Insulin detemir
The basal insulin that binds to albumin, with less weight gain and a place in pregnancy
Insulin detemir carries a fatty acid that binds albumin in the blood, slowing its action. Approved in 2005, its distinguishing findings are less weight gain than other basal insulins and a body of evidence in pregnancy.
What is it?
Detemir's modification is a fatty acid that makes it stick reversibly to albumin: more than 98% of it in the blood is bound at any moment and released gradually. That is a different route to a long action from glargine's precipitation or degludec's chains, and its label lists a terminal half-life of 5 to 7 hours with peak levels 6 to 8 hours after injection, which is why some people need it twice a day.
Against glargine in a basal-bolus regimen, both controlled blood sugar, both achieved clinically significant HbA1c reductions, and detemir produced significantly less weight gain at comparable basal doses, with 87.4% of detemir patients staying on once-daily dosing. Against NPH in type 1 diabetes, it lowered weight while NPH raised it, and brain imaging showed a smaller response to food pictures, one proposed explanation for its weight advantage.
Degludec, which lasts longer, has since edged it out: over a year in type 1 diabetes, degludec caused a third fewer night-time lows at similar HbA1c. Switching between basal insulins is not risk-free even at equal units; in one hospital crossover, several patients had low blood sugar in the first days after moving from glargine to detemir.
Pregnancy is where it has a particular place. A randomised trial found it non-inferior to NPH insulin for gestational and type 2 diabetes in pregnancy, with no differences in perinatal outcomes or maternal weight gain, and a later comparison in type 1 pregnancy found degludec non-inferior to detemir. A trial in adolescents with type 2 diabetes could not recruit enough patients to answer its question.
How the dose is raised matters as much as the starting dose: a simple rule adjusting by 3 units every few days lowered HbA1c as well as a stepped rule, with fewer hypoglycaemia events. Outside diabetes, an intranasal form improved memory in a small three-week trial in mild cognitive impairment, an experimental use.
Novo Nordisk announced in 2023 that it is discontinuing Levemir, so availability should be checked before starting it.
Mechanism of Action
Insulin detemir is a basal insulin made long-acting by a fatty acid that binds it to albumin.
Albumin binding
A myristic acid side chain binds albumin; more than 98% of circulating detemir is albumin-bound (label 12.3).
Insulin receptor
Acts at the insulin receptor to lower glucose by increasing uptake in muscle and fat and suppressing liver glucose output.
Once or twice daily
Peak levels at 6 to 8 hours and a terminal half-life of 5 to 7 hours, dose-dependent (label 12.3).
Published Research
These are the trials in people, read from their PubMed abstracts: comparisons against glargine, NPH and degludec.
Against glargine, with less weight gain
In a randomised basal-bolus trial in type 2 diabetes, detemir and glargine were both effective and safe, with clinically significant HbA1c reductions in both arms but significantly less weight gain with detemir at comparable basal doses. Most detemir patients, 87.4%, stayed on once-daily dosing.
In pregnancy, against NPH
In a randomised controlled trial in pregnant women with gestational or type 2 diabetes, detemir was non-inferior to NPH insulin, with no significant difference in the primary outcome on intention-to-treat, and no differences in perinatal outcomes or maternal weight gain.
Degludec was non-inferior to it in type 1 pregnancy
In pregnant women with type 1 diabetes, insulin degludec with insulin aspart was non-inferior to detemir with aspart, with no additional safety issues observed.
Compared again in pregnancy
In 108 pregnant women with diabetes, a Bayesian analysis gave an 87% probability that detemir reduced the composite neonatal outcome against NPH (adjusted relative risk 0.88).
How the glargine comparison was designed
The design and baseline paper of a 973-patient trial of glargine against detemir: about 30% reported suboptimal well-being and 9.3% scored for depression before starting insulin.
Two titration rules
In 46 people with type 2 diabetes starting once-daily detemir, a simple 3-0-3 titration rule and a 2-4-6-8 rule lowered HbA1c equally (-0.9%) over 20 weeks, with fewer hypoglycaemia events on the simpler rule (807 against 1,427 per 100 patient-years).
Against degludec over a year
In adults with type 1 diabetes on mealtime aspart, degludec once daily gave 33% fewer nocturnal hypoglycaemia events than detemir once or twice daily over a year (rate ratio 0.67), with similar HbA1c.
Weight and the brain's food response
In a 32-patient crossover in type 1 diabetes, 12 weeks of detemir lowered weight by 0.8 kg while NPH raised it by 0.5 kg, with similar glucose control; on detemir, insula activation to food pictures was lower and cerebrospinal fluid insulin higher.
In hospital, and switching from glargine
In a crossover trial in hospitalised people with type 2 diabetes, once-daily detemir and glargine reached fasting glucose targets in similar time at similar doses; after switching from glargine to detemir, six hypoglycaemia events occurred in the first three days, one severe.
Intranasal detemir and memory
In 60 adults with mild cognitive impairment or Alzheimer's disease, 21 days of 40 IU intranasal detemir improved a memory composite against placebo. Intranasal use is experimental and not a labelled route.
