Switching From Levemir to Another Basal Insulin

What happened to Levemir

Novo Nordisk announced in November 2023 that it would stop selling Levemir (insulin detemir) in the United States. The FlexPen was discontinued on 1 April 2024 and the vial on 31 December 2024. The company cited manufacturing constraints, lost insurance coverage and the availability of other basal insulins. It was a business decision, not a safety problem with the medicine. Outside the US, availability varies by country.

Anyone still using Levemir, or restarting basal insulin after a gap, now needs a different long-acting insulin. The switch itself is routine, but the starting dose depends on how Levemir was being taken.

Starting doses when switching from Levemir

Typical starting points from prescribing information and pharmacist switching references. Your prescriber chooses the dose; many start lower if lows have been a problem.

Why twice-daily Levemir usually drops by a fifth

Levemir wears off sooner than glargine or degludec, so many people needed two doses a day to cover 24 hours. Moving that combined total to one flat, longer-lasting dose tends to lower glucose more than expected, especially overnight. Starting at about 80% and adjusting upwards over the next weeks avoids those early lows. Once-daily Levemir users usually switch unit-for-unit, because they were already on a single daily dose.

Worked example

Suppose you take Levemir 20 units in the morning and 16 units at bedtime: 36 units a day in two doses.

• Glargine U-100: 80% of 36 = 28.8, so about 29 units once daily. The Lantus dose calculator covers glargine dosing in more detail.
• Degludec: 29 to 36 units once daily. Dose changes should wait at least 3 to 4 days, because Tresiba takes that long to reach a steady level; the Tresiba dose calculator explains the titration.
• Toujeo: about 29 units once daily, often needing a gradual increase. The Toujeo dose calculator covers its higher-strength pen.
• NPH: about 29 units a day, split 19 units before breakfast and 10 at bedtime. The NPH insulin dose calculator works out this split.

Choosing a replacement

• Glargine U-100 is the most common replacement. Several brands and lower-cost biosimilars exist.
• Degludec lasts more than 42 hours, which allows some flexibility in dose timing from day to day.
• Glargine U-300 holds three times as much insulin per mL, which suits higher doses.
• NPH costs the least but peaks, so it carries more risk of overnight lows.

Insurance coverage often decides between options that are otherwise similar. In pregnancy, discuss the choice with your obstetric and diabetes team, since each insulin has a different amount of pregnancy safety data.

The first weeks after switching

Start the new insulin when your next Levemir dose would have been due, unless your prescriber gives a different time, and stop Levemir at that point. Check fasting glucose every morning for the first one to two weeks. Your prescriber adjusts the dose from those readings, usually every few days, until fasting glucose sits in your target range. Basal, mealtime and supply questions after a switch are covered by our post-switch insulin dose calculators.

Switching From Levemir: Limitations & Safety Notes

• Never switch insulin on your own. The starting doses here are typical, not individual prescriptions.
• Do not take Levemir and the new basal insulin on the same day unless told to; the overlap doubles background insulin.
• Children, older adults and people with kidney disease often start lower.
• Watch for lows in the first week, especially overnight, and treat them promptly.

Frequently Asked Questions: Switching From Levemir