Insulin Detemir

What it is

Insulin detemir is a human insulin molecule made in yeast and then chemically altered: a fatty acid chain is attached so the molecule binds reversibly to albumin in the blood and is released slowly. The result is a clear, colourless solution injected under the skin, with a flat action profile lasting up to about 24 hours and no pronounced peak. It is a basal insulin, which means it covers the body's background insulin need rather than meals; in type 1 diabetes the label requires a rapid- or short-acting insulin alongside it. It is sold as Levemir and is not recommended for treating diabetic ketoacidosis.

What the research says

What is well established is that it lowers blood glucose, and that in randomised trials it reaches the same HbA1c as NPH insulin while causing less hypoglycaemia - particularly overnight - and less weight gain. What is not established is any effect on the things people care about most. The Cochrane review of long-acting analogues against NPH rated the hypoglycaemia benefit low to very low certainty, put the absolute reduction in serious hypoglycaemia at roughly one person in a hundred, and found the trials gave too little information on death, heart and kidney and eye complications or quality of life to say anything. Against insulin glargine it is a draw, with slightly more injection site reactions and slightly less weight gain. Hypoglycaemia is the main harm.

Evidence grade: Well established.

How it works

Drug class: Long-acting (basal) human insulin analogue

Insulin detemir acts on the insulin receptor exactly as the body's own insulin does: it makes muscle and fat tissue take glucose out of the blood and it stops the liver from releasing glucose. It also blocks the breakdown of fat and protein. The fatty-acid side chain makes it stick to albumin, which slows its absorption from the injection site, so one or two injections a day give a steady background level with no pronounced peak. (Source 1)

What it is used for

• Trials in type 1 diabetes show insulin detemir controls glucose at least as well as NPH insulin with less major and nocturnal hypoglycaemia and less weight gain. It cannot be used alone: the label states a rapid- or short-acting insulin must be given with it. Evidence: established. (Source 2)
• Added to oral drugs it lowers HbA1c as much as NPH with less hypoglycaemia and less weight gain. The Cochrane review stresses that the absolute reduction in serious hypoglycaemia is about one person in a hundred, the certainty is low, and the trials did not show any effect on death or diabetes complications. Evidence: established. (Source 3)
• Randomised trials in pre-existing type 1 diabetes and in gestational or type 2 diabetes in pregnancy found insulin detemir non-inferior to NPH, with lower fasting glucose and in pooled analysis fewer maternal hypoglycaemic events. The pooled authors say the evidence is still not enough to name a best regimen, and no trial was powered for perinatal death. Evidence: limited. (Source 4)
• Insulin detemir is not used for ketoacidosis. The label states plainly that it is not recommended for that, because ketoacidosis needs short-acting insulin given intravenously and titrated hour by hour. Evidence: not-supported. (Source 5)

Interactions

• Alcohol (label): Alcohol can push blood glucose either way. The label lists it among drugs that may increase or decrease insulin's glucose-lowering effect, and the patient leaflet says not to drink alcohol while using the insulin. (Source 6)
• Alcohol (delayed hypoglycaemia) (clinical trial): Alcohol blocks the liver's manufacture of new glucose. Once glycogen stores are used up the blood glucose can fall many hours later, which is why alcohol-related hypoglycaemia in insulin users often happens overnight or the next morning rather than while drinking. (Source 7)
• Beta-blockers, clonidine, guanethidine and reserpine (label): These drugs can blunt the warning signs of a low blood glucose - the shaking, sweating and fast heartbeat - so a hypoglycaemia can go unnoticed until it is severe. (Source 6)
• Thiazolidinediones (pioglitazone, rosiglitazone) (label): Insulin combined with a thiazolidinedione can cause fluid retention and heart failure, including in people with no previous heart problem. (Source 8)
• Potassium (and potassium supplements) (label): Insulin drives potassium from the blood into cells, so blood potassium can fall. The label calls hypokalaemia potentially life-threatening and asks for potassium monitoring in people at risk - relevant to anyone whose potassium is already low or who is taking potassium-wasting medicines. (Source 8)
• Meals, carbohydrate and meal timing (label): How much and when you eat changes the insulin requirement. The label asks for dose review whenever meal pattern, macronutrient content or timing of food changes, as well as with changes in activity or illness. (Source 9)
• Glucose-lowering herbal products (for example garlic, ginger, moringa, bitter melon preparations) (theoretical): People with diabetes commonly take herbal products alongside insulin. A cross-sectional study with a targeted literature review found that co-use of such products with insulin and other glucose-lowering drugs has a plausible potential for interaction, mainly additive glucose lowering, but no clinical outcomes were verified. The evidence here is theoretical rather than measured. (Source 10)

