====== 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.

→ [[endocrine:insulin:start|Insulin Therapy]]

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===== Mechanism of Action =====

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

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===== Structural Modification & Protraction =====

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.

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===== Pharmacokinetics =====

Onset:
  * ~1–2 hours

Peak:
  * Minimal peak

Duration:
  * 12–24 hours (dose-dependent)

Compared to:

  * [[endocrine:insulin:glargine|Glargine]] → shorter duration
  * [[endocrine:insulin:degludec|Degludec]] → significantly shorter duration

Some patients require twice-daily dosing.

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===== Clinical Use =====

  * Basal insulin in Type 1 Diabetes
  * Basal insulin in Type 2 Diabetes

Often combined with:

  * Rapid-acting insulin
  * [[endocrine:biguanides:metformin|Metformin]]
  * [[endocrine:glp1:start|GLP-1 Receptor Agonists]]
  * [[endocrine:sglt2:start|SGLT2 Inhibitors]]

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===== Advantages =====

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

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===== Adverse Effects =====

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

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===== Detemir vs Other Basal Insulins =====

[[endocrine:insulin:nph|NPH]]:
  * Clear peak
  * Higher hypoglycemia risk

[[endocrine:insulin:glargine|Glargine]]:
  * Longer duration
  * Once-daily dosing in most patients

[[endocrine:insulin:degludec|Degludec]]:
  * Ultra-long duration (>42 hours)
  * Most stable profile

Detemir:
  * Albumin binding mechanism
  * May require twice-daily dosing
  * Lower weight gain profile

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===== Clinical Pearls =====

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

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===== Related =====

  * [[endocrine:insulin:start|Insulin Therapy]]
  * [[endocrine:insulin:glargine|Glargine]]
  * [[endocrine:insulin:degludec|Degludec]]
  * [[endocrine:insulin:nph|NPH]]
  * [[endocrine:diabetes:start|Diabetes Pharmacology]]