Last week, Novo Nordisk announced that it plans to discontinue sales of Levemir in america. Individuals with diabetes who use Levemir should plan now on transitioning to another.
Levemir is available in two forms, a vial and a “FlexPen.” FlexPen users could have to modify first: the manufacturer states that provide disruptions will begin in mid-January 2024 and that the medication will likely be discontinued entirely by April 1, 2024. Those that use Levemir in a vial have an extended time to transition: vials could also be available until the tip of 2024.
Why is Levemir going away? In a statement, the manufacturer explained that Levemir can be discontinued “as a consequence of global manufacturing constraints, formulary losses impacting patient access, and the provision of different options.”
It is feasible that Levemir sales have flagged after the introduction of quite a lot of lower-cost versions of a rival basal insulin, insulin glargine. Levemir prescriptions have dropped 23 percent within the last yr, in line with SingleCare, a web based prescription savings service.
Additionally it is possible that Novo Nordisk wishes to boost sales of its other (costlier) long-acting insulin, Tresiba. Or perhaps the pharmaceutical giant desires to devote more of its manufacturing capability to the blockbusters Ozempic and Wegovy, which are available an analogous injector pen device.
On social media, some members of the diabetes community responded with skepticism. The non-profit T1International called the move “indefensible.” Others commented that Levemir was the one basal insulin on their insurance formulary, and feared that the switch would mean a large number of red tape and better costs.
Regardless of the reasons, this text will attempt to help make sense of the transition that Levemir users might have to make.
Alternative Options for Type 1 Diabetes
For individuals with type 1 diabetes, who’ve an absolute need of insulin, Levemir users will undoubtedly have to modify to a different long-acting insulin. Listed here are the choices:
- Lantus (insulin glargine) — The country’s best-selling long-acting insulin
- Basalgar (insulin glargine) — An alternate that is actually equivalent to Lantus
- Rezvoglar (insulin glargine) — A “biosimilar” that is actually equivalent to Lantus
- Semglee (insulin glargine) — A “biosimilar” that is actually equivalent to Lantus
- Toujeo (insulin glargine) — a super-concentrated type of insulin glargine, that energetic ingredient in Lantus, primarily used for patients that require larger doses
- Tresiba (insulin degludec) — Novo Nordisk’s other long-acting insulin, Tresiba lasts even longer than Levemir, which can enhance dose timing flexibility
- NPH (isophane insulin) — an intermediate-acting insulin. NPH is inexpensive but tougher to make use of than Tresiba and will include a better risk of hypoglycemia.
It’s essential to talk to your doctor (and work together with your insurer) to learn which insulins can be inexpensive and work best for you. Inexpensive unbranded alternatives might also be available.
Levemir’s discontinuation might also be an opportune time to debate an insulin pump, which uses only rapid insulin.
Most patients switching from Levemir (insulin detemir) will begin using insulin glargine (Lantus and its many equivalents) or insulin degludec (Tresiba).
The Annals of Medicine has published a practical guidance for healthcare practitioners on methods to switch basal insulins safely. In lots of cases, basal insulin dosages seem like perfectly interchangeable between formulations, meaning that you just won’t need to vary the quantity of insulin you’re taking when switching. However the guidance states that “dose adjustment could also be needed if switching from detemir to glargine,” which will likely be relevant to the big number of individuals switching from Levemir to any insulin within the Lantus family. Experts recommend performing extra blood glucose monitoring through the first weeks of transition.
Special caution is required when switching from Levemir to NPH, which has a really different motion curve.
Any change of insulins must be completed only under the guidance of your medical team. The Diabetes Every day forum can also be filled with good advice from those that have switched insulin formulations prior to now.
Alternative Options for Type 2 Diabetes
Individuals with type 2 diabetes who require a basal insulin could also be advised to modify to another insulin listed within the previous section.
Clinicians should want to consider non-insulin alternatives, too. Lately, type 2 diabetes authorities have systematically de-emphasized using insulin in favor of each GLP-1 receptor agonists and SGLT2 inhibitors, newer medications which will help improve high blood sugars but add additional advantages that insulin cannot: weight reduction, heart and kidney protection, and a reduced risk of hypoglycemia.
Novo Nordisk’s own GLP-1, semaglutide (Ozempic), has quickly change into the world’s biggest diabetes and weight reduction blockbuster, and plenty of clinicians are transitioning their patients away from insulin and onto Ozempic or similar drugs comparable to dulaglutide (Trulicity) or tirzepatide (Mounjaro). Insulin has increasingly been seen as a final resort for individuals with type 2 diabetes — it might be a very good time to debate non-insulin alternatives together with your medical provider.