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6.1.1 Insulins

   6.1.1. Insulins

          Patients starting on insulin should receive an insulin passport.
      Short-acting insulin
               GREEN      Human Actrapid® 
               GREEN      Humulin S®
               The insulin analogues have a faster onset and shorter duration of action than standard soluble insulin. 
               They should be injected immediately before or, when necessary, shortly after a meal.
              GREEN      Humalog® (insulin lispro)
              GREEN      NovoRapid®(insulin aspart) (prescribe by brand)
              GREEN      Apidra® (insulin glulisine) 1st line
              GREEN      Trurapi®(insulin aspart) 3rd line bolus insulin
              GREEN restricted*    Fiasp®▼ (insulin aspart) * restricted use/(prescribe by brand) 
            * Insulin Aspart (Fiasp®) is recommended for the treatment of diabetes mellitus in adults who are suitable for NovoRapid®                and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the following 
                                >      Where the doctor believes a faster onset of action would be beneficial to the patient
                                >      Where a patient requires 'tight' control of blood sugar levels
                                >      Where a patient has rapid post meal increase in blood sugar levels
              GREEN restricted**  Lyumjev® [insulin Lispro - Suitable for initiation in primary care in line with restrictions]
              ** Insulin Lispro (Lyumjev®) is recommended for the treatment of diabetes mellitus in adults who are suitable for 
             Humalog and their diabetes cannot be adequately managed with alternative formulary choices and at least one of the 
             following applies:
                                >      Where the prescriber believes a faster onset of action would be beneficial to the patient
                                >      Where a patient requires 'tight' control of blood sugar levels
                                >      Where a patient has rapid post-meal increase in blood sugar levels
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      Intermediate and long-acting insulin 
               GREEN      Insulatard® 
               GREEN      Humulin I®
               Long acting insulin 
               Long-acting recombinant human insulin analogues should be used in accordance with NICE guidance.
               Biosimilars of insulin glargine 100 units/mL (Lantus®) are recommended for use in patients with type 1and type 2 diabetes
               mellitus. The prescribing of biosimilar preparations should be by brand name, followed by the concentration and 
               recommended daily dose in units and a statement of the formulation. Treatment should normally be started with the least 
               expensive drug. The initiation of biosimilar insulins should be in NEW patients or patients assessed to need a medication 
               change, with close monitoring of their blood glucose to ensure good control is achieved. 
               GREEN      Abasaglar® (insulin glargine)   
               GREEN      Lantus® (insulin glargine) 
               GREEN      Levemir® (insulin detemir)   
               Toujeo is a High strength basal Insulin product it is Not bioequivalent to glargine or other insulins. Units are exclusive to  
               the potency of Toujeo®. Dose adjustment is needed if switching patients to or from Toujeo®  
               See Product information Sheet & Good Practice Guide
               Insulin glargine 300 units/mL (Toujeo®) is recommended as an option in adults with type 2 diabetes mellitus (T2DM) only in
               accordance with the recommendations in NICE NG28 and in those who suffer from symptomatic nocturnal hypoglycaemia 
               whilst being treated with a first-line long-acting insulin analogue. it is also recommended as an option in adults with type 1
               diabetes mellitus  in accordance with NICE NG17 and in those patients who experience an unacceptable frequency and/or 
               severity of nocturnal hypoglycaemia on attempting  to achieve better glycaemic control during treatment with first-line 
               long-acting insulin analogues; or as a once daily insulin therapy for patients who require assistance with administering  
               AMBER      Toujeo® SoloStar® DoubleStar® (insulin glargine)
               Insulin Degludec (Tresiba®▼)
               Recommended as an alternative treatment option in patients over the age of 1 year experiencing poor glycaemic control or
               recurrent hypoglycaemic episodes with existing long-acting basal insulin. to be initiated by diabetes specialist only. 
               AMBER        Tresiba®▼  (insulin degludec)  
               Insulin degludec plus liraglutide (Xultophy®)   
               The combination product insulin degludec plus liraglutide (Xultophy®▼) is not recommended to treat type 2 diabetes  
               mellitus (T2DM) to improve glycaemic control in combination with oral glucose-lowering medicinal products when these 
               alone, or combined with basal insulin, do not adequately provide glycaemic control.
               BLACK      Xultophy®
               Click here to access New Medicines Assessment for this product
               GREEN      Humulin M3®  
               GREEN      Insuman Comb 25® 
               GREEN      Humalog Mix25®, Humalog Mix50® (insulin lispro) 
               GREEN      NovoMix 30®
               Biphasic analogue insulins (e.g. Novomix, Humalog Mix) do not offer any advantage over conventional human biphasic 
               insulins in terms of efficacy, long term outcomes or safety but cost considerably more. The above brands of insulin are  
               recommended for new diabetics and are available in a variety of vial, species for established diabetics. The hospital 
               pharmacy will keep stocks of other brands and Insulin is usually available in 3mL cartridges, 10mL vials, and 3mL 
               disposable pens. Pens are available on prescription except disposable pens. Not all insulin cartridges fit all pens.
              The National Patient Safety Agency issued an alert in June 2010 for the safer administration of insulin. 
              Click here to access the full documents online.
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All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the  
public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service. 
  Email: info.elmmb@nhs.net
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