100 units/ml solution for injection in a pre-filled pen.
insulin detemir
What Levemir® is and what it is used for
Levemir is modern insulin (insulin analog) that is long-acting. Modern insulin preparations are improved versions of human insulin.
Levemir is used for lowering high blood sugar in adults, adolescents, and children 1 year of age or older with diabetes ( diabetes mellitus ). Diabetes is a disease in which your body does not produce enough insulin to keep your blood sugar levels under control.
Levemir can be used with fast-acting insulin preparations taken with a meal.
In the treatment of type 2 diabetes mellitus, Levemir can also be used in combination with tablets for diabetes and/or with injectable diabetes preparations, of a type other than insulin.
Levemir has a long-lasting and even blood sugar lowering effect, which sets in within 3-4 hours after injection. Levemir covers the need for basal insulin for up to 24 hours.
What you need to know before using Levemir®
Do not use Levemir
- If you are allergic to insulin detemir or any of the other ingredients of this medicine, see section 6, Contents of the pack and other information.
- If you feel you are experiencing insulin sensation (symptoms of low blood sugar), see a) Summary of serious and very common side effects in section 4.
- in insulin pumps.
- if FlexPen has been dropped, damaged or shocked.
- if your insulin has not been stored properly or if it has been frozen, see section 5, How to store Levemir.
- if the solution of insulin et is not clear, colorless and watery.
If any of these apply to you, do not use Levemir. Talk to a doctor, nurse, or pharmacist.
Before using Levemir
- Check on the label that it is the right kind of insulin .
- Always use a new injection needle for each injection to prevent contamination.
- Injection needles and Levemir FlexPen must not be shared with anyone else.
- Levemir FlexPen should only be injected under the skin. Talk to your doctor if you need to inject your insulin using another method.
Warnings and cautions
Certain conditions and activities may affect your need for insulin. Consult a doctor.
- If you have problems with your kidneys, liver, adrenal glands, pituitary gland or thyroid gland.
- If you exercise more than usual or want to change your diet, as this can affect your blood sugar level.
- If you become ill, continue to take your insulin and consult your doctor.
- If you are traveling abroad, travel over different time zones can affect your need for insulin and when to take it.
- If your albumin levels are very low: check your blood sugar carefully. Discuss this with your doctor.
Skin changes at the injection site
To help prevent changes in the adipose tissue under the skin, e.g. skin thickening, skin shrinkage, or lumps under the skin, you should always change the injection site. It may be that insulin et not work as well if you inject in an area with nodules or in a thickened or shriveled area (see “How to use Levemir”). Contact your doctor if you notice skin changes at the injection site and before changing the injection site if you are currently injecting in an affected area. Your doctor may advise you to check your blood sugar more often and to adjust your insulin dose or the dose of other diabetes medicines.
Children and young people
Levemir can be used in adolescents and children 1 year of age and older.
The safety and efficacy of Levemir in children under 1 year of age have not been established. No data is available.
Other medicines and Levemir®
Tell your doctor, nurse, or pharmacist if you are taking, have recently taken, or might take any other medicines, including medicines obtained without a prescription.
Some medicines affect your blood sugar level and this may mean that your insulin dose needs to be changed. Below is a list of the most common medicines that may affect your insulin treatment.
Your blood sugar level may drop (hypoglycemia) if you take:
- Other medicines to treat diabetes
- MAO inhibitors (for the treatment of depression)
- Beta-blockers (for the treatment of high blood pressure )
- ACE inhibitors (for the treatment of certain heart diseases or high blood pressure )
- Salicylates (analgesics and antipyretics)
- Anabolic steroids (eg testosterone)
- Sulfonamides (for the treatment of infections ).
