Insulin Detemir

Insulin detemir is a long-acting basal insulin analog used for background glucose control.

It provides steady insulin levels but may require once- or twice-daily dosing depending on patient needs.

→ Insulin Therapy

Detemir binds to the insulin receptor (tyrosine kinase receptor).

This activates:

• IRS signaling pathways
• PI3K/Akt cascade
• GLUT4 translocation in muscle and adipose tissue

Primary basal effect:

• Suppresses hepatic gluconeogenesis
• Provides steady background insulin

Detemir differs from human insulin by:

• Removal of threonine at B30
• Addition of a fatty acid side chain to B29 lysine

After injection:

• Binds reversibly to albumin in subcutaneous tissue and plasma
• Slows systemic absorption
• Prolongs duration of action

Albumin binding is the key mechanism of its extended effect.

Onset:

• ~1–2 hours

Peak:

• Minimal peak

Duration:

• 12–24 hours (dose-dependent)

Compared to:

• Glargine → shorter duration
• Degludec → significantly shorter duration

Some patients require twice-daily dosing.

• Basal insulin in Type 1 Diabetes
• Basal insulin in Type 2 Diabetes

Often combined with:

• Rapid-acting insulin
• Metformin
• GLP-1 Receptor Agonists
• SGLT2 Inhibitors

• Lower variability compared to NPH
• Less nocturnal hypoglycemia than NPH
• Less weight gain compared to some basal insulins
• Predictable pharmacokinetics

• Hypoglycemia
• Weight gain (generally modest)
• Injection site reactions

NPH:

• Clear peak
• Higher hypoglycemia risk

Glargine:

• Longer duration
• Once-daily dosing in most patients

Degludec:

• Ultra-long duration (>42 hours)
• Most stable profile

Detemir:

• Albumin binding mechanism
• May require twice-daily dosing
• Lower weight gain profile

• Long-acting basal insulin
• Albumin binding prolongs effect
• May need twice-daily dosing
• Lower hypoglycemia risk than NPH
• Used in basal-bolus regimens

• Insulin Therapy
• Glargine
• Degludec
• NPH
• Diabetes Pharmacology