Levemir (insulin detemir)

What is Levemir?

Levemir is a brand-name prescription medication. It’s used to lower blood sugar levels in:

• adults and children ages 2 years old and older with type 1 diabetes
• adults with type 2 diabetes

Levemir has not been studied in children younger than 2 years of age with type 1 diabetes. It also hasn’t been studied in any children younger than 18 years of age with type 2 diabetes.

Levemir contains the drug insulin detemir, which is a long-acting insulin. Levemir is given as a subcutaneous injection. You’ll give yourself injections either once or twice a day based on your doctor’s or pharmacist’s direction.

Levemir comes as a solution (liquid mixture). The solution is available in two forms: a vial and a prefilled pen.

The vial contains 10 milliliters (mL) of drug solution, with 100 units of insulin detemir per mL. It’s used with a needle for injection. Needles are sold separately and may require a prescription in certain states. The pen is called the FlexTouch pen. Each pen contains 3 mL of drug solution, with 100 units of insulin detemir per mL.

Effectiveness

In clinical studies, adults with type 1 diabetes who took Levemir had their hemoglobin A1c (HbA1c) lowered by an average of 0.1% to 0.8%. In comparison, adults who took either insulin NPH (an intermediate-acting insulin) or insulin glargine (Lantus), a long-acting insulin, had their HbA1c lowered by an average of 0% to 0.7%.

In clinical studies, adults with type 2 diabetes taking Levemir had their HbA1c lowered by an average of 0.6% to 2%. In comparison, people who took insulin NPH saw a reduction in HbA1c of an average of 0.6% to 2.1%. Levemir also lowered fasting blood sugar by an average of 69 mg/dL over 24 weeks. In comparison, people taking insulin NPH had their fasting blood sugar lowered by an average of 74 mg/dL.

For more information on Levemir’s effectiveness, see the “Levemir uses” section.

Levemir generic or biosimilar

Levemir is a biologic drug that’s only available as a brand-name medication. It does not have any biosimilars at this time. Levemir contains the active drug insulin detemir.

A biologic drug is made from parts of living cells. Nonbiologic drugs, on the other hand, are made from chemicals. Nonbiologic drugs have generic versions (exact copies of the active drug in the brand-name form). However, biologics can’t be copied exactly. So, instead of generics, biologic drugs have biosimilars. Biosimilars are considered as safe and effective as the original drug.

Levemir cost

As with all medications, the cost of Levemir can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require a prior authorization before approving coverage for Levemir. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the information and let you and your doctor know if your plan will cover Levemir.

If you’re not sure if you’ll need to get prior authorization for Levemir, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Levemir, or if you need help understanding your insurance coverage, help is available.

Novo Nordisk, the manufacturer of Levemir, offers resources that may help lower the cost of Levemir. For more information and to find out if you’re eligible for support, visit the drug manufacturer’s website.

If you’re not sure if Levemir is covered by your health insurance plan, you can find resources to help on this page.

Some people qualify to receive diabetes treatments without cost. You can check to see if you’re eligible for this assistance by visiting the Novo Nordisk Patient Assistance Program website or calling 866-310-7549.

Levemir vs. Lantus

You may wonder how Levemir compares to other medications that are prescribed for similar uses. Here we look at how Levemir and Lantus are alike and different.

Ingredients

Levemir contains insulin detemir, while Lantus contains insulin glargine.

Uses

Levemir is approved by the Food and Drug Administration (FDA) to lower blood sugar levels in:

• adults and children ages 2 years or older with type 1 diabetes
• adults with type 2 diabetes

Lantus is FDA-approved to lower blood sugar levels in:

• adults and children ages 6 years or older with type 1 diabetes
• adults with type 2 diabetes

Drug forms and administration

Levemir and Lantus both come as a solution (liquid mixture) in a vial. The vials are used with needles, which are sold separately.

Levemir also comes as a prefilled FlexTouch pen. Lantus comes as a SoloStar pen and as a cartridge system for use in an OptiClik pen.

Side effects and risks

Levemir and Lantus can cause very similar side effects. Below are examples of these side effects.

More common side effects

This list contains examples of more common side effects that can occur with both Levemir and Lantus (when taken individually).

• hypoglycemia (low blood sugar)
• hyperglycemia (high blood sugar)
• allergic reaction
• peripheral edema (swelling of the arms, hands, legs, or feet)
• injection site reactions
• lipodystrophy (changes in skin thickness near the injection site)
• upper respiratory infections, such as the common cold
• weight gain

Serious side effects

These lists contain examples of serious side effects that can occur with Lantus or with both Levemir and Lantus (when taken individually).

• Can occur with Lantus
  • hypokalemia (low potassium levels),* which can lead to heart rhythm problems
• Can occur with both Levemir and Lantus:
  • severe hypoglycemia
  • severe hyperglycemia
  • severe allergic reaction

* Some sources state that all forms of insulin, including insulin detemir (Levemir), can cause low potassium levels.

Effectiveness

The use of Levemir and Lantus in treating adults with type 1 diabetes has been directly compared in a clinical study. People who took Levemir twice a day had their hemoglobin A1c (HbA1c) lowered by an average of 0.6%. Those who took Lantus once a day had their HbA1c lowered by an average of 0.5%.

