Click here for insulin formulary choices.
- Refer to NICE Guideline 17 for information on the management of type 1 diabetes, NICE Guideline NG3 for information on diabetes in pregnancy, and NICE Guideline 28 and COMPASS Therapeutic Notes for further 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, for example, administration of Humalog® in place of Humalog® Mix25 or Humalog® Mix50.
- Choice of insulin prescribed is guided by the duration of action and 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 Drug Safety Update April 2015.
|Rapid (analogue)||Short||Intermediate||Long (analogue)||Biphasic||Biphasic Isophane*|
|Immediate with food||15 to 30 mins before food||(isophane)* Same time every day||Same time every day||Up to 15 mins before food||Up to 30 mins before food|
|Formulary Choices||Apidra®||Actrapid®||Humulin I®||Abasaglar®**||Humalog® Mix 25||Humulin® M3|
|Humalog® 100||Humulin S®||Insulatard®||Lantus®||Humalog® Mix 50||Insuman® Comb 15|
|Humalog® 200||Insuman® Rapid||Insuman® Basal||Levemir®||Novomix® 30||Insuman® Comb 25|
|Novorapid®||Toujeo®||Insuman® Comb 50|
|*Human NPH (isophane and biphasic isophane) insulin is the preferred first-choice insulin recommended by NICE for type 2 diabetes|
|**Insulin glargine 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. Abasaglar® is first choice insulin glargine on the formulary (cost-effective choice)|
- For most people with type 2 diabetes, long-acting insulin analogues offer no significant advantage over NPH insulin.
- Consider, as an alternative to NPH insulin, using insulin detemir or insulin glargine if:
- the person needs assistance from a carer or healthcare professional to inject insulin, and use of insulin detemir or insulin glargine would reduce the frequency of injections from twice to once daily or
- the person’s lifestyle is restricted by recurrent symptomatic hypoglycaemic episodes or
- the person would otherwise need twice-daily NPH insulin injections in combination with oral glucose‑lowering drugs
- Clinicians should review and, where appropriate, revise prescribing of long-acting insulin analogues in type 2 diabetes mellitus to ensure that it is in line with NICE guidance.
Insulin Pump Therapy
- Continuous subcutaneous insulin infusion (CSII) is an option for people with type 1 diabetes meeting NICE TA151 recommendations (http://www.nice.org.uk/TA151).
- CSII therapy should be initiated by a trained specialist team.