Your blood sugar level may rise (hyperglycemia) if you take:
- Oral contraceptives ( birth control pills )
- Thiazides (for the treatment of high blood pressure or severe fluid retention)
- Glucocorticoids (eg cortisone for the treatment of inflammation )
- Thyroid hormones (for the treatment of thyroid diseases)
- Sympathomimetics (eg adrenaline or salbutamol , terbutaline for the treatment of asthma )
- Growth hormone (for stimulation of skeletal and body growth with a pronounced effect on the body’s metabolism)
- Danazol (an agent that affects ovulation).
Octreotide and lanreotide (for the treatment of acromegaly, an unusual hormonal disorder with pituitary overproduction one of the growth hormone usually in middle-aged adults) can either raise or lower your blood sugar level.
Beta-blockers (for the treatment of high blood pressure ) may weaken or eliminate the first warning signs of low blood sugar.
Pioglitazone (tablets for the treatment of type 2 diabetes )
Some patients who have had type 2 diabetes and heart disease for many years or previous strokes developed heart failure during treatment with pioglitazone and insulin. Tell your doctor as soon as possible if you get signs of heart failure such as unexpected shortness of breath, rapid weight gain, or local swelling ( edema ).
If you have taken any of these medicines, talk to your doctor, nurse, or pharmacist.
Levemir with alcohol
- If you drink alcohol, your need for insulin may change as your blood sugar level may either rise or fall. Careful blood glucose monitoring is recommended.
Pregnancy and breastfeeding
- If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. The insulin dose may need to be changed during pregnancy and after delivery. Careful monitoring of your diabetes and especially counteracting low blood sugar is important for your baby’s health.
- If you are breast-feeding, talk to your doctor as your insulin dose may need to be adjusted.
Ask your doctor, nurse, or pharmacist for advice before taking any medicine during pregnancy or breastfeeding.
Driving and using machines
Ask your doctor if you can drive or use machines:
- if you often get low blood sugar levels.
- if you find it difficult to recognize signs of low blood sugar (insulin detection).
If your blood sugar is low or high, it can affect your ability to concentrate and react and therefore also your ability to drive or use machines. Remember that you can put yourself and others at risk.
Important information about some of the ingredients of Levemir
Levemir contains less than 1 mmol sodium (23 mg) per dose, ie Levemir is essential ‘sodium-free’.
How to use Levemir®
Dose and when you take your insulin
Always use your insulin and adjust your dose exactly as your doctor advised. If you are not sure, talk to your doctor, nurse, or pharmacist.
Levemir can be used with fast-acting insulin preparations taken with a meal. In the treatment of type 2 diabetes mellitus, Levemir can also be used in combination with diabetes preparations in the form of tablets and/or injectable diabetes preparations, of a type other than insulin.
Only change insulin preparations on the advice of a doctor.
Your doctor may need to adjust your dose if:
• your doctor has switched you from one type of insulin or brand of insulin to another, or
• your doctor has added another medicine to treat your diabetes in addition to your Levemir treatment
Use for children and adolescents
Levemir can be used in adolescents and children 1 year of age or older.
There is no experience in the treatment of children under 1 year of age with Levemir.
Use for special patient groups
If you have impaired kidney or liver function or if you are over 65, you need to check your blood sugar more regularly and discuss changes in your insulin dose with your doctor.
How often to inject
When Levemir is used in combination with tablets for diabetes and/or in combination with injectable diabetes preparations, other than insulin, Levemir should be injected once a day. When Levemir is used as part of a so-called basal-bolus insulin regimen Levemir should be administered once or twice daily as needed. Dose and Levemir should be adjusted individually. Injection one can be given at any time during the day but at the same time every day. Needed injection you twice-daily dosing to optimize blood glucose control, the evening dose can be injected in the evening or at bedtime.
How and where to inject
Levemir is for injection under the skin ( subcutaneously ). You should never inject Levemir directly into a blood vessel ( intravenously ) or a muscle ( intramuscularly ). Levemir FlexPen should only be injected under the skin. Talk to your doctor if you need to inject your insulin using another method.
