Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Insulin related references:
Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18) NICE (Updated November 2016)Type 1 diabetes in adults: diagnosis and management (NG17) NICE (Updated July 2016)
NICE NG28 Type 2 diabetes in adults: management NICE (Updated May 2017)
Cochrane review - Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus
A guide to insulin treated diabetes and driving -DVLA

Insulin Passport
Insulin Passports and patient information booklets should be offered to patients receiving insulin. The Insulin Passport provides a record of the patient's current insulin preparations and contains a section for emergency information. The patient information booklet provides advice on the safe use of insulin. They are supplied either from the insulin manufacturers, or via the Somerset partnership.

Sompar team administrator on 01823 346191

Please read code patients
Insulin passport given 8CE02
Insulin passport completed 8BAi.
Informed dissent not to carry insulin passport 8BAj

Remember to measure TSH levels in adults with type 1 diabetes at annual review
Short acting:Insulin aspart
NovoRapid®






Fast acting insulin aspart
as FiASP®
3ml Penfill cartridge: £28.31 (5)
3ml Flexpen p/f pen: £30.60 (5)
3ml Flextouch p/f pen: £32.13 (5)
10ml vial: £14.08 (1)
1.6ml Pumpcart cartridge: £15.10 (5)

3ml Penfill cartridges=£28.31 (5)
3ml FlexTouch pre-filled pen=£30.60 (5)
10ml vial=£14.08.
Prefilled pens are around £2-3 more expensive per 5 and should be used only when patient choice demands.

NICE NG17
Insulin regimens

 Offer multiple daily injection basal–bolus insulin regimens, rather than twice-daily mixed insulin regimens, as the insulin injection regimen of choice for all adults with type 1 diabetes. Provide the person with guidance on using multiple daily injection basal–bolus insulin regimens.

 Offer rapid-acting insulin analogues injected before meals, rather than rapid-acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes

 Consider adding metformin to insulin therapy if an adult with type 1 diabetes and a BMI of 25 kg/m2(23 kg/m2 for people from South Asian and related minority ethnic groups) or above wants to improve their blood glucose control while minimising their effective insulin dose.

For insulin flowchart please see below

For Onset, duration of action and peak activity of insulins in hours (approx) please see MIMS table below
Insulin Lispro Sanofi®
(Humalog® biosimilar, the cartridges are not interchangeable)

Insulin Lispro
Humalog®
3ml cartridge: £24.06 (5)
3ml pre-filled pen: £25.04 (5)
10ml vial: £14.12 (1)


3ml cartridge: £28.31 (5)
10ml vial: £16.61 (1)
Soluble insulin
Human Actrapid®

Insuman Rapid®

Humulin S®
10ml vial: £7.48 (1)

3ml cartridge: £17.50 (5)

3ml cartridge: £19.08 (5)
10ml vial: £15.68 (1)
Insulin glulisine
Apidra®
Solostar 3ml pf inj. device: £28.30 (5)
3ml cartridge: £28.30 (5)
10ml vial: £16.00 (1)
Intermediate acting:Biphasic isophane insulin

Insuman Comb 15®

Insuman Comb 25®



Insuman Comb 50®

Humulin M3®
3ml cartridge: £17.50 (5)

3ml pf inj. device: £19.80 (5)
3ml cartridge: £17.50 (5)
5ml vial: £5.61 (1)

3ml cartridge: £17.50 (5)

3ml cartridge: £19.08 (5)
3ml kwikpen: £21.70 (5)
10ml vial: £15.68 (1)
Biphasic insulin
aspart
NovoMix 30®
3ml cartridge: £28.79 (5)
Biphasic Insulin
lispro
Humalog Mix25®

Humalog Mix50®
3ml cartridge: £29.46 (5)
3ml kwikpen: £30.98 (5)
10ml vial: £16.61 (1)

3ml cartridge: £29.46 (5)
3ml kwikpen: £30.98 (5)
Isophane insulin
Insuman Basal®


Human Insulatard®



Humulin I®
3ml cartridge: £17.50 (5)
3ml pf inj. device: £19.80 (5)
5ml vial: £5.61 (1)

3ml cartridge: £22.90 (5)
3ml Innolet p/f pen: £20.40 (5)
10ml vial: £7.48 (1)

3ml cartridge: £19.08 (5)
3ml kwikpen: £21.70 (5)
10ml vial: £15.68 (1)
Long acting:Insulin glargine
High strength

as Toujeo®
300 units/ml soln
3 x 1.5ml SoloStar pre-filled pen=£33.13Important- The potency of this medicinal product is stated in units. These units are exclusive to Toujeo and are not the same as IU or the units used to express the potency of other insulin analogues. For conversion see http://www.medicines.org.uk/emc/medicine/30586
Insulin Glargine
Semglee®
Biosimilar insulin glargine 100 units/mL pre-filled pens

Abasaglar®
Biosimilar insulin glargine 100 units/mL cartridges & pre-filled pens

Lantus®
Insulin glargine 100 units/mL
3ml pre-filled pen: £29.99 (5)




3ml cartridge: £35.28 (5) for Autopen Classic or HumaPen ranges
3ml KwikPen: £35.28 (5)