Stopping it

• Insulin detemir is a basal insulin only. In type 1 diabetes it cannot be the whole regimen, and it is not the drug for ketoacidosis, so stopping or omitting the short-acting insulin alongside it leaves mealtime glucose uncovered. (Source 9)
• There is no withdrawal syndrome from insulin, but stopping it in type 1 diabetes is dangerous. A systematic review of deliberate insulin omission found prevalence estimates of 20% to 45% in young people with type 1 diabetes and links to ketoacidosis, worse control and higher mortality. (Source 11)
• In type 2 diabetes, planned reduction of insulin has been studied. A meta-analysis of seven randomised trials found that replacing mealtime insulin with a GLP-1 receptor agonist while keeping basal insulin kept HbA1c the same and reduced weight by about 5 kg and total insulin by about 33 units a day, though whether hypoglycaemia truly falls is still uncertain. (Source 12)

What goes wrong

Injection site reactions were about four times more common with insulin detemir than with insulin glargine. (Source 13)

• Systematic review, Low certainty.
• Size: 4 trials, 2,250 people.
• Who: adults with type 2 diabetes mellitus.
• How long: 24 to 52 weeks.
• Result: injection site reactions 1.8% with insulin detemir versus 0.4% with insulin glargine.
• Funding: not stated in the record we read.

Limit of this finding: This review was published in the Cochrane Database of Systematic Reviews 2011, Issue 7 (CD006383.pub2, PMID 21735405); the cochrane.org page it is quoted from miscites itself as "2022, Issue 3" and shows a published date of 1 April 2022, so the evidence is fourteen years older than that page suggests. The plain-language summary also gives the 0.9 kg weight difference and the injection-site reaction figures (1.8% versus 0.4%) with no confidence intervals and no denominators, and the weight figure comes from a single study. Read these as what one or a few trials reported, not as pooled effect estimates with known precision.

Treatment with insulin glargine resulted in a lower daily basal insulin dose and a lower number of injection site reactions (1.8% of patients treated with insulin detemir compared to 0.4% of patients treated with insulin glargine had injection side reactions).

Hypoglycaemia is the commonest adverse effect of insulin detemir, and severe episodes are defined by needing another person's help. (Source 14)

• Official position, Certainty not rated.
• Size: clinical trial programme pooled in the label (for example 767 adults with type 1 diabetes exposed to detemir versus 388 to NPH)
• Who: adults and children with type 1 or type 2 diabetes in the registration trials.
• How long: 16 to 52 weeks.
• Result: in the label's tables, severe hypoglycaemia occurred in 8.7% (24/276) of adults with type 1 diabetes in one 16-week trial and in 0.4% (1/237) of adults with type 2 diabetes in a 24-week trial; non-severe hypoglycaemia in 88.0% and 40.5% respectively.
• Funding: manufacturer's own label (Novo Nordisk)

Hypoglycemia was the most commonly observed adverse reaction in patients treated with LEVEMIR. The rates of reported hypoglycemia depend on the definition of hypoglycemia used, diabetes type, insulin dose, intensity of glucose control

Repeated injection into the same spot can cause lipodystrophy and localised skin amyloid, which also changes how insulin is absorbed. (Source 15)

• Official position, Certainty not rated.
• Size: not given.
• Who: people using insulin long term.
• How long: long-term use.
• Result: frequency not quantified in the label; listed as a common adverse reaction.
• Funding: manufacturer's own label (Novo Nordisk)

Long-term use of insulin, including LEVEMIR, can cause lipodystrophy at the site of repeated insulin injections. Lipodystrophy includes lipohypertrophy (thickening of adipose tissue) and lipoatrophy (thinning of adipose tissue), and may affect insulin absorption

