It is no exaggeration to say that with the advent of insulin analogues, a new era has begun in the life of diabetics. Due to their unique structure, they allow much more successfully than before to control blood glucose. Insulin Levemir is one of the representatives of modern drugs, an analogue of the basal hormone. It appeared relatively recently: in Europe in 2004, in Russia two years later.
Levemir has all the features of ideal long insulin: it works evenly, without peaks for 24 hours, reduces nighttime hypoglycemia, does not contribute to weight gain of patients, which is especially important for type 2 diabetes. Its action is more predictable and less dependent on the individual characteristics of a person than that of NPH-insulin, therefore, it is much easier to choose the dose. In short, this drug should take a closer look.
Levemir - the brainchild of the Danish company Novo Nordisk, known for its innovative tools for diabetes. The drug has successfully passed numerous studies, including in children and adolescents, during pregnancy. All of them confirmed not only the safety of Levemir, but also greater efficacy than the previously used insulins. Sugar control is equally successful in diabetes type 1, and in conditions with less need for hormone: in type 2 diabetes at the beginning of insulin therapy and in gestational diabetes.
Brief information about the preparation of the instructions for use:
Diabetes and pressure surges will be a thing of the past.
- Sugar normalization -95%
- Elimination of vein thrombosis - 70%
- Elimination of palpitations -90%
- Excessive Blood Pressure - 92%
- Increased vigor during the day, improved sleep at night -97%
|Description||Colorless solution with a concentration of U100, packed in glass cartridges (Levemir Penfill) or syringe pens that do not require refilling (Levemir FlexPen).|
|Composition||The international unlicensed name of the active component of Levemir (INN) is insulin detemir. In addition to it, the drug contains excipients. All components are tested for toxicity and carcinogenicity.|
|Pharmacodynamics||Allows you to reliably simulate the release of basal insulin. It has a low variability, that is, the action differs little, not only in one patient with diabetes mellitus on different days, but also in other patients. The use of insulin Levemir significantly reduces the risk of hypoglycemia, improves their recognition. This drug is the only "weight-neutral" insulin at the present time, it favorably affects body weight, accelerates the appearance of a feeling of fullness.|
Levemir easily forms complex insulin compounds, hexamers, binds to proteins at the injection site, so its release from subcutaneous tissue is slow and even. The drug is devoid of a peak characteristic of Protafan and Humulin NPH.
According to the manufacturer, the action of Levemir is even smoother than that of the main competitor from the same group of insulins - Lantus. In terms of operating time, Levemir surpasses only the most modern and expensive drug Tresiba, also developed by Novo Nordisk.
|Indications||All types of diabetes that require insulin therapy for good compensation. Levemir has the same effect on children, young and elderly patients, and can be used for disorders of the liver and kidneys. With type 2 diabetes, its use is allowed in conjunction with hypoglycemic agents.|
|Contraindications||Levemir cannot be used:|
The drug is administered only subcutaneously, intravenous administration is prohibited.
Studies in children younger than two years have not been conducted, so this category of patients is also mentioned in contraindications. Nevertheless, this insulin is prescribed and very young children.
Termination of the use of Levemir or repeated administration of an insufficient dose leads to severe hyperglycemia and ketoacidosis. This is especially dangerous with type 1 diabetes. Excess doses, skipping meals, unregistered loads are fraught with hypoglycemia. With neglect of insulin therapy and the frequent alternation of episodes of high and low glucose, complications of diabetes mellitus develop most rapidly.
The need for Levemir increases with sports, during illness, especially with high fever, during pregnancy, starting from the second half. Dose adjustment is needed for acute inflammation and exacerbation of chronic.
The instructions recommended for type 1 diabetes to produce an individual dose calculation for each patient. With type 2 disease, dosage selection starts from 10 units of Levemir per day or 0.1-0.2 units per kilogram if the weight is significantly different from the average.
In practice, this amount may be excessive if the patient adheres to a low-carb diet or is actively involved in sports. Therefore, it is necessary to calculate the dose of long insulin using special algorithms, taking into account glycemia over several days.
|Storage||Levemir, like other insulins, requires protection from light, freezing and overheating. A spoiled product may not differ from fresh, so storage conditions need to be given special attention. Opened cartridges remain effective for 6 weeks at room temperature. Spare bottles are stored in the refrigerator, their shelf life from the date of manufacture - 30 months.|
|Price||5 cartridges of 3 ml (total 1500 units) Levemira Penfill cost from 2800 rubles. Price Levemira FlexPen slightly higher.|
About the nuances of Levemir application
Levemir has a working principle similar to other insulin analogues, indications and contraindications. The essential difference is the time of action, dosage, the recommended scheme of injections for different groups of patients with diabetes.
What action insulin Levemir
Levemir is a long insulin. It lasts longer than traditional drugs - a mixture of human insulin and protamine. At a dose of about 0.3 units. per kilogram of the drug works 24 hours. The smaller the required dosage, the shorter the work time. In diabetic patients who are on a low-carb diet, action may end after 14 hours.
Long insulin can not be used to correct blood glucose during the day or before bedtime. If elevated sugar is detected in the evening, it is necessary to make a corrective short-insulin training, and after it to introduce a long hormone in the previous dose. It is impossible to mix insulin analogues of different duration in one syringe.