Young people with type 2 diabetes
A phase 3 trial of detemir against NPH in children aged 10 to 17 with type 2 diabetes stopped after 42 patients, 12% of its target, because recruitment was too slow to answer the question.
Dosing Data
Levemir is injected under the skin once daily with the evening meal or at bedtime, or twice daily, and titrated to blood glucose.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Side Effects & Contraindications
Reported Side Effects
The risks of any basal insulin, with one distinguishing finding.
Contraindications & Cautions
Standard for basal insulin.
Legal Status
An approved basal insulin.
Frequently Asked Questions
?How does detemir last longer?
A fatty acid lets it bind reversibly to albumin in the blood, so most of the dose is held and released gradually.
?How does it compare with glargine?
In a randomised basal-bolus trial both were effective, with significantly less weight gain on detemir at comparable basal doses.
?Is it used in pregnancy?
It was non-inferior to NPH insulin in a randomised trial in gestational and type 2 diabetes in pregnancy, with no differences in perinatal outcomes.
?Is it still available?
Its manufacturer has announced discontinuation in the United States, so availability should be checked locally.
?Why do some people take it twice a day?
Its action can wane before 24 hours: the label lists a terminal half-life of 5 to 7 hours and peak levels at 6 to 8 hours, and allows once- or twice-daily dosing.
?Can I switch from glargine unit for unit?
The label allows a unit-for-unit switch from glargine or NPH, with closer glucose monitoring; in one hospital study some patients had lows in the first days after switching.
References
- [pubmed] Raskin P, et al. "Comparison of insulin detemir and insulin glargine using a basal-bolus regimen in a randomized, controlled clinical study in patients with type 2 diabetes." Diabetes Metab Res Rev, 2009;25(6):542-8. PMID: 19565569.
- [pubmed] Herrera KM, et al. "Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes." Am J Obstet Gynecol, 2015;213(3):426.e1-7. PMID: 26070699.
- [pubmed] Mathiesen ER, et al. "Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial." Lancet Diabetes Endocrinol, 2023;11(2):86-95. PMID: 36623517.
- [pubmed] Fishel Bartal M, et al. "Detemir vs neutral protamine Hagedorn insulin for diabetes mellitus in pregnancy: a comparative effectiveness, randomized controlled trial." Am J Obstet Gynecol, 2021;225(1):87.e1-87.e10. PMID: 33865836.
- [pubmed] Swinnen SG, et al. "Rationale, design, and baseline data of the insulin glargine (Lantus) versus insulin detemir (Levemir) Treat-To-Target (L2T3) study: A multinational, randomized noninferiority trial of basal insulin initiation in type 2 diabetes." Diabetes Technol Ther, 2009;11(11):739-43. PMID: 19905891.
- [pubmed] Havelund S, et al. "The mechanism of protraction of insulin detemir, a long-acting, acylated analog of human insulin." Pharm Res, 2004;21(8):1498-504. PMID: 15359587.
- [fda-pi] FDA. Levemir (insulin detemir) prescribing information. Novo Nordisk.
- [manufacturer] Novo Nordisk. Announcement: discontinuation of Levemir globally, December 2023.
- [clinical-trial] Yu HM, et al. "Comparison of the Efficacy and Safety of Insulin Detemir Administered Once Daily According to Two Titration Algorithms (3-0-3 and 2-4-6-8) in Patients with Type 2 Diabetes Mellitus." Endocrinol Metab (Seoul), 2020;35(1):142-148. PMID: 32207274.
- [clinical-trial] Davies M, et al. "Comparison of insulin degludec with insulin detemir in type 1 diabetes: a 1-year treat-to-target trial." Diabetes Obes Metab, 2016;18(1):96-9. PMID: 26435472.
- [clinical-trial] van Golen LW, et al. "Effects of insulin detemir and NPH insulin on body weight and appetite-regulating brain regions in human type 1 diabetes: a randomized controlled trial." PLoS One, 2014;9(4):e94483. PMID: 24739875.
- [clinical-trial] Zhang T, et al. "Comparison of the Efficacy and Safety of Insulin Detemir and Insulin Glargine in Hospitalized Patients with Type 2 Diabetes: A Randomized Crossover Trial." Adv Ther, 2016;33(2):178-85. PMID: 26809253.
- [clinical-trial] Claxton A, et al. "Long-acting intranasal insulin detemir improves cognition for adults with mild cognitive impairment or early-stage Alzheimer's disease dementia." J Alzheimers Dis, 2015;44(3):897-906. PMID: 25374101.
- [clinical-trial] Wheeler MD, et al. "A 26-week, randomized trial of insulin detemir versus NPH insulin in children and adolescents with type 2 diabetes (iDEAt2)." Eur J Pediatr, 2018;177(10):1497-1503. PMID: 30014302.
- [fda-pi] Levemir (insulin detemir) injection US prescribing information (Novo Nordisk; DailyMed set 82192527, effective October 9, 2024), sections 2.2-2.4 and 12.3; read through openFDA October 6, 2026.
Sources & Citations
Studies were read from their PubMed abstracts; the Levemir label from DailyMed (set 82192527, effective October 9, 2024) through openFDA, read October 6, 2026.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.