Severe generalised allergy including anaphylaxis has happened with insulin detemir and can be life threatening. (Source 8)

• Official position, Certainty not rated.
• Size: not given.
• Who: people treated with insulin.
• How long: any.
• Result: no rate given in the label; described as severe and life-threatening when it occurs.
• Funding: manufacturer's own label (Novo Nordisk)

Hypersensitivity reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue LEVEMIR, monitor and treat if indicated

Taking insulin together with a thiazolidinedione can cause fluid retention and heart failure. (Source 8)

• Official position, Certainty not rated.
• Size: not given.
• Who: people taking insulin with pioglitazone or rosiglitazone.
• How long: any.
• Result: no rate given in the label; the label instructs observation and dose reduction or discontinuation if heart failure occurs.
• Funding: manufacturer's own label (Novo Nordisk)

Fluid retention and heart failure with concomitant use of thiazolidinediones (TZDs): Observe for signs and symptoms of heart failure; consider dosage reduction or discontinuation if heart failure occurs

Deliberately missing insulin doses is common in type 1 diabetes and is linked to ketoacidosis, worse glucose control and higher mortality. (Source 11)

• Systematic review, Low certainty.
• Size: 29 studies.
• Who: mainly adolescents and young adults with type 1 diabetes.
• How long: varied.
• Result: prevalence estimates ranged from 20% to 45%; consistently linked to poor glycaemic control and elevated HbA1c.
• Funding: not stated in the abstract we read.

Despite serious health risks, including diabetic ketoacidosis, microvascular complications, and increased mortality, it remains under-recognised due to stigma, diagnostic ambiguity, and overlap with routine diabetes self-management.

What the evidence supports

Compared with NPH insulin, insulin detemir reduced the number of people having hypoglycaemia, and reduced serious hypoglycaemia, but the absolute benefit was about one person in a hundred and the certainty was low. (Source 16)

• Systematic review, Low certainty.
• Size: 8 detemir trials, 1,321 people randomised to insulin detemir (24 trials and 4,740 people in the whole review)
• Who: adults with type 2 diabetes mellitus.
• How long: 24 weeks to 5 years.
• Result: severe hypoglycaemia RR 0.45 (95% CI 0.17 to 1.20; ARR -0.9%, 95% CI -1.4 to 0.4; very low certainty); serious hypoglycaemia Peto OR 0.16 (95% CI 0.04 to 0.61; ARR -0.9%, 95% CI -1.1 to -0.4; low certainty)
• Funding: not stated in the record we read.

However, serious hypoglycaemic events were rare and the absolute risk reducing effect was low. Approximately one in 100 people treated with insulin detemir instead of NPH insulin benefited.

In a two-year open-label trial in type 1 diabetes, insulin detemir with mealtime aspart lowered HbA1c slightly more than NPH and produced less major and nocturnal hypoglycaemia and less weight gain. (Source 2)

• Randomized trial, Moderate certainty.
• Size: 497 randomised 2:1 (331 detemir, 166 NPH)
• Who: people with type 1 diabetes using a basal-bolus regimen.
• How long: 24 months.
• Result: HbA1c 7.36% versus 7.58%, mean difference -0.22% points (95% CI -0.41 to -0.03); major and nocturnal hypoglycaemia 69% and 46% lower (P < 0.001); weight gain 1.7 kg versus 2.7 kg (P = 0.024)
• Funding: not stated in the abstract we read; the trial was open-label, which the authors state.

Risk of major and nocturnal hypoglycaemia was 69% and 46% lower with detemir than with NPH (P < 0.001), respectively; patients treated with detemir gained less weight (detemir 1.7 kg, NPH 2.7 kg; P = 0.024).

Added to oral drugs in type 2 diabetes, insulin detemir and NPH lowered HbA1c by the same amount, but detemir caused less hypoglycaemia and less weight gain. (Source 3)

• Randomized trial, Moderate certainty.
• Size: 476 insulin-naive adults.
• Who: adults with type 2 diabetes and HbA1c 7.5-10.0% on oral therapy.
• How long: 24 to 26 weeks.
• Result: HbA1c fell 1.8% with detemir and 1.9% with NPH (not significant); all hypoglycaemia 47% lower and nocturnal hypoglycaemia 55% lower with detemir (P < 0.001); weight gain 1.2 kg versus 2.8 kg (P < 0.001)
• Funding: not stated in the abstract we read.

