Last week, Novo Nordisk announced that it plans to discontinue sales of Levemir in the United States. People with diabetes who use Levemir should plan now on transitioning to an alternative.
Levemir comes in two forms, a vial and a “FlexPen.” FlexPen users will have to switch first: the manufacturer states that supply disruptions will begin in mid-January 2024 and that the medication will be discontinued entirely by April 1, 2024. Those who use Levemir in a vial have a longer time to transition: vials may be available until the end of 2024.
Why is Levemir going away? In a statement, the manufacturer explained that Levemir would be discontinued “due to global manufacturing constraints, formulary losses impacting patient access, and the availability of alternative options.”
It is possible that Levemir sales have flagged after the introduction of a variety of lower-cost versions of a rival basal insulin, insulin glargine. Levemir prescriptions have dropped 23 percent in the last year, according to SingleCare, an online prescription savings service.
It is also possible that Novo Nordisk wishes to enhance sales of its other (more expensive) long-acting insulin, Tresiba. Or perhaps the pharmaceutical giant wants to devote more of its manufacturing capacity to the blockbusters Ozempic and Wegovy, which come in a similar injector pen device.
On social media, some members of the diabetes community responded with skepticism. The non-profit T1International called the move “indefensible.” Others commented that Levemir was the only basal insulin on their insurance formulary, and feared that the switch would mean a mess of red tape and higher costs.
Whatever the reasons, this article will try to help make sense of the transition that Levemir users may need to make.
Alternative Options for Type 1 Diabetes
For people with type 1 diabetes, who have an absolute need of insulin, Levemir users will undoubtedly have to switch to another long-acting insulin. Here are the options:
Lantus (insulin glargine) — The country’s best-selling long-acting insulin
Basalgar (insulin glargine) — An alternative that is essentially identical to Lantus
Rezvoglar (insulin glargine) — A “biosimilar” that is essentially identical to Lantus
Semglee (insulin glargine) — A “biosimilar” that is essentially identical to Lantus
Toujeo (insulin glargine) — a super-concentrated form of insulin glargine, that active ingredient in Lantus, primarily used for patients that require larger doses
Tresiba (insulin degludec) — Novo Nordisk’s other long-acting insulin, Tresiba lasts even longer than Levemir, which may enhance dose timing flexibility
NPH (isophane insulin) — an intermediate-acting insulin. NPH is inexpensive but more challenging to use than Tresiba and may come with a higher risk of hypoglycemia.
It’s important to speak to your doctor (and work with your insurer) to learn which insulins would be affordable and work best for you. Less expensive unbranded alternatives may also be available.
Levemir’s discontinuation may also be an opportune time to discuss an insulin pump, which uses only rapid insulin.
Switching Insulins
Most patients switching from Levemir (insulin detemir) will begin using insulin glargine (Lantus and its many equivalents) or insulin degludec (Tresiba).
The Annals of Medicine has published a practical guidance for healthcare practitioners on how to switch basal insulins safely. In many cases, basal insulin dosages appear to be perfectly interchangeable between formulations, meaning that you won’t need to change the amount of insulin you take when switching. But the guidance states that “dose adjustment may be needed if switching from detemir to glargine,” which will be relevant to the large number of people switching from Levemir to any insulin in the Lantus family. Experts recommend performing extra blood glucose monitoring during the first weeks of transition.
Special caution is required when switching from Levemir to NPH, which has a very different action curve.
Any change of insulins should be accomplished only under the guidance of your medical team. The Diabetes Daily forum is also full of good advice from people that have switched insulin formulations in the past.
Alternative Options for Type 2 Diabetes
People with type 2 diabetes who require a basal insulin may be advised to switch to an alternative insulin listed in the previous section.
Clinicians may want to consider non-insulin alternatives, too. In recent years, type 2 diabetes authorities have systematically de-emphasized the use of insulin in favor of both GLP-1 receptor agonists and SGLT2 inhibitors, newer medications which can help improve high blood sugars but add additional benefits that insulin cannot: weight loss, heart and kidney protection, and a reduced risk of hypoglycemia.
Novo Nordisk’s own GLP-1, semaglutide (Ozempic), has quickly become the world’s biggest diabetes and weight loss blockbuster, and many clinicians are transitioning their patients away from insulin and onto Ozempic or similar drugs such as dulaglutide (Trulicity) or tirzepatide (Mounjaro). Insulin has increasingly been seen as a last resort for people with type 2 diabetes — it may be a good time to discuss non-insulin alternatives with your medical provider.