At each injection, change the injection site within the same specific skin area that you are using. This may reduce the risk of developing lumps or pits in the skin (see section 4, Possible side effects ). The best area to take an injection is on: the front of the thighs, the front of the waist (abdomen), or the upper arm. Always check your blood sugar regularly.
How to handle Levemir FlexPen
Levemir FlexPen is a pre-filled, color-coded pen containing insulin detemir, which is discarded when empty.
Carefully read the Levemir FlexPen instructions for use contained in this leaflet. You must use the pen according to the instructions under “Instructions for use”.
Always make sure you use the correct pen before injecting your insulin.
If you take more insulin than you should
If you take too much insulin, your blood sugar may become too low (hypoglycemia). See a) Summary of serious and very common side effects in section 4.
If you forget to take your insulin
If you forget to take your insulin, your blood sugar may become too high (hyperglycemia). See c) Diabetes Disorders in Section 4.
If you stop taking your insulin
Do not stop taking insulin without talking to your doctor, who will tell you what to do. This can lead to very high blood sugar (severe hyperglycemia) and ketoacidosis. See c) Diabetes Disorders in Section 4.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them.
a) Summary of serious and very common side effect s
Low blood sugar ( hypoglycemia ) is a very common side effect. It can occur in more than 1 in 10 users.
Low blood sugar can occur if you:
- injecting too much insulin .
- eat too little or skip a meal.
- exercise more than usual.
- drink alcohol (see Levemir with alcohol in section 2).
Signs of low blood sugar: Cold sweats; cool and pale skin; headache; palpitation; nausea; strong hunger; temporary vision changes; drowsiness; unusual fatigue and weakness; anxiety or trembling; feelings of anxiety; confusion; concentration difficulties.
Very low blood sugar can lead to unconsciousness. If left untreated for a very long time, very low blood sugar can cause brain damage (temporary or permanent) and even death. You can regain consciousness faster if you receive an injection of the hormone et glucagon from someone who knows how to use it. If you are given glucagon, you will need glucose or a sugar-containing snack as soon as you regain consciousness. If you do not respond to glucagon therapy, you will need to be treated in hospital.
What to do if you get low blood sugar:
- If you feel that your blood sugar is too low, eat grape sugar tablets or any other snack that contains a lot of sugar (sweets, cakes, fruit juice). If possible, check your blood sugar and rest. Always take glucose tablets or snacks with a lot of sugar in them for safety.
- When the symptoms of low blood sugar have disappeared or when your blood sugar level has stabilized, you should continue with the insulin treatment as usual.
- If you have had low blood sugar and lost consciousness or if you have needed a glucagon injection , or if you have had many insulin sensations, talk to a doctor. The amount of insulin or when you take it, diet or exercise may need to be adjusted.
Tell them that you have diabetes for people who need to know it, what the consequences can be, and also the risk of becoming unconscious due to low blood sugar. Tell them that if you become unconscious, they should put you on the side and get medical attention immediately. They must not give you anything to eat or drink as there is a risk that you will suffocate.
Severe allergic reactions to Levemir or any of the other ingredients (so-called systemic allergic reaction ) are very rare but can be life-threatening. It may affect less than 1 in 10,000 users.
Contact a doctor immediately:
- if signs of allergy spread to other parts of the body.
- if you suddenly feel unwell and you: start sweating; begins to vomit; have difficulty breathing; get palpitations; feel dizzy.
If you experience any of these, seek medical attention immediately.
Skin changes at the injection site: If you inject insulin at the same site, the adipose tissue may either shrink (lipoatrophy) or thicken (lipohypertrophy) (may affect up to 1 in 100 people). Nodules under the skin can also be caused by the accumulation of a protein called amyloid ( cutaneous amyloidosis. How often this occurs is not known). It may be that insulin et not work as well if you inject in an area with nodules or in a thickened or shriveled area. Change the injection site for each injection to prevent these skin changes.
b) List of side effect s
Uncommon side effects are
May affect less than 1 in 100 users.
