Levemir (insulin detemir) is a long-acting basal insulin analog approved by the FDA in 2005. It is administered via subcutaneous injection and mimics the function of natural insulin, facilitating glucose uptake by cells in muscle and adipose tissues and promoting hepatic glucose output, effectively lowering blood sugar levels throughout the day. Levemir assists patients with Type 1 and Type 2 diabetes in managing their condition.
Levemir vs. Basaglar: A Comparison
Basaglar is another brand name for a long-acting insulin medication called insulin glargine. It is primarily used to manage blood sugar levels in people with diabetes, particularly in adults and children about the age of 6 with Type 1 diabetes, and adults with Type 2 diabetes. While both Levemir and Basaglar are long-acting insulin medications formulated to lower glucose blood levels in patients with diabetes, their active ingredients, peak times, and dosages differ. Levemir contains insulin detemir, while Basaglar contains insulin glargine.
Let's compare Levemir vs Basaglar in terms of approved uses, effectiveness, side effects, drug administration, and costs to find out which of the two might be considered better basal insulin.
| Feature | Levemir (Insulin Detemir) | Basaglar (Insulin Glargine) |
|---|---|---|
| Active Ingredient | Insulin detemir | Insulin glargine |
| FDA Approved Uses | Type 1 & 2 Diabetes (not for diabetic ketoacidosis) | Type 1 & 2 Diabetes (not for diabetic ketoacidosis) |
| Effectiveness (HbA1c Reduction) | Adults (0.1% - 0.8% Type 1, 0.6% - 2% Type 2), Children (variable) | Adults (0.35% Type 1), Comparable to Lantus |
| Weight Gain | May cause some, lower than Basaglar in studies | May cause some |
| Common Side Effects | Low blood sugar, injection site reactions, weight gain, edema, headache, upset stomach, rash/itching, flu-like symptoms, allergic reactions | Low blood sugar, injection site reactions, diarrhea, weight gain, edema, rash/itching, blurred vision, flu-like symptoms |
| Dosage Form | Prefilled pen (FlexTouch) or vial | Single-use pens (KwikPen, Tempo Pen) |
| Cost per Unit | ~$11.99 | ~$23.54 |
| Availability | Discontinued after December 2024 | Available |
Levemir and Weight Loss: Examining the Connection
While neither Levemir nor Basaglar is FDA-approved for weight loss, some studies suggest Levemir may offer some weight loss benefits. However, it is important to note that both medications list weight gain as one of the potential side effects.
Clinical trials have shown that patients with type 1 diabetes who were administering Basaglar gained up to 0.36 kg (around 1 pound) in the first 6 months of the treatment, and patients with Type 2 diabetes noted 1.8 kg (4 lbs) weight gain in the same window of time. In studies comparing Levemir and Basaglar in regards to potential weight gain, the former showed lower weight gain than the latter.
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Weight gain with insulin therapy is partly attributable to reversal of the negative energy balance associated with glycosuria and partly attributable to potent anabolic effects on peripheral tissues. Furthermore, hypoglycaemia is a stimulus for increased energy intake.
Clinical Trial Evidence
The weight advantages observed in clinical trials with Levemir were further validated by a sub-group analysis of the PREDICTIVE 303 study. This study found that diabetes patients switched to Levemir from standard NPH insulin or insulin glargine (Lantus, Sanofi-Aventis) actually lost weight.
In a 24-month study in Type 1 diabetes, patients in the NPH + IAsp group gained an average of 2.7 kg in body weight, compared with a 1.7 kg increase in the Levemir + IAsp group. The PREDICTIVE 303 analysis also provided further evidence of Levemir’s weight advantage over other basal insulins. In patients switched from Lantus to Levemir, mean body weight dropped from 98.9 kg at baseline to 98.2 kg at 26 weeks, and in the NPH to Levemir group, it came down from 97.2 kg to 95.7 kg.
Potential Mechanisms Behind Levemir's Weight-Sparing Effect
Clinical studies have shown that insulin detemir, a basal insulin analogue, exerts a unique weight‐sparing effect compared with other basal insulins. While the precise mechanism remains unclear, it is likely that the weight‐sparing effect of insulin detemir can be explained by a combination of mechanisms. Several hypotheses have been proposed to understand this property, exploring the interplay of efferent and afferent signals between the muscles, brain, liver, renal and adipose tissues in response to insulin detemir and comparator basal insulins.
These include:
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- Central Nervous System (CNS) Effects: Insulin detemir may reduce food intake through direct or indirect effects on the central nervous system (CNS).
- Hepatic Glucose Metabolism: It may have favorable actions on hepatic glucose metabolism through a selective effect on the liver.
- Renal Effects: It may influence fluid homeostasis through renal effects.