3ml cartridge: £37.77 (5)
3ml Solostar pre-filled pen: £37.77 (5)
10ml vial: £27.92 (1)
Insulin detemir
Levemir®
3ml cartridge :£42.00 (5)
Insulin degludec
Tresiba®
100 units/ml
5 x 3ml Penfill cartridges=£46.60 (for NovoPen 5 or NovoPen Echo;
5 x 3ml FlexTouch pre-filled pen=£46.60 (for use with NovoFine or NovoTwist needles).
200 units/ml soln:
3 x 3ml FlexTouch pre-filled pen=£55.92 (for use with NovoFine or NovoTwist needles).
For management of Type-1 diabetes. See NICE ESMN24 for
further information.
For management of Type-2 diabetes see NICE ESMN25 for
further information.
Insulin/ GLP-1 combinationDegludec/ liraglutide as Xultophy100iu/3.6mg per ml, 3 x 3ml pre-filled pen=£95.53 (for use with NovoFine or NovoTwist needles).Xultophy is AMBER with the hand over to GP prescribing after 3 months successful treatment for patients stabilised in secondary care.
Hypodermic equipmentChoice of needle & lancet may be governed by specific insulin prescribed and injection technique. Pen needles priced at <£4.10 per 100 and lancets at <£3.00 will be formulary approved.
Insulin pen needles4mm needles are considered to be the safest pen needle for adults and children regardless of age, gender and Body Mass Index (BMI).
Therefore, the most cost effective 4mm needle should be prescribed.
For patients currently using 8mm or 12mm pen needles, it is advisable to change to a shorter needle length (6mm or less) but only after discussion with a healthcare professional, to ensure they receive advice on the correct injection technique.
First line
GlucoRx Carepoint®



GlucoRx Carepoint Ultra®

Microdot Max®

BD Viva®


Omnican Fine®


Tricare®
4mm/31G: £2.75 (100)
5mm/31G: £2.75 (100)
6mm/31G: £2.75 (100)

4mm/32G: £2.75 (100)

4mm/32G: £2.79 (100)


4mm/32G: £3.64 (90)
5mm/31G: £3.64 (90)

4mm/32G: £3.95 (100)
5mm/32G: £3.95 (100)
6mm/32G: £3.95 (100)


4mm/31G: £3.95(100)
5mm/31G: £3.95 (100)
6mm/31G: £3.95 (100)
First line pen needles meet the scorecard requirement of below £4.10 per 100
All first line needles are compatible with mainstream brands of insulin pen

https://www.glucorx.co.uk/wp-content/uploads/pdf/GlucoRx FinePoint Compatibility Chart.pdf
Second lineNeon Verifine®4mm/31G: £4.50 (100)
5mm/31G: £4.50 (100)
6mm/31G: £4.50 (100)
GlucoRx FinePoint®4mm/31 gauge: £4.50 (100)
5mm/31 gauge: £4.50 (100)
6mm/31 gauge: £4.50 (100)
GlucoRx Finepoint Ultra®4mm/32 gauge: £4.95 (100)
Microdot droplet®4mm/32G: £5.95 (100)
6mm/31G: £5.95 (100)
Glucoject 4mm/32 gauge: 100=£5.95.
5mm/31 gauge: 100=£5.95.
6mm/31 gauge: 100=£5.95.
Safety needlesFirst line:
Microdot Max Safety Needles

GlucoRx Safety Needles

Second line:
MyLife Clickfine Autoprotect
5mm 30 gauge: £12.89 (100)

5mm 30 gauge: £12.95 (100)


5mm 31 gauge: £19 (100)
Only for patients who have their insulin administered by healthcare assistants, nurses, carers etc to help prevent needlestick injuries:

 Shield automatically locks after injection to help prevent accidental needlestick injuries
 Metal tabs provide visual confirmation that the safety feature is activated
LancetsApollo twist lancets

Glucoject Plus lancets

IME-DC

Agamatrix Ultra-thin lancets


GlucoZen

Fastclix

GlucoRx

0.36mm/28G 200=£4.50.

0.20mm/33G. 200=£5.50.

0.3mm/30G 100=£3.00

0.35mm/28G 200=£5.43.
0.20mm/33G 200=£5.43.


0.36mm/28G, 200=£4.99

0.3mm /30G lancets Pack of 204:£5.90

0.31mm /30G Lancet Pack of 200: £4.50
Aim to prescribe lancets below £3 per 100

Apollo twist, Glucoject PLUS and IDE lancets are considered compatible with all marketed finger pricking devices
Safety lancetsGlucoRx Safety lancets1.6mm/30 gauge (100) £5.50
1.8mm/28 gauge (100) £5.50
1.8mm/26 gauge (100) £5.50
2.2mm/23 gauge (100) £5.50
For healthcare staff to use when testing patients
Approved by PAMM Jan 16
Microdot safety lancets30G, 28G, 26G, 23G (200) £10.75
This section specifically covers drugs used for management of blood glucose, however the majority of patients with diabetes should be considered to be at high risk of CVD and hence should also be prescribed Atorvastatin 20mg for primary prevention (unless C/I). For secondary prevention guidance see lipid regulation
ATT meta-analysis : Aspirin for primary prevention of CVD
Aspirin is not licensed for the primary prevention of vascular events but there remains the possibility that for particular sub-groups of individuals at higher CV risk (including conditions such as diabetes) the risk: benefit of aspirin is favourable. Until more evidence is available, the use of Aspirin 75mg for patients with diabetes should be based on an individual risk assessment.
Quick guide to insulin therapy
Guide to insulin therapy 1

Guide to insulin therapy 2

MIMS table: Insulin Preparations