In the clinical study, people who took Levemir had their fasting blood sugar lowered by an average of 38 milligrams per deciliter (mg/dL). Those taking Lantus had their fasting blood sugar lowered by an average of 41 mg/dL.

Costs

Levemir and Lantus are both brand-name drugs. There is currently no biosimilar version of Levemir available.

Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs. Brand-name medications usually cost more than biosimilars.

There is a biosimilar version of Lantus called Basaglar, which is less expensive than Lantus. See the “Levemir vs. Basaglar” section below for details about how these two drugs compare.

Levemir is generally more expensive than Lantus. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Also, Levemir vials are used with insulin syringes, which are sold separately and may require a prescription in certain states.

Levemir dosage

The Levemir dosage your doctor prescribes will depend on several factors. These include:

• the type and severity of the condition you’re using Levemir to treat
• your age or weight
• other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Usage information

Levemir can be taken either once or twice daily. If you have type 1 diabetes, you’ll take it along with a mealtime insulin. If you have type 2 diabetes, you may or may not take Levemir along with a mealtime insulin.

If your doctor prescribes Levemir to be taken once a day, take it with dinner or at bedtime. If they prescribe Levemir to be taken twice a day, take the first dose in the morning. Take the second dose either with dinner, at bedtime, or 12 hours after your morning dose.

Drug forms and strengths

Below we describe the two forms of Levemir and their strengths.

Levemir vial

Levemir comes in a 10-mL vial. For every 1 mL of Levemir, there are 100 units of insulin. Each vial of Levemir contains 1,000 units (or 10 mL) of insulin. If your doctor prescribes you 50 units of insulin, for example, you would draw 0.5 mL of Levemir into your insulin needle to take the dose.

Levemir vials are used with insulin syringes, which are sold separately and may require a prescription in certain states.

Levemir FlexTouch pen

Levemir also comes in a 3-mL FlexTouch pen. For every 1 mL of Levemir, there are 100 units of insulin. Each FlexTouch pen contains 300 units of insulin. The maximum dose that can be given by the Levemir FlexTouch pen is 80 units per injection.

If you need to take more than 80 units in one dose, you can give yourself two injections, one right after the other. These can be given in the same area of your body but not in the exact same spot.

The Levemir FlexTouch pen is used with NovoFine or NovoTwist pen needles, which are sold separately and may require a prescription in certain states.

Dosage for type 1 diabetes

If you’re just starting to use insulin, your Levemir dose should be about one-third of your total daily insulin requirement. The rest of your insulin requirement should come from mealtime insulin.

If you’re switching from another long-acting insulin such as Lantus (insulin glargine) to Levemir, you’ll probably take the same dosage with Levemir as you did with Lantus.

If you’re switching from an intermediate-acting insulin such as insulin NPH to Levemir, you’ll probably take the same dosage with Levemir as you did with insulin NPH. However, you may need to take more Levemir than insulin NPH.

Talk with your doctor if you have questions about what your dosage of Levemir should be.

Dosage for type 2 diabetes

If you’re just starting to use insulin, the recommended starting dose for Levemir is 10 units, or 0.1 to 0.2 units per kilogram (kg)* of body weight. You’ll take Levemir once a day in the evening or divide it into two doses a day. Your doctor or pharmacist will then adjust your dose based on your blood sugar measurements over time.

If you’re switching from another long-acting insulin such as Lantus (insulin glargine) to Levemir, you’ll probably take the same dosage with Levemir as you did with Lantus. Your doctor might have you monitor your blood sugar levels more frequently than usual when you’re switching insulins or when your dosage is adjusted.

If you’re switching from an intermediate-acting insulin such as insulin NPH to Levemir, you’ll probably take the same dosage with Levemir as you did with insulin NPH. However, you may need to take more Levemir than insulin NPH.

Talk with your doctor if you have questions about what your dosage of Levemir should be.

* One kg equals about 2.2 pounds (lb).

Pediatric dosage

If your child is just starting to take insulin, their Levemir dose should be about one-third of their total daily insulin requirement. The rest of their insulin requirement should come from mealtime insulin.

If your child is switching from another long-acting insulin such as Lantus (insulin glargine) to Levemir, they can probably take the same dosage with Levemir as they did with Lantus.

If your child is switching from an intermediate-acting insulin such as insulin NPH to Levemir, they’ll probably take the same dosage with Levemir as they did with insulin NPH. However, they may need to take more Levemir than insulin NPH.

Your child’s doctor will likely recommend monitoring your child’s blood sugar levels more frequently than usual when changing insulins or dosages.

Talk with your doctor if you have questions about what your child’s dosage of Levemir should be.

What if I miss a dose?

If you miss your dose of Levemir, take it as soon as you remember. If you remember close to the time of your next dose, just skip the missed dose and take your next dose at the normal time. Never take a double dose to make up for a missed dose.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Levemir is meant to be used as a long-term treatment. If you and your doctor determine that Levemir is safe and effective for you, you’ll likely take it long term. Your dose of Levemir may change over time.

Levemir side effects

Levemir can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Levemir. These lists do not include all possible side effects.

