Insulin Levemir is indicated to regulate blood glucose levels in patients that require long acting insulin. Patients that are using Levemir have been diagnosed with diabetes mellitus type 1 (adults and children), or type 2 (adults only) (4). Diabetes Mellitus (DM) is an endocrine problem that results on increased levels of blood sugar, or hyperglycemia, due to diverse factors such as a decrease in the secretion of insulin, increase in the secretion of glucose, and decrease of glucose utilization(1). DM is present in 7% of the US population, and it is expected to double by 2030. There are two broad classifications of diabetes mellitus, type 1 and type 2.
Type 1 DM is denominated as insulin-dependent, and it accounts for 10% of the diabetes diagnosis in the USA (2). There is an increase in the incidence of the disease worldwide at the rate of 3-4 %( 1). In the US, the incidence is at an average of 16 per 100,000. Type 1 DM can develop at any age, but it is more common at early ages, mainly around puberty (3). It is characterized by the autoimmune destruction of pancreatic beta cells, which are responsible for insulin secretion (1). This leads to practically absent insulin blood levels and increased glucagon levels (3). Type 1 DM results from genetic, environmental, or autoimmune factors. Patients that have relatives with DM type 1 are prone to developing the disease in their lifetime (3). Genetically predisposed patients are born with a normal number of pancreatic beta cells, but lose them because of autoimmune destruction. Autoimmunity can also be triggered by an environmental or an infectious stimulus, such as a viral infection, bovine milk proteins, and nitrosourea compounds (1). T-lymphocytes are responsible of penetrating pancreatic islets and destroying beta cells, a process called insulitis (3). Features of the disease are not noticeable until about 80% of the total beta cells are destroyed (1). DM type 1 is insulin dependent, meaning that patients require daily doses of insulin to regulate their blood sugar. Levemir should be approximately one third of the total insulin daily dosages, divided into two daily doses (0.2 to 0.6 units/kg total). The remaining two thirds should be completed by using rapid-acting or short acting insulin (6).
Type 2 DM is denominated as insulin-resistant or non-insulin dependent, and it accounts for 90% of all diabetes diagnosis in the USA (2). There is a global increase in the prevalence of the disease, more noticeably in developed countries. The USA ranks third in the world’s list of countries with the highest number of diabetic patients (8). DM type 2 can develop because of the relative deficiency of insulin secretion, and the resistance to insulin of target tissues. It can be also caused by the excessive glucose production by the liver, and defective fat metabolism. The development of DM type 2 is a combination of genetic and environmental factors (physical activity, diet, and obesity). Environmental factors may act as triggers in a genetically predisposed person. More than 80% of patients with DM type 2 present obesity, and most of them are in their adulthood. The two main features that lead to the development of DM type 2 are insulin resistance and insulin impaired secretion, and they are both genetically predisposed (1). Insulin resistance is the inappropriate sensitivity/uptake of insulin by tissues. The tissues that are most affected in type 2 DM are the liver, skeletal muscle, and adipose tissue (8). Pancreatic beta cells increase insulin production in response to resistance, leading to a hyperinsulinemic state. However, insulin secretion is still insufficient, and beta cells become eventually atrophied (1). Beta cells not being able to compensate for insulin insensitivity is what ultimately leads to the development of diabetes type 2. At the beginning of the disease, there is no insulin requirement. It is usually treated with anti-hyperglycemics, such as metformin. As the insulin secretion capacity of beta cells diminishes, insulin becomes a requirement in the treatment in order to maintain appropriate glucose levels (3). The recommended dose in combination therapy (metformin + insulin Levemir) is of 0.1 or 0.2 units per kg once daily.
In general, insulin requirements vary from patient to patient. Diabetic patients taking insulin require constant patient monitoring and frequent medical supervision and adjustment. To avoid the potential for hypoglycemia treatments must be individualized based on the patient lifestyle, diet, response to insulin, weight, renal problems, and age (6).
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