Compared with NPH insulin, the risk for all hypoglycemia with insulin detemir was reduced by 47% (P < 0.001) and nocturnal hypoglycemia by 55% (P < 0.001).

In pregnant women with type 1 diabetes, insulin detemir was non-inferior to NPH for HbA1c at 36 weeks and gave lower fasting glucose, with similar hypoglycaemia rates. (Source 4)

• Randomized trial, Moderate certainty.
• Size: 310 women (152 detemir, 158 NPH)
• Who: pregnant women with type 1 diabetes, also using insulin aspart.
• How long: from up to 12 months before pregnancy or 8-12 weeks gestation to 36 gestational weeks.
• Result: the trial's primary endpoint was noninferiority of A1C at 36 gestational weeks: estimated A1C 6.27% for detemir versus 6.33% for NPH, difference -0.06% (95% CI -0.21 to 0.08), within the 0.4% margin. Fasting plasma glucose, a secondary outcome, was lower with detemir at 24 weeks (96.8 versus 113.8 mg/dL, P = 0.012) and 36 weeks (85.7 versus 97.4 mg/dL, P = 0.017). Major and minor hypoglycaemia rates were similar.
• Funding: not stated in the abstract we read.

Major and minor hypoglycemia rates during pregnancy were similar between groups.

The FDA-approved indication is broad - glycaemic control in adults and children with diabetes - and it carries one stated limitation: not for ketoacidosis. This is a regulator's position dated 10/2024, not trial evidence. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: adult and paediatric patients with diabetes mellitus.
• How long: not applicable.
• Result: no effect size; the label records what was approved and excludes diabetic ketoacidosis from the indication.
• Funding: manufacturer's own label (Novo Nordisk), revised 10/2024.

LEVEMIR is indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. Limitations of Use LEVEMIR is not recommended for the treatment of diabetic ketoacidosis.

What the evidence does not support

The same Cochrane review found almost no usable data on the outcomes that matter most - death, diabetes complications and quality of life - so it could not show that insulin detemir changes them. (Source 16)

• Systematic review, Very low certainty.
• Size: 24 randomised trials, 4,740 people randomised to an analogue.
• Who: adults with type 2 diabetes mellitus.
• How long: 24 weeks to 5 years.
• Result: no meaningful differences for the outcomes where any data existed; HbA1c change comparable; no clear difference in weight gain or adverse events.
• Funding: not stated in the record we read.

Information on patient-relevant outcomes such as death from any cause, diabetes-related complications, health-related quality of life and socioeconomic effects was insufficient or lacking in almost all included trials.

Head to head against insulin glargine, insulin detemir performed the same on blood glucose and hypoglycaemia; detemir caused less weight gain, glargine needed a lower dose and caused fewer injection site reactions. (Source 13)

• Systematic review, Low certainty.
• Size: 4 trials, 2,250 people.
• Who: adults with type 2 diabetes mellitus.
• How long: 24 to 52 weeks.
• Result: no significant difference in HbA1c or in overall, nocturnal and severe hypoglycaemia; weight difference 0.9 kg in one study favouring detemir.
• Funding: not stated in the record we read.

Limit of this finding: This review was published in the Cochrane Database of Systematic Reviews 2011, Issue 7 (CD006383.pub2, PMID 21735405); the cochrane.org page it is quoted from miscites itself as "2022, Issue 3" and shows a published date of 1 April 2022, so the evidence is fourteen years older than that page suggests. The plain-language summary also gives the 0.9 kg weight difference and the injection-site reaction figures (1.8% versus 0.4%) with no confidence intervals and no denominators, and the weight figure comes from a single study. Read these as what one or a few trials reported, not as pooled effect estimates with known precision.

There were no differences in overall, nocturnal and severe hypoglycaemia when comparing insulin detemir to insulin glargine.