Forms of release
Insulin Levemir in a vial
Levemir FlexPen and Penfill differ only in form, the drug in them is identical. Penfill are cartridges that can be inserted into a syringe pen or to draw insulin from them with a standard insulin syringe. Levemir FlexPen - pre-filled manufacturer of syringe pens, which are used until the solution is over. Refill them can not. Pens allow you to enter insulin in 1 unit increments. They need to separately purchase NovoFine needles. Depending on the thickness of the subcutaneous tissue, particularly thin (diameter 0.25 mm) length 6 mm or thin (0.3 mm) 8 mm are chosen. The price of a pack of 100 needles is about 700 rubles..
Levemir FlexPen is suitable for patients with an active lifestyle and lack of time. If the need for insulin is small, a step of 1 unit will not allow you to accurately dial the desired dose. For such people, Levemir Penfill is recommended in combination with a more accurate syringe pen, for example, NovoPen Echo.
The dose of Levemir is considered correct if not only sugar on an empty stomach, but also glycated hemoglobin is within the normal range. If the compensation of diabetes is insufficient, you can change the amount of long insulin every 3 days. To determine the necessary correction, the manufacturer recommends taking an average sugar on an empty stomach, the last 3 days are involved in the calculation.
|Glycemia, mmol / l||Dose change||Correction value, units|
Related article: rules for calculating the dose of insulin for injections
- With type 1 diabetes The instruction recommended the administration of insulin twice a day: after waking up and before bedtime. Such a scheme provides better compensation for diabetes than a one-time. Doses are calculated separately. For morning insulin - based on fasting day sugar, for evening sugar - based on its nightly values.
- With type 2 diabetes perhaps one or two times the introduction. Studies show that at the beginning of insulin therapy one injection per day is enough to reach the target sugar level. A single dose does not require an increase in the calculated dose. With long-term diabetes, it is more rational to inject long insulin twice a day.
Use in children
In order to allow the use of Levemir among various groups of the population, large-scale research involving volunteers is needed. For children under 2 years old, this is associated with a lot of difficulties, therefore, the instructions for use and there is an age limit. The situation is similar with other modern insulins. Despite this, Levemir is successfully used in babies up to one year old. Treatment for them is as successful as in older children. According to parents, there is no negative effect.
Switching to Levemir from NPH insulins is necessary if:
- sugar fasting unstable,
- hypoglycemia is observed at night or late in the evening,
- the child is overweight.
Comparison of Levemir and NPH-insulin
Unlike Levemir, all insulins with protamine (Protafan, Humulin NPH and their analogs) have a pronounced maximum of action, which increases the risk of hypoglycemia, there are sugar jumps during the day.
Proven advantages of Levemir:
- Has a more predictable effect.
- Reduces the likelihood of hypoglycemia: heavy by 69%, nighttime by 46%.
- Causes less weight gain with type 2 diabetes: for 26 weeks in patients on Levemir weight increases by 1.2 kilograms, in diabetics on NPH-insulin by 2.8 kg.
- Regulates the feeling of hunger, which leads to a decrease in appetite in patients with obesity. Diabetics on Levemir consume an average of 160 kcal / day less.
- Increases the secretion of GLP-1. With type 2 diabetes, this leads to increased synthesis of its own insulin.
- It has a positive effect on water-salt metabolism, which reduces the risk of hypertension.
The only drawback of Levemir compared with NPH preparations is its high cost. In recent years, he has been included in the list of essential medicines, so diabetics can get it for free.
Levemir is a relatively new insulin, so it does not have cheap generics. The closest in terms of properties and duration of action are drugs from the group of long insulin analogues - Lantus and Tujeo. Switching to another insulin requires dose recalculation and inevitably leads to a temporary deterioration in the compensation of diabetes mellitus, therefore, it is only necessary to change drugs for medical reasons, for example, if you are hypersensitive.
Levemir or Lantus - which is better
The manufacturer revealed the advantages of Levemir compared to its main competitor - Lantus, which he happily reported in the instructions:
- insulin action is more consistent;
- The drug gives less weight gain.
According to reviews, these differences are almost imperceptible, so patients prefer the drug, the recipe for which is easier to obtain in this region.
The only significant difference that is important for patients who dilute insulin: Levemir tolerates mixing with saline, and Lantus partially loses its properties when diluted.
Pregnancy and Levemir
Levemir does not affect fetal development.therefore, it can be used by pregnant women, including those with gestational diabetes. The dose of the drug during pregnancy needs frequent adjustment, and should be chosen together with the doctor.
In case of type 1 diabetes, patients during the period of carrying a child remain on the same long insulin that they received earlier, only its dosage changes. Switching from NPH to Levemir or Lantus is not necessary if sugar is normal.
With gestational diabetes, in some cases, normal glycemia can be achieved without insulin, solely on diet and physical education. If sugar is often elevated, insulin therapy is needed to prevent fetal fetopathy in the fetus and ketoacidosis in the mother.
The overwhelming number of patient reviews about Levamir are positive. In addition to improving glycemic control, patients noted ease of use, excellent tolerability, good quality vials and pens, thin needles, which allow painless injections. Most diabetics claim that hypoglycemia on this insulin is less common and weaker.
Negative reviews are rare. They come mainly from parents of babies with diabetes and women with gestational diabetes. These patients require reduced doses of insulin, so Levemir FlexPen is inconvenient for them. If there is no alternative, and only such a drug can be obtained, diabetics have to break the cartridges out of a disposable syringe pen and transfer them to another one or inject them with a syringe.
Levemir action sharply worsens after 6 weeks after opening. Patients with a low need for long insulin do not have time to spend 300 units of the drug, so the balance has to be thrown away.