General Notes

Insulin is frequently in the list of top 10 high-alert medicines (those with the highest risk of causing patient injury – National Patient Safety Agency June 2010) and should be prescribed using the brand name with the dose in UNITS (do not abbreviate to U or IU).

  • Insulin should NOT be withdrawn from an insulin pen or pen refill and then administered using a syringe and needle.
  • Cartridges are generally more cost efficient than pre-filled pens.
  • Reusable pens are specific to the insulin prescribed.
  • Spare insulin should be stored in the fridge.
  • An 8mm needle is the preferred choice in those with Type 2 Diabetes.
  • A new needle should be used for each injection as the needle degrades after just one use and can impact on the effectiveness of insulin therapy.
  • Needles should be disposed of using a needle clipping device, available on prescription.
  • Injection sites should be rotated and avoided if lumpy (lipohypertrophy), as this may affect the absorption of insulin.
  • Injection of insulin can lead to deposits of amyloid protein under the skin (cutaneous amyloidosis) at the injection site. This may affect glycaemic control.
  • The MHRA advises healthcare professionals should consider cutaneous amyloidosis as a differential diagnosis to lipodystrophy when patients present with subcutaneous lumps at an insulin injection site. 

 

For inpatient guidance please refer to the NHSL Administration of Insulin in Hospital document.

Rapid Acting Analogue Insulins

Specialist initiation (S1)

INSULIN ASPART (NovoRapid®)

  • Should generally be administered immediately before a meal, but may be given soon after a meal if necessary.

INSULIN ASPART (Fiasp®)

  • Can be administered up to 2 minutes before the start of a meal or up to 20 minutes after starting a meal if necessary.
  • Fiasp® and NovoRapid® are not interchangeable due to differences in bioavailability.
  • Fiasp® has a quicker onset of action and shorter duration.

INSULIN LISPRO (Humalog® 100 units/ml)

INSULIN LISPRO (Humalog® 200 units/ml KwikPen)

  • Caution: high-strength insulin preparation.
  • Specialist initiation and monitoring.

Prescribing Notes:

  • Humalog KwikPen® is available in two strengths - 200 units/ml and 100 units/ml.
  • Both KwikPens® deliver 1 – 60 units in steps of 1 unit in a single injection.
  • The number of insulin units is shown in the dose window of the pen regardless of strength and no dose conversion should be done when transferring a patient to a new strength or to a pen with a different dose step provided the dose is prescribed as number of units.
  • For further information, see SPC: Humalog 200 units/ml KwikPen®.

Short Acting Soluble Insulins

Specialist initiation (S1)

SOLUBLE INSULIN (Humulin S®)

Specialist use only (S2)

SOLUBLE INSULIN (Actrapid®)

  • Hospital only.

Intermediate Acting Insulins

Specialist initiation (S1)

ISOPHANE INSULIN (Humulin I®)

  • This should be mixed gently to re-suspend the insulin before injected.

ISOPHANE INSULIN (Insulatard Innolet®)

  • Restriction: for use in patients with manual dexterity problems.

Long Acting Insulins

Specialist initiation (S1)

INSULIN GLARGINE

  • For use in patients with type 1 or type 2 diabetes where hypoglycaemia is a concern with Humulin I®.
  • Available as brands Abasaglar® and Lantus®.

INSULIN DETEMIR (Levemir®)

  • Restriction: For use in patients with type 1 diabetes ONLY.
  • Levemir duration of action is up to 24 hours depending on dose, providing an opportunity for once or twice daily administration.

INSULIN DEGLUDEC (Tresiba® 100 units/ml or 200 units/ml)

  • Caution: available as high-strength insulin preparation.

INSULIN GLARGINE (Toujeo® 300 units/ml)

  • Caution: high-strength insulin preparation.
  • Specialist initiation and monitoring.

Specialist use only (S2)

INSULIN GLARGINE (Lantus® 10ml vial)

  • Restriction: Hospital inpatients with type 1 or type 2 diabetes where hypoglycaemia is a concern with Humulin I®.

Premixed Insulins – Biphasic

Specialist initiation (S1)

BIPHASIC ISOPHANE INSULIN (Humulin M3®)

BIPHASIC INSULIN ASPART (Novomix 30®)

  • For use in patients with type 1 or type 2 diabetes.

BIPHASIC INSULIN LISPRO (Humalog Mix25®)

  • Restriction: For use in patients with type 2 diabetes ONLY.

BIPHASIC INSULIN LISPRO (Humalog Mix50®)

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.