Where the evidence is mixed

Pooling five randomised trials of pregnancy, insulin detemir was associated with fewer maternal hypoglycaemic events and slightly later delivery than NPH, but the authors say the evidence is not yet enough to call it the better choice. (Source 17)

• Meta-analysis, Low certainty.
• Size: 5 randomised controlled trials, 1,450 participants.
• Who: pregnant women with gestational or pre-existing diabetes needing insulin.
• How long: pregnancy.
• Result: maternal hypoglycaemic events RR 0.64 (95% CI 0.48-0.86, p = 0.003); gestational age at delivery MD 0.48 weeks (95% CI 0.16-0.81, p = 0.003)
• Funding: not stated in the abstract we read.

More research should be conducted to reach a safe conclusion about the optimal insulin regimen for women with diabetes in pregnancy.

In type 2 diabetes already on basal-bolus insulin, swapping the mealtime insulin for a GLP-1 receptor agonist while keeping basal insulin held HbA1c steady and cut weight and insulin dose. (Source 12)

• Meta-analysis, Moderate certainty.
• Size: 7 randomised controlled trials, 1,332 participants.
• Who: adult outpatients with type 2 diabetes on established basal-bolus insulin or multiple daily injections.
• How long: not stated in the abstract.
• Result: HbA1c mean difference -0.08 percentage points (95% CI -0.28 to 0.12; p = 0.391); weight -4.94 kg (95% CI -7.37 to -2.51); total daily insulin -33.32 U/day (95% CI -52.23 to -14.41); at least one hypoglycaemic event RR 0.76 (95% CI 0.66 to 0.87)
• Funding: not stated in the abstract we read.

A potential reduction in hypoglycaemia remains uncertain. This strategy may represent an option for treatment optimisation in appropriately selected patients receiving intensive insulin therapy; however, further studies are needed to determine its long-term sustainability and optimal implementation.

Where the research disagrees

Whether long-acting insulin analogues such as detemir are genuinely better than older human NPH insulin, or only better on a surrogate measure under trial conditions

• Cochrane review authors (Semlitsch and colleagues, 2020), Cochrane systematic review with GRADE of 24 randomised trials in adults with type 2 diabetes; the review also reports that data on death, diabetes complications and quality of life were insufficient or lacking in almost all the trials: While the effects on HbA1c were comparable, treatment with insulin glargine and insulin detemir resulted in fewer participants experiencing hypoglycaemia when compared with NPH insulin. Treatment with insulin detemir also reduced the incidence of serious hypoglycaemia. However, serious hypoglycaemic events were rare and the absolute risk reducing effect was low. Approximately one in 100 people treated with insulin detemir instead of NPH insulin benefited. (Source 16)
• Investigators of the two-year type 1 diabetes treat-to-target trial (Bartley and colleagues, 2008), 24-month multi-national open-label parallel-group randomised trial; 497 patients randomised 2:1 to detemir (n = 331) or NPH (n = 166), treat-to-target design with insulin aspart at meals: Long-term treatment with the insulin analogues detemir + aspart was superior to NPH + aspart in reducing HbA(1c), with added benefits of less major and nocturnal hypoglycaemia and less weight gain. (Source 2)

How much

• Reference intake: The dose is set by the prescriber, not by any reference intake. The US label (revised 10/2024) says it can be given once or twice daily by subcutaneous injection, that the dose is individualised and titrated to blood glucose results and an agreed target, and that for insulin-naive people with type 1 diabetes about one third to one half of the total daily insulin dose is given as detemir, with 0.2 to 0.4 units per kg of body weight used to work out the initial total daily insulin dose. This is the label's position, not a recommendation to a reader. (Source 9)
• Upper limit: The label sets no maximum daily dose and no upper limit: it states instead that the dose is individualised and titrated to the person's metabolic needs, blood glucose monitoring results and glycaemic goal. That is the label's position as of 10/2024. (Source 18)
• Studied: In the 26-week type 2 diabetes trial, doses were not fixed: insulin was titrated over 24 weeks toward pre-breakfast and pre-dinner plasma glucose targets of 6.0 mmol/l or below (108 mg/dl or below). (Source 3)
• Studied: In the two-year type 1 diabetes trial, basal insulin was started once daily in the evening and titrated individually against self-measured glucose aiming for pre-breakfast and pre-dinner targets of 6.0 mmol/l or below, with a second morning dose allowed by pre-defined criteria. (Source 2)
• Studied: In the Cochrane head-to-head review, 13.6% to 57.2% of people randomised to insulin detemir were injecting it twice daily by the end of the trial, at a higher basal dose than glargine. (Source 13)

A common belief, and what the research shows

The belief: That a modern long-acting analogue like insulin detemir prevents the complications of diabetes better than older human insulin.

