Juicebox Podcast: Type 1 Diabetes
Episode #1652: Save Levemir
Host: Scott Benner
Guest: Allison Smart, President of the Alliance to Protect Insulin Choice
Date: October 14, 2025
Overview
This episode, "Save Levemir," spotlights the urgent advocacy efforts to maintain patient choice in basal insulins—specifically the fight to keep Levemir (Detemir) available in the U.S. market. Host Scott Benner is joined by Allison Smart, a passionate advocate, mother to a teenager with type 1 diabetes, and president of the Alliance to Protect Insulin Choice, as she shares her journey and the broader implications of losing Levemir. Their discussion moves from Allison’s deeply personal reasons, through regulatory and business barriers, to wider questions of patient autonomy and pharmaceutical industry priorities.
Key Discussion Points & Insights
1. Allison’s Personal Story and Motivation
- Diagnosis and Adaptation: Allison’s daughter was diagnosed with type 1 diabetes at age 13 (2021). Like many families, they initially relied on physician guidance and insurance coverage to select insulins ([04:18]).
- Discovering Levemir: After trialing other basal insulins (Lantus, Basaglar), they found that Levemir uniquely fit her daughter's needs—especially for athletic performance in tennis ([05:05]).
- Novo Nordisk’s Announcement: In November 2023, Allison learned Levemir would be discontinued in the U.S. by the end of 2024. Finding no immediate solution from manufacturers, legislators, or advocacy groups, she founded the Alliance to Protect Insulin Choice ([03:36]).
Notable Quote
“I started calling people. I said, of course. Of course someone's gonna fix this... and I learned pretty quick that no one was going to.” — Allison Smart [03:36]
2. Why Levemir? The Value of Options
- Pharmacological Advantage: Levemir’s shorter, easily titratable action profile allows precise adjustments—especially vital for teens and athletes ([07:29]).
- Flexibility as a Strength: What many see as a flaw (shorter action), Allison sees as Levemir’s greatest benefit—enabling tailored, “pump-like” basal adjustments, responsive to daily changes and factors like menstrual cycles and sports ([07:29]).
- Basal Insulin Choice: Alternatives like Glargine-based insulins (Lantus, Basaglar) and Tresiba either lack flexibility or have unwanted properties (e.g., longer “tails,” acidic pH that causes burning) ([10:34]; [43:31]).
Notable Quotes
“The flexibility of [Levemir]... is the huge advantage that we absolutely love.” — Allison Smart [07:29]
“Your physician doesn’t bat an eye when you go and say, I didn’t love that pain reliever... They give you a different one. It’s fundamentally about choice.” — Allison Smart [16:33]
3. Regulatory & Industry Barriers
- Business Disinterest in Detemir: Generic/biosimilar manufacturers focus on Glargine, Aspart, Lispro—drugs with clearer regulatory paths and bigger markets. Even companies interested in Levemir (like rbio) face immense regulatory and financial hurdles ([13:38]; [16:33]).
- Novo Nordisk’s Priorities: The manufacturer is shifting resources to lucrative weight loss drugs (Ozempic, Wegovy), de-prioritizing less profitable insulins ([13:38]; [28:10]).
- Bottlenecks: Regulatory processes in the U.S. are slow, expensive, and heavily favor established products. Bringing a Detemir biosimilar would cost $20–$50 million and require Novo’s cooperation or regulatory overhaul ([14:04]; [16:33]; [20:45]).
- Historical Context: This is part of a longer pattern where older insulins are removed from the market, often with no ready substitute ([49:04]).
Notable Quotes
“The only long acting generic coming to the market is Glargine. So this is a problem. A company wants to make it, why can't we figure this out?” — Allison Smart [13:38]
“There’s a clear path [for Glargine]. Dedimir has not been a clear path. The patent was over in 2019.” — Allison Smart [16:33]
4. Advocating for a Solution
-
Potential Pathways:
- Novo Nordisk could sign over or license manufacturing rights to a company like rbio; this could be a simple signature or a licensing deal where everyone profits ([25:13]; [29:43]).
- Alternatively, regulatory reforms could lower barriers for biosimilar/generic entrants ([25:54]).
-
Legislative Work: Allison’s group (501c3) is petitioning Congress and the FDA, emphasizing physician preference for Levemir, especially in pediatrics and pregnancy ([13:38]; [37:59]).