Signs of allergy: Local allergic reactions (pain, redness, hives, inflammation, bruising, swelling, and itching ). These symptoms usually go away after taking your insulin for a few weeks. If they do not disappear, or if they spread throughout the body, contact a doctor immediately. See also Severe allergic reactions above.
Vision problems: At the beginning of insulin treatment, visual disturbances may occur, but these are usually temporary.
Swollen joints: When you start taking insulin, your body may bind water, causing you to swell around the ankles and other joints. This usually passes soon. If not consult a doctor.
Diabetic retinopathy (an eye disease associated with diabetes that can lead to vision loss): If you have diabetic retinopathy, it can worsen if your blood sugar level improves very quickly. Ask your doctor about this.
Rare side effects are
May affect less than 1 in 1000 users.
Painful neuropathy (pain due to nerve damage): If your blood sugar level improves very quickly, you may get nerve-related pain. This is called acute painful neuropathy and is usually transient.
c) Problems with diabetes
High blood sugar (hyperglycemia)
High blood sugar can occur if you:
- have not injected enough insulin .
- forget to take your insulin or stop taking insulin .
- repeatedly take less insulin than you need.
- get an infection or fever.
- eat more than usual.
- exercise less than usual.
High blood sugar warning signs:
The warning signals appear gradually. They manifest as: increased urine output; thirst; loss of appetite; feeling sick (nausea, vomiting); drowsiness or fatigue; redness; dry skin; dry mouth, and a breath that smells of fruit (acetone).
What should I do if I get high blood sugar:
- If you get any of these warning signs: check your blood sugar, do a ketone test on your urine if possible and then contact a doctor immediately.
- The symptoms can be a sign of a very serious condition called diabetic ketoacidosis (accumulation of acid in the blood when the body breaks down fat instead of sugar). If left untreated, it can lead to diabetic coma and eventually death.
How to store Levemir®
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the label and carton of FlexPen after EXP. The expiration date is the last day of the specified month.
To protect the insulin from light, always put the pen cap on your FlexPen when you are not using it.
Levemir should be protected from strong heat and light.
Before opening: The unused Levemir FlexPen should be stored in a refrigerator at 2 ° C-8 ° C, not near the cooling element. Do not freeze.
During use or as a reserve: You can take your Levemir FlexPen with you and store it at a maximum temperature of 30 ° C or in a refrigerator (2 ° C to 8 ° C) for up to 6 weeks. When storing in a refrigerator, do not store it near the refrigerator. Do not freeze.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
Contents of the pack and other information
Content declaration
- The active substance is insulin detemir. Each ml contains 100 units of insulin detemir. Each pre-filled pen contains 300 units of insulin detemir in 3 ml solution for injection . 1 unit of insulin detemir corresponds to 1 international unit of human insulin .
- The other ingredients are glycerol , phenol, metacresol, zinc acetate, disodium phosphate dihydrate, sodium chloride, hydrochloric acid , sodium hydroxide and water for injections.
What the medicine looks like and contents of the pack
Levemir is a solution for injection.
Pack sizes: 1 (with or without needles), 5 (without needles), and 10 (without needles) 3 ml pre-filled pens. Not all pack sizes may be marketed.
Marketing Authorization Holder and Manufacturer
Marketing Authorisation Holder
Novo Nordisk A / S, Novo Allé, DK-2880 Bagsværd, Denmark
Manufacturer
The manufacturer can be identified by the number of the batch (Lot) printed on the tab on the carton and the label:
- If the second and third characters are S6, P5, K7, R7, VG, FG or ZF, the manufacturer is Novo Nordisk A / S, Novo Allé, DK-2880 Bagsværd, Denmark
- If the second and third characters are H7 or T6, the manufacturer is Novo Nordisk Production SAS, 45 Avenue d’Orléans, F-28000 Chartres, France.
Turn the sheet over and read the instructions for using FlexPen.