Levemir (insulin detemir) is a long-acting basal insulin developed by Novo Nordisk and approved by the FDA in 2005. It is dosed once or twice daily for basal insulin coverage in adults and pediatric patients with type 1 (T1D) or type 2 diabetes (T2D). Novo Nordisk announced in late 2023 that Levemir would be discontinued in the United States, with the FlexTouch pen ending in April 2024 and the vial in December 2024. Patients currently using Levemir need to plan a transition to an alternative basal insulin.
What Levemir Is
Levemir contains insulin detemir, a long-acting human insulin analog. Detemir’s defining structural feature is a fatty acid (myristic acid) attached to the insulin B-chain, which allows it to bind reversibly to albumin in subcutaneous tissue and the bloodstream. This binding slows release and provides a more predictable, less peaked profile than older basal insulins like NPH. Detemir is approved for once or twice-daily dosing depending on individual response and total dose required.
The U.S. Discontinuation
In November 2023, Novo Nordisk announced it would discontinue Levemir in the United States by the end of 2024. The FlexTouch pen ended in April 2024, and the vial supply ended in December 2024. Novo cited several factors: declining patient demand as longer-acting and once-daily alternatives took market share, manufacturing constraints, and a strategic shift toward GLP-1 and other newer products. Levemir remains marketed in other countries. The discontinuation has been a significant clinical issue for several patient populations, including pregnant patients (where detemir has been a preferred basal insulin) and some pediatric users.
Indications and Pharmacology
Levemir was indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes (age 2 and older) and adults with type 2 diabetes. Per the Levemir prescribing information, onset of action is approximately 1 hour, with a relatively flat profile and a duration of action that ranges from 12 to 24 hours depending on dose (longer at higher doses). Many patients used Levemir twice daily because the duration at typical doses fell short of a full 24 hours.
| Property | Levemir (detemir) | Lantus (glargine U-100) | Tresiba (degludec) |
|---|---|---|---|
| Onset | ~1 hour | 1-4 hours | 1-4 hours |
| Peak | Minimal | None pronounced | None pronounced |
| Duration | 12-24 hours (dose-dependent) | ~24 hours | ~42 hours |
| Typical frequency | Once or twice daily | Once daily | Once daily |
| US availability | Discontinued (2024) | Available | Available |
Common Alternatives
The choice of replacement depends on the patient’s current Levemir dosing pattern and clinical situation. Common alternatives include:
- Insulin glargine U-100 (Lantus, Basaglar, Semglee): once-daily basal insulin with a flatter 24-hour profile. Switching is typically unit-for-unit when transitioning from twice-daily Levemir if total daily dose is preserved, but some patients need a 10 to 20 percent reduction.
- Insulin glargine U-300 (Toujeo): more concentrated, longer-duration glargine; often associated with lower nocturnal hypoglycemia rates.
- Insulin degludec (Tresiba): ultra-long-acting (42-hour duration), once-daily, with the most flexible dosing window of any basal insulin.
- Insulin glargine biosimilars: Semglee (interchangeable) and Basaglar (follow-on biologic) both work as basal insulins and can be used in place of Lantus.
Pregnant patients on Levemir need particularly careful planning, since detemir was extensively studied in pregnancy and was a preferred basal in many regimens. Discuss alternatives with a maternal-fetal medicine specialist or endocrinologist experienced in diabetes in pregnancy.
Side Effects
The most common side effects reported in Levemir clinical trials included hypoglycemia, weight gain (typically less than with NPH or glargine in some studies), injection site reactions, lipodystrophy with repeated injection in the same area, and rare allergic reactions. Hypoglycemia is the dose-limiting toxicity of any insulin. Hypokalemia can occur with insulin therapy. Detemir was associated with slightly less weight gain than glargine in some head-to-head comparisons, although the magnitude was modest.
Dosing Considerations During Transition
If you are switching from Levemir to another basal insulin, your prescriber will typically:
- Calculate your total daily Levemir dose (sum of morning and evening if dosed twice daily).
- Use a unit-for-unit conversion to glargine U-100 or degludec, then adjust based on the dosing schedule and your hypoglycemia history.
- Switch from twice-daily Levemir to once-daily glargine or degludec, often with a 10 to 20 percent dose reduction to avoid early hypoglycemia.
- Recommend more frequent home glucose monitoring or continuous glucose monitor use for 1 to 2 weeks after the switch.
For broader treatment guidance, see our treatment hub, and for information on monitoring response, the A1C levels guide.
What to Do If You Currently Use Levemir
The most important step is to schedule an appointment with your prescriber as soon as possible to plan the transition. Do not wait until your last refill runs out — finding the right alternative and stabilizing on it can take several weeks. Pharmacy inventory may vary by region, but residual stock has been working through the system into 2025. Carry a wallet card or note on your phone listing your current Levemir dose so any clinician you see has the information.
The Bottom Line
Levemir was a useful long-acting basal insulin for nearly two decades, particularly valued for its predictable profile and applicability in pregnancy and pediatrics. Novo Nordisk’s 2023 announcement of US discontinuation, completed by the end of 2024, has required all current users to transition. Common alternatives include Lantus, Basaglar, Semglee, Toujeo, and Tresiba. Work with your prescriber on the switch as soon as possible, monitor glucose closely during the first 1 to 2 weeks, and ensure you have stable coverage before the last Levemir pen or vial runs out.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, stopping, or changing any medication or treatment plan.