Studies have consistently shown that insulin detemir reduces energy intake, and moreover, it is clear that this shift in energy balance is not a consequence of reduced hypoglycaemia.
Impact on Food Intake and Appetite
The effect of insulin detemir on reduction of food intake was investigated in a 32‐week, randomized, crossover trial in people with T1D (n = 23) . Subjects received insulin detemir or NPH insulin as part of a basal‐bolus regimen for 16 weeks and then the alternative treatment. Several outcomes were assessed, including total energy expenditure, resting energy expenditure, diet‐induced thermogenesis, activity energy expenditure, energy intake, weight change, hypoglycaemia (<3.1 mmol/l), glycaemic control, and satiety and fuel partitioning‐related hormones. Insulin detemir significantly reduced body weight by 0.69 kg compared with a weight gain of 1.7 kg with NPH insulin (p < 0.001). No differences were reported in energy expenditure, glycated haemoglobin (HbA1c) concentration or rate of hypoglycaemia, but energy intake, based on a 7‐day food diary, was significantly lower with insulin detemir than with NPH insulin (2016 kcal/day vs 2181 kcal/day; p = 0.02).
In another animal‐based study, Vasselli et al. investigated the feeding- and body weight-inhibitory effects for 5 days after single equimolar doses of insulin detemir or regular human insulin administered directly via microinjection into the brain (third ventricle) of normal Sprague-Dawley rats. Although both treatments reduced food intake significantly over 2 days [by 20-35% compared with the control (p < 0.01)], the reduction was significantly greater with insulin detemir than with regular human insulin (p < 0.01) and was dose‐dependent using 0.5, 1.0 and 2.0 mU/rat (corresponding to doses of regular human insulin of 4.0, 8.0 and 16.0 mU/rat).
Insulin Signaling in the Brain
Several lines of evidence show that insulin signalling in the brain plays a key role in weight control. IRs are abundant in satiety and appetite‐controlling regions of the brain, such as the hypothalamus , and downregulation of brain IRs has been associated with hyperphagia and impaired insulin‐mediated suppression of endogenous glucose production . Furthermore, direct injection of insulin into the brain reduces food intake .
Hennige et al. hypothesized that insulin signalling in the brain may be different with insulin detemir compared with human insulin. They examined this with a study of the impact of insulin detemir (2.4 mmol/l) versus human insulin (0.6 mmol/l) on the insulin signalling cascade in both brain (hypothalamic and cerebrocortical regions) and peripheral (liver and muscle) tissues in C57Bl/6 mice. Insulin detemir was injected via a non‐clinically relevant route directly into the inferior vena cava to avoid the effect of altered subcutaneous absorption kinetics. In muscle and liver, both insulin detemir and human insulin displayed equal activation/phosphorylation of the IR signalling cascade at several time points ranging from 2 to 30 min post‐injection, suggesting that insulin detemir does not alter peripheral IR signalling kinetics; however, in hypothalamic tissue, activation/phosphorylation of both the IR and the IR substrate 2 was significantly elevated, and occurred earlier, with insulin detemir than with human insulin. Similar results were obtained in cortical tissue.
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Side Effects of Levemir
Levemir can cause side effects that range from mild to serious. Examples include weight gain and sore throat. Common side effects of Levemir include:
- Upper respiratory infection, such as the common cold
- Headache
- Back pain or abdominal pain
- Sore throat
- Low blood sugar
Serious side effects that have been reported with Levemir include:
- Severe low blood sugar
- Low potassium levels
- Allergic reaction
Levemir and Weight Gain
Levemir may cause weight gain. This is a common side effect of all forms of insulin. Studies have shown that Levemir can cause small weight increases in people with type 1 or type 2 diabetes. But it causes less weight gain than other types of long-acting insulin.
If you have weight gain while using Levemir and you’re concerned, talk with your doctor. They can suggest ways to manage your weight, such as moderate exercise and eating a diet that’s healthy for you.
Important Considerations
Levemir Discontinuation
In 2023, Novo Nordisk, a Levemir producer, decided to discontinue the medication. After December 2024, Levemir will be unavailable for purchase. Therefore, patients currently using Levemir should talk to their doctor about other options to include in their diabetes management plan.
Potential Drug Interactions
Medicines that interact with Levemir may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Levemir. It is important to speak with your doctor about how drug interactions should be managed.
Usage During Pregnancy and Breastfeeding
Studies have shown Levemir to be safe for use during pregnancy. Diabetes during pregnancy can increase your risk of serious health complications, including the risk of pregnancy loss. Levemir and other types of insulin have been found in breast milk. But there are no reports in studies of Levemir that the drug caused harmful effects to children who are breastfed.