For more information on the possible side effects of Levemir, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you’ve had with Levemir, you can do so through MedWatch.

More common side effects

The more common side effects of Levemir can include:

• hypoglycemia (low blood sugar)
• hyperglycemia (high blood sugar)
• injection site reactions
• lipodystrophy (changes in skin thickness near the injection site)
• swelling of your hands and feet
• allergic reaction
• weight gain (see “Side effect details” below)

Serious side effects

Serious side effects from Levemir aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects are explained in “Side effect details” below. These include:

• severe hypoglycemia
• severe hyperglycemia
• severe allergic reaction

Side effect details

You may wonder how often certain side effects occur with Levemir. Here’s some detail on a few of the side effects this drug may cause.

Severe hypoglycemia

As with most drugs that lower blood sugar, you may experience severe hypoglycemia (low blood sugar) while taking Levemir. Hypoglycemia may be more likely to develop any time there are changes to your insulin treatment plan.

Symptoms of severe hypoglycemia can include:

• feeling dizzy or faint
• cold sweat
• not being able to concentrate
• loss of consciousness (not being able to respond to sound or touch)
• convulsions

In some cases, you might need another person’s help to reverse your hypoglycemia by eating food or taking medication to raise your blood sugar.

Call your doctor right away if you experience severe hypoglycemia. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Severe hyperglycemia

It’s possible to develop severe hyperglycemia (high blood sugar) with Levemir. Hyperglycemia may be more likely to occur any time there are changes in your insulin treatment plan.

Symptoms of hyperglycemia can include:

• frequent urination
• excessive thirst and hunger
• blurred vision
• headache
• kidney or heart problems, in severe or long-term cases

Call your doctor right away if you’re experiencing severe hyperglycemia. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Levemir. Symptoms of a mild allergic reaction can include:

• skin rash
• itchiness
• flushing

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your tongue, mouth, or throat
• trouble breathing

Call your doctor right away if you have a severe allergic reaction to Levemir. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Weight gain or weight loss

As with most insulin, you may experience weight gain while taking Levemir. In clinical studies, adults with type 1 diabetes who took Levemir gained an average of 0.4 to 1.1 pounds (0.2 to 0.5 kilograms). In comparison, people who took insulin NPH gained 0.7 to 1.8 lb (0.3 to 0.8 kg). Those who took insulin glargine (Lantus) gained an average of 2.2 lb (1 kg).

Patients with type 2 diabetes who took Levemir gained an average of 1.1 to 2.4 lb (0.5 to 1.1 kg), patients who took insulin NPH gained 2.65 to 6.17 lb (1.2 to 2.8 kg).

In general, people who take insulin detemir (the drug in Levemir) tend to gain less weight than people who take other long-acting insulins.

Talk with your doctor if you’re concerned about gaining weight while taking Levemir.

Common questions about Levemir

Here are answers to some frequently asked questions about Levemir.

Is Levemir a long-acting insulin?

Yes, Levemir is a type of long-acting insulin. It works to help keep your blood sugar levels steady over time, including between meals and overnight.

You might also be prescribed a rapid-acting insulin that you’ll use with Levemir, to further help regulate your blood sugar levels as needed.

Your doctor can answer other questions you may have about long-acting insulins such as Levemir.

If I’m using Levemir, can I switch to using Lantus?

Yes, you can switch if your doctor thinks Lantus would work well for you. Both Lantus and Levemir are long-acting insulins that work all day to lower your blood sugar levels. Talk with your doctor or pharmacist if you’re interested in switching to a different insulin.

Your dosage when switching from Levemir to Lantus will depend on whether you took Levemir once or twice a day.

Will I need to use mealtime insulin with Levemir?

Possibly. If you have type 1 diabetes, you’ll take mealtime insulin when using Levemir. If you have type 2 diabetes, you may or may not need to take mealtime insulin when using Levemir. Talk with your doctor if you have questions about whether you should be taking mealtime insulin.

If I’m taking Tresiba, can I switch to Levemir?

Yes, you can switch if your doctor thinks Levemir would work well for you. Both Tresiba and Levemir are long-acting insulins that work all day to lower your blood sugar levels. Talk with your doctor or pharmacist if you’re interested in switching to a different insulin.

Your dosage when switching from Tresiba to Levemir will depend on whether your doctor wants you to take Levemir once or twice a day.

Is it better to take Levemir in the morning or in the evening?

It depends on whether you take Levemir once or twice a day. If your doctor prescribes Levemir to be taken once a day, take it with your dinner or at bedtime.

If your doctor prescribes Levemir to be taken twice a day, take the first dose in the morning. Take the second dose either with dinner, at bedtime, or 12 hours after your morning dose.

Levemir vs. Tresiba

Tresiba has uses similar to those of Levemir. Here’s a comparison of how these drugs are alike and different.

Ingredients

Levemir contains insulin detemir, while Tresiba contains insulin degludec.

Uses

Levemir is used to lower blood sugar in:

• adults and children ages 2 years and older with type 1 diabetes
• adults with type 2 diabetes

Tresiba is used to lower blood sugar in:

• adults and children ages 1 year and older with type 1 diabetes
• adults and children ages 1 year and older with type 2 diabetes

Drug forms and administration

Levemir and Tresiba both come as a solution (liquid mixture) in a vial. They both also come as a FlexTouch pen. The needles used with Levemir and Tresiba are sold separately.

