Insulin Detemir and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lisinopril
Insulin Detemir
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
You're taking lisinopril (a blood pressure medicine) along with insulin detemir (Levemir) for your blood sugar. When these are used together, there's a chance your blood sugar could drop a little lower than expected. That means you might notice signs of low blood sugar, like feeling shaky, sweaty, dizzy, or extra hungry.
The good news is this is easy to keep an eye on. Your care team can check your blood sugar more often and adjust your insulin dose if needed. Keep taking both medicines as prescribed, and let your doctor or pharmacist know if you notice any low blood sugar symptoms. This is very manageable.
Effect: Additive risk of hypoglycemia when an ACE inhibitor (lisinopril) is combined with insulin detemir. Neither agent is a prodrug requiring bioactivation here; direction is a potential enhancement of the glucose-lowering effect.
Mechanism: Unknown / not fully characterized.
- Evidence: Theoretical; case-series data suggest ACE inhibitors plus insulin secretagogues are not clearly linked to serious hypoglycemia (possible exception: glimepiride).
- Onset: Unspecified.
- Management: More frequent glucose monitoring during therapy and after ACE inhibitor withdrawal; individualize and adjust insulin dose as needed.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Taking ACE inhibitors together with antidiabetic drugs can raise the likelihood of hypoglycemia231. When such combined use cannot be avoided, glucose levels should be checked more often, both during therapy and following discontinuation of an ACE inhibitor4. Modifications to the insulin dose might also be required23. Findings from a self-controlled case series indicate that using ACE inhibitors alongside insulin secretagogues does not correlate with higher rates of serious hypoglycemia, though glimepiride may be an exception5.
Why it happens (mechanism)
Unknown
How to manage this interaction
This combination is used commonly and can be managed well by your care team.
- Keep taking both lisinopril and insulin detemir exactly as prescribed unless your doctor tells you otherwise.
- Check your blood sugar more often, as your team advises, both while on lisinopril and if it is ever stopped.
- Your insulin dose may need to be adjusted and individualized by your care team based on your readings.
- Learn the signs of low blood sugar (shakiness, sweating, confusion) and know how to treat it quickly.
Raise any low blood sugar episodes with your pharmacist or prescriber so they can fine-tune your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A self-controlled case series examined Medicare claims data drawn from 5 states spanning 1999 to 2011 to assess the simultaneous use of ACE inhibitors together with insulin secretagogues (glimepiride, glipizide, glyburide, nateglinide, and repaglinide) or metformin (used as a negative control). The endpoint assessed was hospital presentation for serious hypoglycemia. During the observation period, the counts of serious hypoglycemic events were 8159, 14,353, 11,129, 1595, 2901, and 32,639 for glimepiride, glipizide, glyburide, nateglinide, repaglinide, and metformin, respectively. The confounder-adjusted rate ratio (RR) was not significantly raised for glipizide, glyburide, repaglinide, or metformin, but was slightly increased for glimepiride (RR, 1.23; 95% CI, 1.11 to 1.37) and slightly decreased for nateglinide (RR, 0.73; 95% CI, 0.56 to 0.96). Aside from glimepiride, these findings indicate that concurrent use of an ACE inhibitor and insulin secretagogues was not linked to a higher risk of serious hypoglycemia 5.
Common questions
Can I take Insulin Detemir and Lisinopril together?
Combining lisinopril with insulin detemir may slightly increase the chance of low blood sugar, so monitor your glucose more closely and tell your care team about any low readings, as your insulin dose may need adjusting. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Insulin Detemir and Lisinopril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Insulin Detemir and Lisinopril interaction managed?
This combination is used commonly and can be managed well by your care team. Keep taking both lisinopril and insulin detemir exactly as prescribed unless your doctor tells you otherwise. Check your blood sugar more often, as your team advises, both while on lisinopril and if it is ever stopped. Your insulin dose may need to be adjusted and individualized by your care team based on your readings. L… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Insulin Detemir or Lisinopril need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (5)
- Product Information: Zestril(R) oral tablets, lisinopril oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2014. DailyMed
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AFREZZA(R) oral inhalation powder, insulin human oral inhalation powder. MannKind Corporation(TM) (per manufacturer), Danbury, CT, 2014. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Hee Nam Y, Brensinger CM, Bilker WB, et al: Angiotensin-converting enzyme inhibitors used concomitantly with insulin secretagogues and the risk of serious hypoglycemia. Clin Pharmacol Ther 2022; 111(1):218-226. PubMed
Keep reading about Lisinopril
Keep reading about Insulin Detemir
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist