar.
Corticosteroids, oral contraceptives, drugs containing heparin, antidepressants, diuretic drugs, especially thiazide diuretics, morphine, nicotine, clonidine, growth hormone, calcium blockers can weaken the effect of Levemir.
If reserpine or salicylates, as well as octreotide are used together with Levemir, they have a multidirectional effect, and can weaken or strengthen the pharmacological properties of Levemir.
The video in this article provides an overview of insulin Levemir FlexPen.