What the research shows: No trial has shown that. The Cochrane review of 24 randomised trials reported that "Information on patient-relevant outcomes such as death from any cause, diabetes-related complications, health-related quality of life and socioeconomic effects was insufficient or lacking in almost all included trials." Where any data existed there were "no meaningful differences between treatment with glargine or detemir and treatment with NPH". The documented advantage is less hypoglycaemia and less weight gain, and even there the absolute gain was about one person in a hundred.

Questions and answers

What is it?

Insulin detemir is a laboratory-made version of human insulin, altered so that it sticks to albumin in the blood and is absorbed slowly. That slow absorption gives it a flat action lasting up to about 24 hours, which is why it is used as a background, or basal, insulin rather than a mealtime one. It is given by injection under the skin of the thigh, upper arm or abdomen. It is sold as Levemir. (Source 1)

What does it do in the body?

Like all insulin, it lowers blood glucose in two ways: it makes muscle and fat take glucose out of the blood, and it tells the liver to stop releasing glucose. It also blocks the breakdown of fat and protein and helps build protein. Because its action is flat and long, it covers the body's background insulin need between meals and overnight. (Source 1)

Is it good or bad for you?

For someone who needs insulin it is necessary, not optional. Against NPH insulin it gives the same HbA1c with less hypoglycaemia and less weight gain. But the benefit on serious hypoglycaemia is small in absolute terms - roughly one person in a hundred - the certainty of that evidence is low, and the trials never showed an effect on death or diabetes complications. Too much insulin causes hypoglycaemia, which can be life threatening. (Source 16)

How do you get more of it?

This is not something to get more of. It is a prescription injectable whose dose is set and adjusted by the prescriber against blood glucose readings and an agreed target. The label says the dose is individualised and titrated, and that it may need to change with activity, meals, kidney or liver function and illness. There are no foods or supplements that supply it. (Source 18)

If it is harmful, what reduces it?

There is no way to remove insulin once injected; its effect has to be ridden out. When too much has acted, the fix is sugar. The label's own definition of a severe low describes recovery after oral carbohydrate, intravenous glucose or glucagon. Hypoglycaemia is the commonest adverse effect, so this matters more than any other handling question. (Source 14)

Why might someone be low in it or missing it?

Someone can be short of it for two different reasons. In type 1 diabetes the body makes almost none of its own, so the injected basal insulin is the only source and the label requires mealtime insulin alongside it. Separately, doses get missed - sometimes by accident, sometimes deliberately to lose weight, which a systematic review found in 20% to 45% of young people with type 1 diabetes. (Source 11)

Which whole foods contain it or feed it?

No food contains insulin detemir. Food matters the other way round: what is eaten and when changes how much insulin is needed. The label asks for dose review when meal pattern, the make-up of meals or the timing of food changes, and the patient leaflet tells people not to drink alcohol while using it. (Source 9)

What happens if you do not have it?

In type 1 diabetes, going without insulin leads to very high glucose and then diabetic ketoacidosis, a medical emergency. The systematic review of deliberate insulin omission links it to ketoacidosis, small-vessel complications and increased death. The label also makes clear this insulin is not the treatment for ketoacidosis once it has happened. (Source 11)

How can you test for it?

