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6.1.1 Insulins

General Advice

  • 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)ShortIntermediate (isophane)* Long (analogue)BiphasicBiphasic Isophane*
Immediate with food15 to 30 mins before foodSame time every day (given once or twice daily)Same time every day**Up to 15 mins before foodUp to 30 mins before food
Apidra®Actrapid®Humulin I® Abasaglar®Humalog® Mix 25Humulin® M3
Humalog® 100 Humulin S® Insulatard®Lantus®Humalog® Mix 50
Humalog® 200 Levemir®NovoMix® 30
Fiasp ® Tresiba®100

*Human NPH (isophane and biphasic isophane) insulin is the preferred first-choice insulin recommended by NICE for type 2 diabetes
**Levemir® (insulin detemir) is given once or twice daily according to individual requirements

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.

Prescribing Notes

  • 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

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.