Levemir and Tresiba can both be injected subcutaneously in the thigh, abdomen, or upper arm. You should rotate where you give yourself the injection to lower your risk of your skin scarring or thickening.

Side effects and risks

Levemir and Tresiba both contain long-acting insulins. Therefore, they can cause very similar side effects. Below are examples of these side effects.

More common side effects

This list contains examples of more common side effects that can occur with both Levemir and Tresiba (when taken individually).

• hypoglycemia (low blood sugar)
• hyperglycemia (high blood sugar)
• allergic reaction
• injection site reactions
• lipodystrophy (changes in skin thickness near the injection site)
• weight gain
• peripheral edema (swelling of the arms, hands, legs, or feet)

Serious side effects

These lists contain examples of serious side effects that can occur with Tresiba and with both Levemir and Tresiba (when taken individually).

• Can occur with Tresiba:
  • hypokalemia (low potassium levels),* which can lead to heart rhythm problems
• Can occur with both Levemir and Tresiba:
  • severe hypoglycemia
  • severe hyperglycemia
  • severe allergic reaction

* Some sources state that all forms of insulin, including insulin detemir (Levemir), can cause low potassium levels.

Effectiveness

A clinical study compared Levemir and Tresiba, each used alongside Novolog (insulin aspart), to treat type 1 diabetes in adults. After 26 weeks, people taking Levemir had their hemoglobin A1c (HbA1c) lowered by an average of 0.61%. People taking Tresiba had their HbA1c lowered by an average of 0.71%.

In the study, people taking Levemir had their fasting blood sugar lowered by an average of 13.5 mg/dL. Those taking Tresiba had their fasting blood sugar lowered by an average of 43.3 mg/dL.

A clinical study also compared Levemir and Tresiba, each used alongside Novolog (insulin aspart), to treat type 1 diabetes in children ages 1 to 17 years old. After 26 weeks, children taking Levemir had their HbA1c lowered by an average of 0.34%. Those taking Tresiba had their HbA1c lowered by an average of 0.19%.

In the study, children taking Levemir had their fasting blood sugar lowered by an average of 59.6 mg/dL. Those taking Tresiba had their fasting blood sugar lowered by an average of 52 mg/dL.

Costs

Levemir and Tresiba are both brand-name drugs. There are currently no biosimilar forms of either drug.

Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs. Brand-name medications usually cost more than biosimilars.

Levemir is generally less expensive than Tresiba. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Alternatives to Levemir

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Levemir, talk with your doctor. They can tell you about other medications that may work well for you.

Alternatives for treating type 1 or type 2 diabetes

Examples of other drugs that may be used to lower blood sugar levels in people with type 1 or type 2 diabetes include these long-acting insulins:

• insulin glargine (Lantus, Basaglar, Toujeo)
• insulin degludec (Tresiba)

Levemir uses

The Food and Drug Administration (FDA) approves prescription drugs such as Levemir to treat certain conditions.

Levemir for type 1 diabetes

Levemir is approved to lower blood sugar levels in adults and children ages 2 years and older with type 1 diabetes.

Levemir has not been studied in children younger than 2 years of age with type 1 diabetes.

About type 1 diabetes

Type 1 diabetes is a chronic (long-term) disease. If you have type 1 diabetes, your body can’t make insulin (or can’t make enough of it). Your body needs insulin to allow glucose (sugar) to enter your cells, which then convert the sugar into energy.

Everyone with type 1 diabetes has to take insulin. Levemir is a type of insulin called basal insulin. It works over a longer period of time to maintain a steady level of insulin in your body.

If you have type 1 diabetes, you’ll take mealtime insulin as needed to cover the rise in your blood sugar after meals. You’ll do this along with taking Levemir either once or twice a day to maintain steady insulin levels.

Talk with your doctor about how often you should check your blood sugar. Your blood sugar measurements are averaged over a period of about 3 months to find your hemoglobin A1c (HbA1c) level.

Effectiveness

In clinical studies, adults with type 1 diabetes who took Levemir had their hemoglobin A1c (HbA1c) lowered by an average of 0.1% to 0.8%. In comparison, adults who took insulin NPH (an intermediate-acting insulin) or insulin glargine (Lantus) had their HbA1c lowered by an average of 0% to 0.7%.

Levemir lowered their fasting blood sugar by an average of 30 to 44 mg/dL over 16 to 24 weeks. Adults taking insulin NPH had their fasting blood sugar lowered by an average of 9 mg/dL. In comparison, people taking insulin glargine (Lantus) had their fasting blood sugar lowered by an average of 41 mg/dL.

Levemir for type 2 diabetes

Levemir is approved to lower blood sugar levels in adults with type 2 diabetes.

Levemir has not been studied in any children younger than 18 years of age with type 2 diabetes.

About type 2 diabetes

Type 2 diabetes is a chronic (ongoing) disease. If you have this condition, sugar levels build up in your bloodstream. This is because your body’s cells can’t respond to insulin like they should.