There is no routine blood test for insulin detemir itself. What is measured instead is its effect: self-monitored or continuously monitored blood glucose day to day, and HbA1c over two to three months. The label ties dosing directly to blood glucose monitoring results and an agreed glycaemic target, and asks for more frequent monitoring when the regimen, other drugs, meals or activity change, or in kidney or liver impairment. (Source 8)

References

1. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Section 12 Clinical Pharmacology: 12.1 Mechanism of Action and the first paragraph of 12.2 Pharmacodynamics). 2024. Read the source
2. Diabetic medicine : a journal of the British Diabetic Association. Long-term efficacy and safety of insulin detemir compared to Neutral Protamine Hagedorn insulin in patients with Type 1 diabetes using a treat-to-target basal-bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trial.. 2008. PMID 18387078, DOI 10.1111/j.1464-5491.2007.02407.x. Read the source
3. Diabetes care. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes.. 2006. PMID 16732007, DOI 10.2337/dc05-1365. Read the source
4. Diabetes care. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes.. 2012. PMID 22851598, DOI 10.2337/dc11-2264. Read the source
5. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (the DailyMed table-of-contents footnote, Section 1 Indications and Usage with its Limitations of Use, and the opening of Section 2.1 Important Administration Instructions; the footnote line exists in the DailyMed HTML rendering, not in the SPL XML). 2024. Read the source
6. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Section 7 Drug Interactions). 2024. Read the source
7. Journal of Laboratory and Precision Medicine. Literature review: drug and alcohol-induced hypoglycaemia. 2021. DOI 10.21037/jlpm-21-16. Read the source
8. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Highlights: the five WARNINGS AND PRECAUTIONS bullets for 5.3 to 5.7; no Adverse Reactions content is quoted. Note that the Highlights bullet quoted here says "thiazolidinediones (TZDs)" where the corresponding full prescribing information heading 5.7 reads "Fluid Retention and Heart Failure with Concomitant Use of PPAR-gamma Agonists"; the two wordings must not be swapped). 2024. Read the source
9. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Section 2.2 General Dosing Instructions, final two bullets; nothing from 2.3 Starting Dose in Insulin Naive Patients is quoted). 2024. Read the source
10. Pharmaceutical biology. An exploratory evaluation of the interaction risk between herbal products and pharmaceutical medicines used concurrently for disease management in Blantyre, Malawi.. 2025. PMID 41259156, DOI 10.1080/13880209.2025.2586351. Read the source
11. Journal of clinical medicine. Intentional Insulin Omission (Diabulimia) in Patients with Insulin-Dependent Diabetes: An Eating Disorder? A Systematic Review.. 2026. PMID 42123251, DOI 10.3390/jcm15093518. Read the source
12. Diabetes, obesity & metabolism. GLP-1 Receptor Agonist-Based Prandial Insulin De-Intensification in Outpatients With Type 2 Diabetes Receiving Basal-Bolus Insulin Therapy or Multiple Daily Injections: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.. 2026. PMID 42736042, DOI 10.1111/dom.71359. Read the source
13. Cochrane Database of Systematic Reviews. Insulin detemir versus insulin glargine for type 2 diabetes mellitus (Cochrane Review; Cochrane Database of Systematic Reviews 2011, Issue 7, Art. No. CD006383, PMID 21735405, first published 6 July 2011. The cochrane.org plain-language page cited here miscites its own review in its Citation block as "Cochrane Database of Systematic Reviews 2022, Issue 3" and gives a published date of 1 April 2022; both the year and the issue number on that page are wrong, which is why the year field here reads 2011 and not 2022). 2011. PMID 21735405, DOI 10.1002/14651858.CD006383.pub2. Read the source
14. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Section 6 Adverse Reactions). 2024. Read the source
15. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Section 6.1 Clinical Trial Experience: Insulin Initiation and Intensification of Glucose Control, Lipodystrophy, and Weight Gain). 2024. Read the source
16. Cochrane Database of Systematic Reviews. (Ultra-)long-acting insulin analogues versus NPH insulin (human isophane insulin) for adults with type 2 diabetes mellitus (Cochrane Review abstract page). 2020. DOI 10.1002/14651858.CD005613.pub4. Read the source
17. Diabetes research and clinical practice. Safety and efficacy of insulin detemir versus NPH in the treatment of diabetes during pregnancy: Systematic review and meta-analysis of randomized controlled trials.. 2022. PMID 35878788, DOI 10.1016/j.diabres.2022.110020. Read the source
18. DailyMed SPL labeled by A-S Medication Solutions (relabeler); the label text is the Novo Nordisk Levemir US prescribing information, revised 10/2024. LEVEMIR (insulin detemir) injection, solution - FDA prescribing information (Highlights: Dosage and Administration). 2024. Read the source