6.1.1 Insulins

Refer to NICE Guideline NG17 for information on the management of type 1 diabetes, NICE Guideline NG3 for information on diabetes in pregnancy and NICE Guideline NG28 for information on the management of type 2 diabetes.
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 the administration of Humalog^® in place of Humalog^® Mix25 or Humalog^®Mix50.
Choice of insulin prescribed is guided by the duration of action, regimen choice and patient choice regarding device types. The table below indicates preferred choices where all things are equal regarding device choice.
Several new high strength, fixed combination and biosimilar insulin products are now on the market. Healthcare professionals and patients need to understand the insulin strength of these products and how to use them correctly to minimise the risk of medication errors, such as the wrong insulin strength being prescribed or supplied. Insulin should only be initiated and managed by healthcare professionals with the relevant expertise and training. For further information on minimising the risk of medication error with insulin, see MHRA.


Formulary choices
Rapid (analogue)	Short	Intermediate (isophane)*	Long (analogue)	Biphasic	Biphasic Isophane*
Immediate with food	15 to 30 mins before food	Same time every day (given once or twice daily)	Same time every day**	Up to 15 mins before food	Up to 30 mins before food
Apidra®	Actrapid®	Humulin I®	Abasaglar®	Humalog® Mix 25	Humulin® M3
Humalog® 100	Humulin S®		Lantus®	Humalog® Mix 50
Humalog® 200				NovoMix® 30
NovoRapid®			Toujeo®
Fiasp ®			Tresiba®100
			Tresiba®200
Insulin is available as different branded products, some of which are biosimilars. It is important they are prescribed by brand name to ensure the patient receives the intended product.

For Type 2 diabetes; Prescribe insulin as per NICE NG28 (refer to pages 53 and 54 – ‘choosing a type of insulin’ and ‘choosing an insulin preparation’) see also Summary of Medicines Recommendations.

Insulin Pump Therapy

Continuous subcutaneous insulin infusion (CSII) is an option for people with type 1 diabetes meeting NICE TA151
CSII therapy should be initiated by a trained specialist team.