Notable Quotes
“If Novo Nordisk were to help us... There are several ways they could. They could sign over the right to manufacture...contract manufacturing or license it.” — Allison Smart [24:16]
“It shouldn’t be this hard to bring something to the market.” — Allison Smart [26:13]
5. The Broader Case for Choice (and What’s at Stake)
- Patient-Led Customization: Choice is essential. Some insulins burn, don’t last, or don’t fit certain lifestyles/medical needs ([31:07]; [43:31]).
- Backups Are Essential: Even pump users may need backup long-acting insulin (e.g., for hospitalizations, pump breaks, imaging studies) ([20:02]).
- Equity & Affordability: Not everyone can afford or tolerate pumps or newer insulins; options reduce risk ([37:59]; [41:10]).
Notable Quotes
“Even people that use insulin pumps need backup long acting insulin.” — Allison Smart [11:19]
“It really comes down to choice. I think we should have the ability to choose.” — Allison Smart [32:31]
6. Industry Economics & Counterarguments
- Profit Motive: Manufacturers may see discontinuing Levemir as a move to consolidate users into newer, higher-margin drugs (like Tresiba) ([48:28]).
- Goodwill Opportunity: Scott suggests Novo Nordisk could win lasting goodwill by licensing Levemir, benefiting reputation at minimal financial cost ([40:12]; [41:10]).
Notable Quotes
“You can lose $571 [million] a year for the next 10 years or take 10% of [that] for the next 10 years... That’s just money coming in that you don’t have to do anything for.” — Scott Benner [40:12]
“Way to buy goodwill in the diabetes community. And don’t discount that at all.” — Scott Benner [41:10]
7. Call to Action
- Amplify the Message: Listeners are urged to contact their senators, congressional representatives, and the FDA, making noise about Levemir’s importance—even if they aren’t current users ([37:59]).
- Support Alliance Efforts: Engage with the Alliance to Protect Insulin Choice and share stories or sign up for updates.
Notable Quotes
“If more people would speak up about it... Even people who aren’t Levemir users. If people would send a message to your legislators... [that] would really help us.” — Allison Smart [37:59]
Notable Quotes & Memorable Moments (with Timestamps)
- “I found Levemir... We really felt like things are dialed in. My daughter's a tennis player... We had little disruption to her tennis from type 1.” — Allison Smart [03:36]
- “Levemir lasts approximately eight to fourteen hours, which is awesome... The flexibility... is a huge advantage [for us].” — Allison Smart [07:29]
- “Your physician doesn’t bat an eye when you go and say, I didn’t love that pain reliever... It’s fundamentally about choice.” — Allison Smart [16:33]
- “It shouldn’t be this hard to bring something to the market. It’s kind of silly that our regulatory process is so time consuming and so expensive.” — Allison Smart [26:13]
- “Why don’t you just say something out loud in the middle of your office and make it happen?... Just be cool, man.” — Scott Benner [41:10]
- “Choice is what it comes down to... If someone finds a method that works, it’s so important.” — Allison Smart [42:59]
Timestamps for Key Segments
- [03:36] Allison’s personal journey from diagnosis to advocacy
- [07:29] Detailed pharmacological comparison: Levemir vs. Glargine and Tresiba
- [13:38] Challenges with biosimilar manufacturing; industry focus on other drugs
- [16:33] Regulatory and financial barriers to Levemir alternatives
- [24:16] Potential solutions: licensing, regulatory fixes, need for multiple pathways
- [31:07] The importance of choice; Alison addresses “just use a pump” arguments
- [37:59] Call to listeners: legislative advocacy and amplifying the message
- [40:12] Scott’s marketing and goodwill argument to Novo Nordisk
- [43:31] Unique traits of Levemir: pH, dilution, and tolerability
- [46:36] Levemir userbase numbers and patient stories
Tone & Language
The conversation is deeply informed by empathy, mutual understanding, and lived experience. Allison is measured, data-driven, and consistently centers patient autonomy and real-world needs. Scott brings candor, humor, and pointed devil’s-advocate questions, always steering the discussion toward actionable change and real-world impact.
Conclusion
This episode captures a pivotal moment in the struggle to preserve insulin choice: a grassroots movement led by informed patients and parents, up against entrenched pharmaceutical and regulatory systems. At its heart, the discussion asks why basic medical options are shrinking, and points toward realistic, collaborative solutions—urging advocacy, business innovation, and regulatory sense.
Learn More: alliancetoprotectinsulinchoice.org
Get Involved: Contact your legislators, share your story, and stay connected with the Alliance.
End of summary.