Be Ready to Help Patients Switch Insulin

You’ll get questions about how to switch patients off insulin detemir (Levemir)...since it will be discontinued in the US in 2024.

Anticipate supply disruptions of Levemir FlexPen soon...with market removal in April. Vials will be discontinued at year end.

Explain that it’s a business decision by the manufacturer...and reassure patients that the current supply is still safe to use.

Be ready to navigate common insulin switching scenarios...and individualize plans with patients and prescribers.

Long-acting to long-acting. Recommend the same daily dose when switching from insulin detemir to insulin glargine U-100 (Basaglar, Lantus, Semglee, etc) or insulin degludec (Tresiba).

Be aware of differences with insulin glargine U-300 (Toujeo). For example, for patients on insulin detemir twice daily, reduce the daily dose by 20% and give insulin glargine U-300 once daily.

If switching to insulin degludec or glargine U-300, don’t increase the dose more often than every 3 to 4 days...since they’re longer acting.

Keep in mind that sometimes insulin glargine U-100 may need to be given twice daily instead of once daily to maintain glycemic control.

Long-acting to NPH. Suggest the same daily dose when switching from insulin detemir or glargine U-100...and dividing the NPH dose twice daily.

If switching from insulin degludec or glargine U-300, consider reducing the daily dose by 20% and dividing the NPH dose twice daily.

For any insulin change, prepare patients for blood glucose changes.

If the patient has a history of hypoglycemia, err on the side of caution and decrease the daily dose by limit hypoglycemia risk.

Advise close monitoring of blood glucose...and titrate the insulin dose if needed after a switch.

Get our resource, How to Switch Insulin Products, for more details about switching between other insulins (70/30, U-500, regular, etc).

Key References

  • Mehta R, Goldenberg R, Katselnik D, Kuritzky L. Practical guidance on the initiation, titration, and switching of basal insulins: a narrative review for primary care. Ann Med. 2021 Dec;53(1):998-1009.
  • Diabetes Disaster Response Coalition. Information for health care professionals. Switching between insulin products in disaster response situations. Approved by the American Diabetes Association, the Endocrine Society, and JDRF. August 2020. (Accessed November 30, 2023).
  • FDA. Information regarding insulin storage and switching between products in an emergency. Content current as of September 19, 2017. (Accessed December 11, 2023)
Pharmacist's Letter. January 2024, No. 400104

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