Levemir, a Long-Acting Insulin, Will Be Discontinued

Final week, Novo Nordisk introduced that it plans to discontinue gross sales of Levemir in america. Individuals with diabetes who use Levemir ought to plan now on transitioning to an alternate.

Levemir is available in two varieties, a vial and a “FlexPen.” FlexPen customers must change first: The producer states that offer disruptions will start in mid-January 2024 and that the treatment shall be discontinued totally by April 1, 2024. Those that use Levemir in a vial have an extended time to transition: Vials could also be accessible till the tip of 2024.

Why is Levemir going away? In a press release, the producer defined that Levemir can be discontinued “resulting from world manufacturing constraints, formulary losses impacting affected person entry, and the provision of other choices.”

It’s doable that Levemir gross sales have flagged after the introduction of quite a lot of lower-cost variations of a rival basal insulin, insulin glargine. Levemir prescriptions have dropped 23 % previously yr, based on SingleCare, a web-based prescription financial savings service.

Additionally it is doable that Novo Nordisk needs to boost gross sales of its different (costlier) long-acting insulin, Tresiba. Or maybe the pharmaceutical big desires to commit extra of its manufacturing capability to the blockbusters Ozempic and Wegovy, which are available an identical injector pen machine.

On social media, some members of the diabetes group responded with skepticism. The nonprofit 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 large number of purple tape and better prices.

Regardless of the causes, this text will attempt to assist make sense of the transition that Levemir customers could have to take.

Various Choices for Kind 1 Diabetes

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

• Lantus (insulin glargine) — The nation’s best-selling long-acting insulin
• Basaglar (insulin glargine) — Another that’s primarily similar to Lantus
• Rezvoglar (insulin glargine) — A “biosimilar” that’s primarily similar to Lantus
• Semglee (insulin glargine) — A “biosimilar” that’s primarily similar to Lantus
• Toujeo (insulin glargine) — A brilliant-concentrated type of insulin glargine, the 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 better danger of hypoglycemia.

It’s necessary to talk to your physician (and work along with your insurer) to be taught which insulins can be inexpensive and work finest for you. Cheaper unbranded options may be accessible.

Levemir’s discontinuation may 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 Drugs has printed a sensible steering for healthcare practitioners on find out how to change basal insulins safely. In lots of instances, basal insulin dosages look like completely interchangeable between formulations, which means that you just gained’t want to alter the quantity of insulin you’re taking when switching. However the steering states that “dose adjustment could also be wanted if switching from detemir to glargine,” which shall be related to the big variety of folks switching from Levemir to any insulin within the Lantus household. Specialists advocate performing further blood glucose monitoring throughout the first weeks of transition.

Particular warning is required when switching from Levemir to NPH, which has a really totally different motion curve.

Any change of insulins ought to be completed solely below the steering of your medical group. The Diabetes Day by day discussion board can also be full of excellent recommendation from those who have switched insulin formulations previously.

Various Choices for Kind 2 Diabetes

Individuals with kind 2 diabetes who require a basal insulin could also be suggested to modify to an alternate insulin listed within the earlier part.

Clinicians could wish to take into account noninsulin options, too. Lately, kind 2 diabetes authorities have systematically deemphasized the usage of insulin in favor of each GLP-1 receptor agonists and SGLT2 inhibitors, newer drugs that may assist enhance excessive blood sugars however add further advantages that insulin can not: weight reduction, coronary heart and kidney safety, and a lowered danger of hypoglycemia.

Novo Nordisk’s personal GLP-1, semaglutide (Ozempic), has shortly turn into the world’s greatest diabetes and weight reduction blockbuster, and lots of clinicians are transitioning their sufferers away from insulin and onto Ozempic or comparable medicine corresponding to dulaglutide (Trulicity) or tirzepatide (Mounjaro). Insulin has more and more been seen as a final resort for folks with kind 2 diabetes: It could be time to debate noninsulin options along with your medical supplier.