Insulins

MHRA alert: Insulins (all types): risk of cutaneous amyloidosis at injection site.  Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. Remind patients to rotate injection sites within the same body region. (September 2020) (www.gov.uk).

Insulin preparations should be initiated by appropriately trained individuals. Thereafter, tailor therapy to the patient's needs.

• Type 2 patients who are newly prescribed insulin should usually be started on once- daily Insuman® Basal given at bedtime. Long-acting recombinant human insulin analogues (eg Levemir®, Abasaglar®, Lantus®, Toujeo®) are much more expensive and are not required for the majority of patients with type 2 diabetes, however they may be useful for patients requiring help administering insulin or if there are concerns regarding hypoglycaemia.
• Choose devices and insulin on the basis of patient suitability and review regularly; refer to the insulins table for prescribing guidance.
• Changes should, where possible, be implemented when current patient supplies have been used up. Patients whose diabetes is stable should remain on their current insulin regimen unless a change is clinically indicated.
• A needle clipping (chopping) device consisting of a clipper to remove a needle from its hub and a container from which cut-off needles cannot be retrieved, can be prescribed for patients to use in the community. It is designed to hold 1500 needles; it is unsuitable for use with lancets. In hospitals, needle clipping devices can be ordered from Supplies for patients at discharge.
• Containers for sharps are available on prescription in primary care, however arrangements for their disposal must be agreed with the prescriber.
• If insulin administration is being carried out to a patient by a healthcare professional then a safety engineered device must be used.