Long-acting insulin derivatives are currently the primary basal insulin in the multiple injection therapy of insulin-dependent diabetes. The effect of basal insulin is always individual and dependent on the dose. Different long-acting insulin derivatives do not always have the same effect per unit. If the basal insulin product is changed, it may be necessary to increase or decrease the dose by 10% to 20%.
Long-acting insulin derivatives
Long-acting insulin derivatives include insulin degludec, insulin detemir and insulin glargine.
Insulin detemir has an onset of action of 1–2 hours and duration of action of 12–24 hours, depending on the dose. The effect is relatively even. Some people may experience a slight peak effect 6–8 hours after injecting.
Insulin detemir is usually taken twice a day, approximately every 12 hours, in the morning or before noon and then again around 21-23. Initially, the doses are normally of the same size, i.e. the amount of insulin required for the day (for example, 16 units) is divided between morning (8 units) and evening (8 units). The doses and their injection times are adjusted on the basis of glucose sensor or blood sugar self-measurement. Often, less insulin is required at night than during the day, so when dividing an odd number (e.g., 17 units), the morning dose should be bigger (9 units) than the evening dose (8 units), for example.
The brand name of insulin detemir is Levemir® (10/2023).
Insulin glargine 100 units/ml has an onset of action of 2–4 hours and a typical duration of action of 20–24, even 26 hours. The effect is relatively even. Some may experience a slight peak effect.
Insulin glargine 100 units/ml is usually recommended to be taken in the evening so as to reach the insulin's maximum effect in the morning when the need for insulin is high.
The brand names of 100 units/ml insulin glargine products are Abasaglar® and Lantus® (10/2023).
Insulin glargine 300 units/ml has an onset of action of 2–4 hours and a duration of action of 24–36 hours. The effect is even: most people do not experience a peak effect.
Insulin glargine 300 units/ml is injected once a day. The injection can take place at any time of the day but, ideally, it should be roughly within few hours of the same time every day. The product strength is 300 units/ml. When using an insulin pen, units are dosed out as normal. However, the volume of the insulin dose is a third of the 100 units/mL strength. This is significant, specifically with regard to large insulin doses.
The brand name of 300 units/mL insulin glargine product is Toujeo® (10/2023).
Insulin degludec has an onset of action of 3-4 hours and duration of action of 33–42 hours. It is the longest-acting of basal insulins. An adjustment of the dose is evident in blood sugar within roughly 3 days. If necessary, there can be some flexibility regarding the time insulin degludec is injected from day to day. The time between injections is 8 hours at the minimum and 40 hours at the maximum.
Insulin degludec is available in two different strengths. There is no material difference in their effects. The volume of the stronger 200 units/ml product is half of the volume of the 100 units/ml product.
The brand name of insulin degludec is Tresiba® (10/2023).
Updated 11.10.2023