6.3.1.1 Insulins
*SUPPLY ISSUE: A Medicine Supply Notification (MSN) was issued on the 24th May 2023 on the shortage of Tresiba® (insulin degludec) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens. Supplies are not expected to return until December 2024. Please see the SPS medicines supply tool (free subscription required) for further information, actions and advice on alternatives and the current anticipated re-supply date.
Please do not initiate new patients on Tresiba® (insulin degludec) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens for the duration of the shortage.
**A National Patient Safety Alert (NPSA) was issued on the 8th of December 2023 about the "Potential for inappropriate dosing of insulin when switching insulin degludec (Tresiba®) products". Please refer to the NPSA for further information on the identified safety issue, clinical information and actions required.**
Note: Prescribing Insulins
- Always remember to prescribe the needles for SC injection.
- The type of insulin and administration device needed should always be specified alongside the insulin prescription. (e.g disposable pen or 3ml cartridge)
- Nurses should ensure that an individual sharps bin is given to patients who are self-managing.
For more information on the PRGC Recommendations please click the following links (pdf)
Insulin Degludec/ Liraglutide (IDegLira; Xultophy) for type 2 diabetes mellitus
• For Kent and Medway Guidance on Safe Insulin Prescribing
&
• Kent and Medway Guidance of Biosimilar Insulin Prescribing
Click Here
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
Insulin Aspart - (FIASP) Initiation and stabilisation should be in SECONDARY CARE ONLY and only for patients fitting in the specialist criteria:
- Pregnancy where tight control is needed
- Clinical diagnosis of gastroparesis
- Type 1 diabetics only requiring tighter control
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
New patients should be started on Trurapi. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Trurapi as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 1 vial |
New patients should be started on Trurapi. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Trurapi as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 5 cartridge |
New patients should be started on Trurapi. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Trurapi as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 5 pre-filled disposable injection |
This is only for initiation by diabetes specialist consultants, diabetes specialist nurses and GPs with specialist interest in diabetes. Criteria for use are specified in the PRGC document PR 2017-04 Insulin degludec for type 1 diabetes in adults and PRGC document PR 2019-06: Insulin degludec for adults with type 2 diabetes mellitus.
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 3 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 3 pre-filled disposable injection |
| Pack |
|---|
| 3 pre-filled disposable injection |
• Warning where there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
New patients should be started on Admelog. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Admelog as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 1 vial |
New patients should be started on Admelog. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Admelog as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 5 cartridge |
New patients should be started on Admelog. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Admelog as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
|---|
| 5 pre-filled disposable injection |
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 1 vial |
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 pre-filled disposable injection |
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 pre-filled disposable injection |
Lyumjev® is the second line option for the treatment of diabetes mellitus in patients who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
o Where the prescriber believes a faster onset of action would be beneficial to the patient
o Where a patient requires ‘tight’ control of blood sugar levels
o Where a patient has rapid post-meal increase in blood sugar levels”
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 1 vial |
Lyumjev® is the second line option for the treatment of diabetes mellitus in patients who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
o Where the prescriber believes a faster onset of action would be beneficial to the patient
o Where a patient requires ‘tight’ control of blood sugar levels
o Where a patient has rapid post-meal increase in blood sugar levels”
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 cartridge |
Lyumjev® is the second line option for the treatment of diabetes mellitus in patients who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
o Where the prescriber believes a faster onset of action would be beneficial to the patient
o Where a patient requires ‘tight’ control of blood sugar levels
o Where a patient has rapid post-meal increase in blood sugar levels”
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 pre-filled disposable injection |
Lyumjev® is the second line option for the treatment of diabetes mellitus in patients who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
o Where the prescriber believes a faster onset of action would be beneficial to the patient
o Where a patient requires ‘tight’ control of blood sugar levels
o Where a patient has rapid post-meal increase in blood sugar levels”
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance
| Pack |
|---|
| 5 pre-filled disposable injection |
This device allows half unit doses titration of insulin which will be useful to optimise glucose control.
Lyumjev® is the second line option for the treatment of diabetes mellitus in patients who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
o Where the prescriber believes a faster onset of action would be beneficial to the patient
o Where a patient requires ‘tight’ control of blood sugar levels
o Where a patient has rapid post-meal increase in blood sugar levels”
• Warning there are 2 strengths available- to avoid errors ensure the brand, strength and device is clear and in line with MHRA guidance’’
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
|---|
| 5 pre-filled disposable injection |
- First Line Choice
- On Formulary
- Specialist Initiation Only
- Hospital Only
- KMPT Initiation Only