6.1.1 Insulins

General Notes
  • Refer to the Lothian Diabetes Handbook 2010, prepared by the Lothian Diabetes Network.
  • Refer to SIGN 116 and NICE Clinical Guideline 87 for further information on the management of diabetes.
  • Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
  • Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog® in place of Humalog® Mix25 or Humalog® Mix50.
  • The B–D Safe–Clip® device snaps the needle off insulin syringes and stores the needle safely inside the clipper; this device is available on prescription.
  • Insulin is available in 3mL cartridges, 10mL vials, 3mL disposable pens and Innolet® devices. Not all insulin cartridges fit all pens.
  • Choice of insulin prescribed is guided by the duration of action and regime choice and patient choice regarding device types. The following table indicates preferred choices where all things are equal regarding device choice.
 
 
 
 
Rapid
Immediate with food
Short
15 to 30 mins before food
Long
Same time every day
Intermediate
Same time every day
Analogue
Up to 15 mins before food
Fixed Mixture
Up to 30 mins before food
First choice
Novorapid
Actrapid
*Insulin Glargine
Insulatard
Humalog Mix 25
Humulin M3
Alternate choice
Humalog Apidra
Fiasp
Velosulin HumulinS Insuman rapid
Levemir
Humulin I Insuman Basal
Humalog Mix 50
Novomix 30
Insuman Comb
(15, 25, 50)


* Insulin Glargine is available as different branded products. It is important that they are prescribed by brand name to ensure the patient receives the intended product. Brands include Lantus 100units/mL and Abasaglar 100units/mL (biosimilar). Toujeo is non-formulary and should not be prescribed, it is not a bioequivalent for other insulin glargines. There is a safety issue if doses are swapped on a unit per unit basis.