Your body might also produce less insulin than you need to maintain healthy blood sugar levels. Insulin is needed to allow sugar to enter your cells, which then convert the sugar into energy.

If you’re diagnosed with type 2 diabetes, you probably won’t start taking insulin right away. Instead, you’ll most likely take oral diabetes medications or other types of injectable medications to manage your blood sugar. But over time, as your body adapts and changes, you may need insulin to keep your blood sugar well managed.

What Levemir does

Levemir is a type of insulin called basal insulin. It works over a longer period of time to maintain a steady level of insulin in your body. If you have type 2 diabetes, you may or may not take a mealtime insulin along with Levemir.

Talk with your doctor about how often you should check your blood sugar. Your blood sugar measurements are averaged over a period of about 3 months to find your HbA1c level.

Effectiveness

In clinical studies, adults with type 2 diabetes taking Levemir had their HbA1c lowered by an average of 0.6% to 2%. In comparison, people who took insulin NPH saw a reduction in HbA1c of an average of 0.6% to 2.1%. Levemir also lowered fasting blood sugar by an average of 69 mg/dL over 24 weeks. In comparison, people taking insulin NPH had their fasting blood sugar lowered by an average of 74 mg/dL.

Levemir and children

Levemir can be used to improve blood sugar in children with type 1 diabetes who are at least 2 years old.

In clinical trials, children and teenagers ages 6 to 17 years old with type 1 diabetes took Levemir. The results were as follows:

• Their HbA1c ranged from being raised by an average of 0.3% to being lowered by an average of 0.7%.
• Their fasting blood sugar went down an average of 10 mg/dL to 39 mg/dL.
• They gained an average of 3.5 lb (1.6 kg) to 6 lb (2.7 kg).

In these clinical trials, children and teenagers ages 6 to 17 years old who took insulin NPH had the following results:

• Their HbA1c ranged from being raised by an average of 0.2% to being lowered by an average of 0.8%.
• Their fasting blood sugar went down by an average of 0 mg/dL to 21 mg/dL.
• They gained an average of 6 lb (2.7 kg) to 8 lb (3.6 kg).

Levemir has not been studied in children younger than 2 years of age with type 1 diabetes. It also hasn’t been studied in any children younger than 18 years of age with type 2 diabetes.

Levemir use with other drugs

You may be prescribed other drugs to take with Levemir.

Levemir use with mealtime insulins (Humalog, Novolog, and Fiasp)

You can use Levemir with mealtime insulins if you need help lowering your blood sugar quickly after each meal. Mealtime insulins currently available include Novolog (insulin aspart), Fiasp (faster acting insulin aspart), and Humalog (insulin lispro).

Levemir use with metformin

If you have type 2 diabetes, you can use Levemir along with metformin to help improve your blood sugar levels.

Levemir use with GLP-1 RAs (Victoza, Ozempic, Trulicity, Bydureon)

Levemir can be used with drugs called glucagon-like peptide-1 receptor agonists. These include Victoza (liraglutide), Ozempic (semaglutide), Trulicity (dulaglutide), or Bydureon (exenatide).

Levemir vs. Basaglar

Levemir and Basaglar are prescribed for similar uses. Here’s a comparison of how these drugs are alike and different.

Ingredients

Levemir contains insulin detemir, while Basaglar contains insulin glargine.

Basaglar is a biosimilar of Lantus (insulin glargine). A biosimilar is a medication that’s similar to a brand-name drug. A generic medication is an exact copy of a brand-name drug. Both biosimilars and generics are as safe and effective as the brand-name drug they’re trying to copy.

Uses

Levemir is used to lower blood sugar in:

• adults and children ages 2 years or older with type 1 diabetes
• adults with type 2 diabetes

Basaglar is used to lower blood sugar levels in:

• adults and children ages 6 years or older with type 1 diabetes
• adults with type 2 diabetes

Drug forms and administration

Levemir and Basaglar both come as a solution (liquid mixture) in a vial. The needles used with these vials are sold separately. Levemir also comes as a prefilled FlexTouch pen, and Basaglar comes as a prefilled KwikPen.

Levemir and Basaglar can both be injected subcutaneously in the thigh, abdomen, or upper arm. You should rotate where you give yourself the injection to lower your risk of your skin scarring or thickening.

Side effects and risks

Levemir and Basaglar can cause very similar side effects. Below are examples of these side effects.

More common side effects

This list contains examples of more common side effects that can occur with Levemir or Basaglar (when taken individually).

• hypoglycemia (low blood sugar)
• hyperglycemia (high blood sugar)
• allergic reaction
• injection site reactions
• lipodystrophy (changes in skin thickness near the injection site)
• weight gain
• peripheral edema (swelling of the arms, hands, legs, or feet)

Serious side effects

These lists contain examples of serious side effects that can occur with Basaglar or with both Levemir and Basaglar (when taken individually):

• Can occur with Basaglar:
  • hypokalemia (low potassium levels),* which can lead to heart rhythm problems
• Can occur with both Levemir and Basaglar:
  • severe hypoglycemia
  • severe hyperglycemia
  • severe allergic reaction

* Some sources state that all forms of insulin, including insulin detemir (Levemir), can cause low potassium levels.

