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May 27, 2005

Insulin Analogs

Question from Pennsylvania, USA:

The insulin Detemir is referenced in books and reportedly was approved by the FDA. Do you know when it will be available? When using Detemir, I have a few questions: Will the dose for Detemir be the same as the current dose of Lantus? Should the total dose of Detemir be split between morning and night or given the same time, once, like Lantus? I understand that Detemir can be mixed with Humalog and NPH in the same syringe. Is this true? My son currently does Humalog and NPH at breakfast (one shot) and Humalog and Lantus at dinner (two shots) Have you started using Detemir? What is your opinion on this new insulin?

Answer:

I do not know when Detemir will be commercially available. I live in Italy and have some patients that use Detemir, buying this insulin in Switzerland, where it has been available for about one year.

The dose for Detemir will usually be the same as the current dose of Lantus, but I think each patient have to discuss this topic with his/her diabetes team.

Detemir will last usually 12 hours, so it is necessary to split its dose between morning and night.

Detemir can be mixed with Humalog and NovoLog, but it does not make sense to mix it with a NPH insulin. In my experience, however, I have mixed Lantus with Humalog or NovoRapid or rapid acting insulin, such as Actrapid or Humulin R also if “off label.” The reason is because the different pH of the two insulins make precipitate in the solution if the preparation stays in the syringe too long. But, if you inject the preparation as soon as you have done it, there is no problem.

In my experience, I have a few patients using Detemir as they used it in Switzerland. They have been successful using it.

AS