Novo Touts Levemir as a 24-Hour Insulin

Nov 27, 2007

Novo Nordisk's Levemir, which came out about five years after sanofi-aventis's Lantus, constitutes about twenty percent of the long-acting basal insulin sold worldwide. Lantus, the only other long-acting insulin analogue, makes up the other eighty percent.

The disparity may be due in part to the perception that Levemir should be used twice daily, while Lantus is used only once daily. In 2006, sanofieven filed a suit, later rejected, claiming that Novo was falsely promoting Levemir as effective for 24 hours.

But now Novo Nordisk is adding the slogan "24/7" to its ads about Levemir (detemir), saying that they have plenty of data to prove that it's a 24-hour insulin after all. According to their review of ten studies pitting Levemir against Lantus, nine of the studies found that both insulins lasted at least 24 hours in patients with type 2 diabetes and nearly 24 hours in patients with type 1.

For another opinion on whether long-acting insulins are really long-acting, see Dr. Bernstein's article, "There is No 24-Hour Basal Insulin."


Dr. Zachary Bloomgarden of Mount Sinai School of Medicine, prescribes Levemir to his patients.

His type 2 patients generally take one shot a day, but some take it twice. His type 1 patients always take it twice a day. He finds that Levemir is very similar to Lantus, but notes that there is some evidence of lesser glucose variability with Levemir. Most interesting to Dr. Bloomgarden is Levemir's possible weight benefit, although he emphasizes that there is neither extremely strong evidence of this nor any good clinical head-to-head study.

Allen King, MD, our advisory board member, prescribes Levemir to his diabetic patients.

Most of his type 2 patients use Levemir once a day. In low doses and in type 1 patients, either Levemir or Lantus is used twice a day.

Clinically, Dr. King sees no difference in duration of action between Lantus and Levemir. He notes, however, that the literature suggests that Levemir has less variability of action compared to Lantus (and therefore less hypoglycemia when achieving lower glucose targets), and possibly less weight gain associated with its use.

Also, Levemir is approved for 42 days after the first use of the vial or pen, while Lantus is approved for only 28 days - a difference that may be important to patients using small daily doses. Dr. King adds that both Levemir and Lantus are decided improvements over NPH.

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Categories: Diabetes, Diabetes, Insulin, Lantus, Low Blood Sugar, Novo Nordisk, Professional Issues, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 29 November 2007

In Levemir's PI it states that Levemir can last up to 23.5 hours. In order for Levemir to last that long, you must increase the dose to 1.6 IUs/kg. When you increase the dose of Levemir, you increase the peak of Levemir making it closely resemble NPH. It also states that to convert a patient from Levemir to NPH, the patient must increase the dose by 48% suggesting that Levemir isn't as powerful as NPH. When converting a patient on BID NPH to QD Lantus, you must decrease the dose by 20% suggesting that Lantus is more powerful than NPH. Levemir is nothing but an expensive NPH.

Posted by CissiMae on 1 December 2007

You're right...Levemir is nothing but an expensive NPH. I tried Levemir for 2 weeks, felt sick, with high blood sugars (300-500) and high Levemir dosage (up to 50 units). I went back to Lantus at 30 units and have normal blood sugars now (90-120). Previous to Levemir, I took 25 units Lantus and started getting higher blood sugars, that is why I was changed to Levemir. Doc should have just highered my Lantus in the first place. Plus, I now take it in the a.m., instead of p.m., so if it peaks, it peaks when I am awake to take care of it. Levemir will not make it as far as I am concerned.

Posted by Anonymous on 10 December 2007

I love the sanofi-aventis reps posing as patients and/or someone who knows what they are talking about....pathetic. I am out of the industry now for a couple of years, but have been on Levemir since last summer. I know diabetes and know insulin. You guys are a joke. I hated sanofi-aventis back then and you guys have not changed my mind at all.

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