Effectiveness

Levemir and Basaglar haven’t been directly compared in clinical studies, but studies have found both drugs to be effective for treating diabetes.

Costs

Levemir is a brand name drug, while Basaglar is a biosimilar drug of the long-acting insulin Lantus. There are currently no generic or other biosimilar forms of either drug.

Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs. Brand-name medications usually cost more than biosimilars or generics.

Levemir is significantly more expensive than Basaglar. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

How Levemir works

Levemir helps improve blood sugar levels in adults and children ages 2 years old and older with type 1 diabetes. It’s also approved for adults with type 2 diabetes.

How diabetes affects blood sugar

Diabetes is a chronic (ongoing) disease. If you have type 1 diabetes, your body can’t make insulin (or can’t make enough of it). Your body needs insulin to allow glucose (sugar) to enter your cells, which then convert the sugar into energy.

If you have type 2 diabetes, your body’s cells can’t respond to insulin like they should. Your body might also produce less insulin than you need to maintain healthy blood sugar levels.

If your cells don’t get enough glucose, they may not work properly. If glucose can’t enter your cells, it can also result in too much sugar in the blood. Over time, this can damage your nerves and certain organs, including your eyes, heart, and kidneys.

What Levemir does

Levemir is a type of insulin called basal insulin. It works over a longer duration (period of time) to maintain a steady level of insulin in your body. It does this by moving glucose from your bloodstream into your cells. This helps keep your blood sugar levels from getting too high. This is Levemir’s mechanism of action (the way the drug works in your body.)

How long does it take to work?

Levemir begins to work almost immediately after you inject it, but it reaches its full effect about 6 to 8 hours after you inject it.

Levemir is a long-acting insulin, which means it helps maintain steady levels of insulin in your body. You shouldn’t take it to quickly lower your blood sugar after a meal.

How to use Levemir

You should take Levemir according to your doctor’s or healthcare professional’s instructions.

Your doctor, nurse, or pharmacist will show you how to inject Levemir using either the Levemir vial with an insulin needle or the FlexTouch pen. Please refer to the instructions for use for detailed instructions on how to inject Levemir.

Be sure to monitor your blood sugar levels as often as directed by your doctor while you’re using Levemir.

When to take

Typically, you’ll give yourself Levemir injections either once or twice a day.

• If your doctor prescribes Levemir to be taken once a day, take it with your dinner or at bedtime.
• If your doctor prescribes Levemir to be taken twice a day, take the first dose in the morning. Take the second dose either with dinner, at bedtime, or 12 hours after your morning dose.

Medication reminders can help make sure that you don’t miss a dose.

Where to inject

You can inject Levemir subcutaneously in your thigh, abdomen (belly), or upper arm. You should rotate where you give yourself the injection to lower your risk of your skin scarring or thickening. For example, use a different place on your abdomen for each injection.

It’s important not to inject Levemir into areas of damaged skin. This includes thickened or scarred skin.

If you change your injection site (such as from your abdomen to your thigh), your doctor may recommend monitoring your blood sugar levels more often than usual for a while. This is because changing injection sites can increase your risk of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Injecting the drug into damaged skin can also increase the risk of these conditions.

Taking Levemir with food

Levemir can be taken with or without food. Talk with your doctor about whether it’s best for you to take it with a meal or at another time.

Levemir vs. Toujeo

You may wonder how Levemir compares to other medications that are prescribed for similar uses. Here we look at how Levemir and Toujeo are alike and different.

Ingredients

Levemir contains insulin detemir, while Toujeo contains insulin glargine.

Uses

Levemir is used to lower blood sugar in:

• adults and children ages 2 years and older with type 1 diabetes
• adults with type 2 diabetes

Toujeo is used to lower blood sugar in:

• adults with type 1 diabetes
• adults with type 2 diabetes

Drug forms and administration

Levemir comes as a solution (liquid mixture) in a vial. It also comes as a FlexTouch pen. The needles used with Levemir are sold separately.

Toujeo comes as a SoloStar pen or as a Max SoloStar pen. Both types of pens require pen needles, which are sold separately.

Levemir and Toujeo can be injected subcutaneously in the thigh, abdomen, or upper arm. You should rotate where you give yourself the injection to lower your risk of your skin scarring or thickening.

Side effects and risks

Levemir and Toujeo both contain long-acting insulin. Therefore, they can cause very similar side effects. Below are examples of these side effects.

More common side effects

This list contains examples of more common side effects that can occur with both Levemir and Toujeo (when taken individually).

• hypoglycemia (low blood sugar)
• hyperglycemia (high blood sugar)
• allergic reaction
• injection site reactions
• lipodystrophy (changes in skin thickness near the injection site)
• weight gain
• peripheral edema (swelling of the arms, hands, legs, or feet)
• upper respiratory infections, such as the common cold

Serious side effects

These lists contain examples of serious side effects that can occur with Toujeo or with both Levemir and Toujeo (when taken individually).

• Can occur with Toujeo:
  • hypokalemia (low potassium levels),* which can lead to heart rhythm problems
• Can occur with both Levemir and Toujeo:
  • severe hypoglycemia
  • severe hyperglycemia
  • severe allergic reaction

* Some sources state that all forms of insulin, including insulin detemir (Levemir), can cause low potassium levels.

