Levemir, a Long-Acting Insulin, Will Be Discontinued

Last week, Novo Nordisk introduced that it plans to discontinue gross sales of Levemir within the United States. People with diabetes who use Levemir ought to plan now on transitioning to an alternate.

Levemir is available in two kinds, a vial and a “FlexPen.” FlexPen customers should change first: the producer states that offer disruptions will start in mid-January 2024 and that the medicine can be discontinued completely by April 1, 2024. Those who use Levemir in a vial have a longer time to transition: vials could also be out there till the top of 2024.

Why is Levemir going away? In a assertion, the producer defined that Levemir can be discontinued “due to global manufacturing constraints, formulary losses impacting patient access, and the availability of alternative options.”

It is feasible that Levemir gross sales have flagged after the introduction of a number of lower-cost variations of a rival basal insulin, insulin glargine. Levemir prescriptions have dropped 23 % within the final 12 months, in keeping with SingleCare, a web-based prescription financial savings service.

It can be attainable that Novo Nordisk needs to reinforce gross sales of its different (costlier) long-acting insulin, Tresiba. Or maybe the pharmaceutical large needs to dedicate extra of its manufacturing capability to the blockbusters Ozempic and Wegovy, which are available in a related injector pen system.

On social media, some members of the diabetes neighborhood responded with skepticism. The non-profit T1International known as the transfer “indefensible.” Others commented that Levemir was the one basal insulin on their insurance coverage formulary, and feared that the change would imply a mess of pink tape and better prices.

Whatever the explanations, this text will attempt to assist make sense of the transition that Levemir customers could have to make.

Alternative Options for Type 1 Diabetes

For folks with sort 1 diabetes, who’ve an absolute want of insulin, Levemir customers will undoubtedly have to change to a different long-acting insulin. Here are the choices:

• Lantus (insulin glargine) — The nation’s best-selling long-acting insulin
• Basalgar (insulin glargine) — An various that’s basically equivalent to Lantus
• Rezvoglar (insulin glargine) — A “biosimilar” that’s basically equivalent to Lantus
• Semglee (insulin glargine) — A “biosimilar” that’s basically equivalent to Lantus
• Toujeo (insulin glargine) — a super-concentrated type of insulin glargine, that energetic ingredient in Lantus, primarily used for sufferers that require bigger doses
• Tresiba (insulin degludec) — Novo Nordisk’s different long-acting insulin, Tresiba lasts even longer than Levemir, which can improve dose timing flexibility
• NPH (isophane insulin) — an intermediate-acting insulin. NPH is cheap however tougher to make use of than Tresiba and should include a larger danger of hypoglycemia.

It’s necessary to talk to your physician (and work together with your insurer) to be taught which insulins can be reasonably priced and work greatest for you. Less costly unbranded alternate options might also be out there.

Levemir’s discontinuation might also be an opportune time to debate an insulin pump, which makes use of solely fast insulin.

Switching Insulins

Most sufferers switching from Levemir (insulin detemir) will start utilizing insulin glargine (Lantus and its many equivalents) or insulin degludec (Tresiba).

The Annals of Medicine has revealed a sensible steering for healthcare practitioners on easy methods to change basal insulins safely. In many instances, basal insulin dosages seem like completely interchangeable between formulations, which means that you simply received’t want to vary the quantity of insulin you’re taking when switching. But the steering states that “dose adjustment may be needed if switching from detemir to glargine,” which can be related to the massive variety of folks switching from Levemir to any insulin within the Lantus household. Experts suggest performing further blood glucose monitoring in the course of the first weeks of transition.

Special warning is required when switching from Levemir to NPH, which has a very completely different motion curve.

Any change of insulins ought to be completed solely underneath the steering of your medical workforce. The Diabetes Daily discussion board can be full of excellent recommendation from people who have switched insulin formulations previously.

Alternative Options for Type 2 Diabetes

People with sort 2 diabetes who require a basal insulin could also be suggested to change to an alternate insulin listed within the earlier part.

Clinicians could wish to think about non-insulin alternate options, too. In latest years, sort 2 diabetes authorities have systematically de-emphasized the usage of insulin in favor of each GLP-1 receptor agonists and SGLT2 inhibitors, newer medicines which might help enhance excessive blood sugars however add further advantages that insulin can’t: weight reduction, coronary heart and kidney safety, and a lowered danger of hypoglycemia.

Novo Nordisk’s personal GLP-1, semaglutide (Ozempic), has shortly change into the world’s largest diabetes and weight reduction blockbuster, and lots of clinicians are transitioning their sufferers away from insulin and onto Ozempic or related medicine reminiscent of dulaglutide (Trulicity) or tirzepatide (Mounjaro). Insulin has more and more been seen as a final resort for folks with sort 2 diabetes — it might be a good time to debate non-insulin alternate options together with your medical supplier.

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Read extra about GLP-1, insulin, insulin pumps, Intensive administration, Lantus, Levemir, low blood sugar (hypoglycemia), Novo Nordisk, SGLT-2, toujeo, Tresiba insulin.