How does Levemir work?

William Lee Dubois
Endocrinology Diabetes & Metabolism

Super-quick history lesson: back in the day, we only had animal insulin. It was harvested from the pancreases of cows and pigs at slaughter houses and then purified (genetically made human insulin has replaced animal insulins in the US, avoiding the buildup of anti-bodies against animal hormones in your body which lead to tissue death at the injection site). It took 30 minutes to an hour to start working, so people had to take it long before meals, and it was gone from the body in about eight hours, so it wouldn’t carry you overnight.

The solution to the lack of overnight coverage using traditional insulin was solved with a “bubble-wrapped” insulin, called NPH. Think of it like little drops of insulin wrapped in a coating that slowly dissolved, letting the insulin work for 14 hours or so.

The problem with NPH was that it looked a bit like the first leg of a rollercoaster, it had a high peak and a long tail. The timing of long acting shots for nighttime, and between meals during the day, along with regular insulin for meal coverage, became a dangerous dance of overlapping action curves with risks for both highs and lows.

Scientists realized that those of us with diabetes need a true “basal” insulin, something that would last all day and have a flat action profile. The first breakthrough in this area was Lantus. You can think of Lantus as the pinnacle of technology in bubble wrapped insulin.

Levemir is the newest kid on the block in modern insulins. It is also a basal insulin, and  is designed to act slowly, flatly, and for long periods of time. But instead of being micro-encapsulated for absorption at the injection site, it is absorbed into the blood where is uses the magic of molecular biology to slowly evolve into an active state.

In theory, Levemir should have a flatter profile that Lantus, but in actual practice it depends on their person. Most study data shows that Levemir has a mild hump to it, however in clinical practice I’ve noticed that it seems to run smoother than Lantus does in our patients.

Levemir also has a reputation for not lasting quite a long as Lantus, and this is true. Lantus generally gives most people a full 24 hours, while Levemir can run anywhere from 18 to 22 hours—so it often requires two shots. While some regard this as a minus, I actually think it is a plus. The need to take two shots opens the possibility of making the two shots different volume. Taking two differently sized shots allows you to better match your medicine to you needs.

Insulin is a natural hormone made by our bodies to take glucose (sugar) from the blood and send it to cells in the body to provide energy. After eating, the blood glucose level rises and the pancreas sends out insulin to take the sugar to the cells. People with diabetes either do not make insulin or cannot properly utilize the insulin their bodies make. High blood sugar creates health problems and may make the individual feel fatigued and thirsty. Levemir (insulin detemir) is a synthetic (man-made) long-lasting, basal insulin that provides a constant supply of insulin during the day and night to help control fluctuating glucose levels.


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