Effectiveness

Levemir and Toujeo haven’t been directly compared in clinical studies, but studies have found both drugs to be effective for lowering blood sugar levels in people with diabetes.

Costs

Levemir and Toujeo are both brand-name drugs. There are currently no biosimilar forms of either drug.

Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs. Brand-name medications usually cost more than biosimilars.

Levemir generally costs more than Toujeo. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Levemir expiration, storage, and disposal

When you get Levemir from the pharmacy, the pharmacist will add an expiration date to the bottle’s label. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage and refrigeration

How long a medication remains good can depend on many factors, including how and where you store the medication.

The Levemir vial and FlexTouch pen should be stored in the refrigerator (36°F to 46°F/2°C to 8°C) until the expiration date. Do not freeze. If frozen, do not use the drug.

If your Levemir vial or pen is kept out of the refrigerator, it’s only good for 42 days. This is the case even if you haven’t opened the vial or pen yet.

After opening or using a Levemir pen, you should keep the pen at room temperature (below 86°F/30°C). It’s good for up to 42 days after opening. Do not put your opened FlexTouch pen back in the refrigerator after initial use.

After you open a Levemir vial, it can be kept in the refrigerator or at room temperature. Either way, the solution is good for up to 42 days after it’s been opened.

Do not store the Levemir FlexTouch pen with a needle attached. Always remove the needle before storing the pen.

Disposal

If you no longer need to take Levemir and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

Levemir interactions

Levemir can interact with several other medications. Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Levemir and other medications

Below is a list of medications that can interact with Levemir. This list does not contain all drugs that may interact with Levemir.

Before taking Levemir, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Levemir and other diabetes drugs

Levemir can interact with certain diabetes drugs.

Levemir and thiazolidinediones

Taking Levemir with a thiazolidinedione (a class of diabetes drugs) may cause fluid retention and heart failure. If you already have heart failure, taking the two drugs together can make your condition worse.

Before you start using Levemir, tell your doctor if you take a thiazolidinedione. Examples of thiazolidinedione drugs include pioglitazone hydrochloride (Actos) and rosiglitazone maleate (Avandia).

If you take Levemir with a thiazolidinedione, your doctor will monitor you closely for symptoms of heart failure due to fluid retention. They may also recommend that you take different medication so you aren’t taking Levemir with a thiazolidinedione.

Levemir and certain other diabetes drugs

Taking Levemir with certain other diabetes medications may cause hypoglycemia (low blood sugar). To avoid this interaction, you and your doctor will need to carefully monitor your blood sugar when you take Levemir with these diabetes medications.

Examples of diabetes medications that may lower blood sugar if taken with Levemir include:

• metformin (Glucophase)
• glipizide (Glucotrol)
• liraglutide injection (Victoza)
• pioglitazone hydrochloride (Actos)
• pramlintide acetate (Symlin)

If you need to take another diabetes drug with Levemir, talk with your doctor to find a combination that’s safe for you.

Levemir and certain heart or blood pressure drugs

Taking Levemir with certain heart or blood pressure drugs may increase the effects of Levemir. This could cause low blood sugar. Examples of these drugs include:

• lisinopril (Zestril, Prinivil)
• captopril (Capoten)
• enalapril (Vasotec)
• benazepril (Lotensin)

Taking Levemir with other types of heart drugs may have an unpredictable effect on the effects of Levemir. These drugs may also mask or reduce the signs of low blood sugar. Examples of these heart medications include:

• metoprolol (Toprol)
• nadolol (Corgard)
• atenolol (Tenormin)
• carvedilol (Coreg)
• clonidine (Catapres)

Talk with your doctor if you need to take heart or blood pressure medications with Levemir.

Levemir and certain antibiotics

Taking Levemir with certain antibiotic drugs may increase the effects of Levemir. This could cause low blood sugar. Examples of these drugs include:

• sulfamethoxazole/trimethoprim (Bactrim)
• zonisamide (Zonegran)
• sulfisoxazole (Gantrisin)

If you need to take an antibiotic, talk with your doctor to find one that’s safe to take with Levemir.

Levemir and certain drugs for growth disorders

Taking certain drugs used for growth disorders may increase the effects of Levemir. This could cause low blood sugar. Examples of these drugs include:

• octreotide (Sandostatin)
• lanreotide (Somatuline)
• pasireotide (Signifor)

If you need to take this type of drug with Levemir, talk with your doctor to find a safe option.

Levemir and certain drugs for circulation

Taking Levemir with certain drugs that help with blood flow or clotting may increase the effects of Levemir. This could cause low blood sugar. Examples of these drugs include:

• pentoxifylline (Trental, Pentoxil)
• aspirin

Talk with your doctor if you need to take a drug for circulation along with Levemir.

Levemir and certain steroids

Taking Levemir with certain steroids may decrease the effects of Levemir. This could cause hyperglycemia (high blood sugar). Examples of these steroids include:

• prednisone (Deltasone)
• hydrocortisone (Cortef)
• methylprednisolone (Medrol)

Talk with your doctor if you need to take a steroid while using Levemir.

Levemir and certain diuretics

Taking Levemir with certain diuretics (water pills) may decrease the effects of Levemir. This could cause high blood sugar. Examples of these diuretics include:

• hydrochlorothiazide (Microzide)
• furosemide (Lasix)

Talk with your doctor if you need to take a diuretic with Levemir.

Levemir and certain allergy or asthma drugs

Taking Levemir with certain drugs used for allergy attacks or asthma attacks may decrease the effects of Levemir. This could cause high blood sugar. Examples of these drugs include:

• epinephrine (EpiPen)
• albuterol (ProAir, Ventolin)
• terbutaline (Bricanyl)

If you need to take an allergy or asthma drug, talk with your doctor to find one that’s safe to take with Levemir.

Levemir and certain hormone therapies

Taking Levemir with certain hormone therapies may decrease the effects of Levemir. This could cause high blood sugar. Examples of these hormone therapies include:

• thyroid hormones, such as levothyroxine
• hormones found in female contraceptives, such as estrogen or progestogen

If you need to take a hormone therapy with Levemir, talk with your doctor about your options.

Levemir and certain psychiatric drugs

Taking Levemir with certain psychiatric medications may decrease the effects of Levemir. This could cause high blood sugar. Examples of these drugs include:

• olanzapine (Zyprexa)
• clozapine (Clozaril, FazaClo)

If you need to take a psychiatric drug, talk with your doctor to find one that’s safe to take with Levemir.

Levemir and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Levemir. However, you should still check with your doctor or pharmacist before using any of these products while taking Levemir.

Levemir and alcohol

There is no known interaction between Levemir and alcohol. However, drinking too much alcohol while taking Levemir can increase your risk for hypoglycemia (low blood sugar). This is because both alcohol and Levemir can lower your blood sugar levels on their own.

If you drink alcohol, talk with your doctor about how much alcohol is safe to drink while you’re taking Levemir.

Levemir and pregnancy

Levemir is considered safe to use during pregnancy. Levemir has been studied in females* who were 8 to 12 weeks pregnant. In the study, Levemir did not increase the risk of harm to the fetus.

However, having diabetes may raise the risk of congenital anomalies (commonly known as birth defects), pregnancy loss, and other pregnancy-related side effects.

If you’re pregnant or planning to become pregnant while taking Levemir, talk with your doctor about the risks and benefits. Your body’s insulin requirements may change during pregnancy. If you’ll be using Levemir, your dosage may need to be different during your pregnancy.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Levemir and birth control

Levemir has been studied in females* who were 8 to 12 weeks pregnant. In the study, Levemir did not increase the risk of harm to the fetus. If you are sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Levemir.

* Sex and gender exist on spectrums. Use of the term “female” in this article refers to sex assigned at birth.

Levemir and breastfeeding

There isn’t enough information available to know whether Levemir passes into breast milk. However, other types of insulin, like human insulin, have been found in breast milk.

Talk with your doctor if you’re taking Levemir and are breastfeeding or plan to breastfeed.

Levemir precautions

Before taking Levemir, talk with your doctor about your health history. Levemir may not be right for you depending on certain factors, including some medical conditions. These include:

• Kidney problems. If you have a history of kidney problems, such as your kidneys not filtering your blood as well as they used to, you may be more sensitive to Levemir. Your doctor will monitor your blood sugar and may adjust your Levemir dosage if necessary.
• Liver problems. If you have a history of liver problems, such as your liver not filtering your blood as well as it used to, you may be less sensitive to Levemir. Your doctor will monitor your blood sugar and may adjust your Levemir dosage if necessary.
• Hyperglycemia or hypoglycemia. As with all diabetes drugs, it’s possible to develop hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). In some cases, these conditions can be severe. Hyperglycemia or hypoglycemia are more likely to occur any time there are changes to your insulin treatment plan. This includes starting a new type of insulin and having changes made to your Levemir dosage. These conditions are also more likely if you inject Levemir into damaged skin or if you use a new injection site. Your doctor might recommend monitoring your blood sugar levels more often at certain times during your treatment. Be sure to follow their instructions for monitoring your blood sugar levels.
• Pregnancy. Levemir is considered safe to use during pregnancy. For more information, see the “Levemir and pregnancy” section above.
• Breastfeeding. There isn’t enough information available to know whether Levemir passes into breast milk. For more information, see the “Levemir and breastfeeding” section above.

Note: For more information about the potential negative effects of Levemir, see the “Levemir side effects” section above.

Levemir overdose

Using more than the recommended dosage of Levemir can lead to serious side effects, such as severe hypoglycemia (low blood sugar). Call your doctor right away if you have severe hypoglycemia.

What to do in case of overdose

Call your doctor if you think you’ve taken too much of this drug. You can also call the American Association of Poison Control Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

It’s important to tell your friends and family about the symptoms of severe hypoglycemia. One of the possible side effects is loss of consciousness (not being able to respond to sound or touch). Therefore, your friends and family should know what symptoms to look for and how to help.

A medication called glucagon comes as an injection that can be given in an emergency to raise your blood sugar very quickly. Teach your friends and family how to give you a glucagon injection in case you experience severe hypoglycemia.

If you take Levemir, you should also have a prescription for glucagon. Always carry glucagon with you in case your blood sugar levels get dangerously low.