Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Insulins related references:
Diabetes (type 1 and type 2) in children and young people: diagnosis and management (NG18) NICE Aug 2015
August 2015 Type 1 diabetes in adults: diagnosis and management (NG17) NICE Aug 2015
NICE NG28 Type 2 diabetes in adults: management NICE Dec 2015

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 suppled either from the insulin manufacturers, or via the Somerset partnership.

Eli Lilly – Russell Pearce – 07825 990332 / Debbie Gilmore 07714 308537
Novo Nordisk – Rachael Boarder 07803 899765
Sanofi – Rob Bartlett Robert.bartlett@sanofi.com 07841 321709

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 cartridge £30.60 (5)
3ml Flextouch cartridge £32.13 (5)
10ml vial: £14.08 (1)

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
Insulin lispro
Humalog®
3ml cartridge: £28.31 (5)
10ml vial: £16.61 (1)
Soluble insulin
Human Actrapid®
Insuman Rapid®
10ml vial: £7.48 (1)
3ml cartridge: £17.50 (5)
Insulin glulisine
Apidra®
Solostar 3ml pf inj. device: £28.30 (5)
3ml cartridge: £28.30 (5)
10ml vial: £16.00 (1)
Intermediate acting:Biphasic insulin
aspart
NovoMix 30®
3ml cartridge: £28.79 (5)
Biphasic Insulin
lispro
Humalog Mix25®
3ml cartridge: £29.46 (5)
Isophane insulin
Human Insulatard®

Insuman Basal®
3ml cartridge: £22.90 (5)
10ml vial: £7.48 (1)

3ml pf inj. device: £19.80 (5)
3ml cartridge: £17.50 (5)
5ml vial: £5.61 (1)
Biphasic isophane insulin
Insuman Comb 15®
Insuman Comb 25®


Insuman Comb 50®
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)
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
Abasaglar (biosimilar insulin Glargine) 100 units/mL cartridges & pre-filled pens
5 x 3ml cartridges=£35.28 (for Autopen Classic or HumaPen ranges 5 x 3ml KwikPen=£35.28.PAMM approved biosimilar glargine as Abasaglar as a cost effective alternative to Lantus, with a saving of around £6 per 5 cartridges
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).
Hypodermic equipmentChoice of needle & lancet may be governed by specific insulin prescribed and injection technique. As a general rule pen needles priced at <£6 per 100 will be formulary approved
Insulin pen needlesThere is no clinical reason for recommending needles longer than 8mm in adults or 6mm in children or adolescents
First lineBD Viva®



GlucoRx Carepoint®








Omnican Fine®




Tricare®
4mm/32G: £3.64 (90)
5mm/31G: £3.64 (90)
8mm/31G: £3.64 (90)

4mm/31 gauge, 100=£3.95.
5mm/31 gauge, 100=£3.95.
6mm/31 gauge, 100=£3.95.
8mm/31 gauge, 100=£3.95
10mm/29 gauge, 100=£3.95.
12mm/29 gauge, 100=£3.95.


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)
8mm/31G: £3.95 (100)
First line pen needles meet the scorecard requirement of below £4.10 per 100
Second lineGlucoject 4mm/32 gauge: 100=£5.95.
5mm/31 gauge: 100=£5.95.
6mm/31 gauge: 100=£5.95.
8mm/31 gauge: 100=£5.95.
10mm/29 gauge: 100=£5.95.
12mm/29 gauge: 100=£5.95.
GlucoRx FinePoint®4mm/31 gauge: £5.95 (100)
5mm/31 gauge: £5.95 (100)
6mm/31 gauge: £5.95 (100)
8mm/31 gauge: £5.95 (100)
GlucoRx Finepoint Ultra®4mm/32 gauge: £5.95 (100)
Microdot droplet®4mm/32G: £5.95 (100)
6mm/31G: £5.95 (100)
8mm/31G: £5.95 (100)
Neon Verifine®4mm/31G: £4.50 (100)
5mm/31G: £4.50 (100)
6mm/31G: £4.50 (100)
8mm/31G: £4.50 (100)
Safety needles
First line:
MyLife Clickfine Autoprotect
Second line
BD Autoshield DUO®
5mm 31 gauge/8mm 29 gauge £19 (100)

5mm/30 gauge: £30.08 (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 needlesticks
 Metal tabs provide visual confirmation that the safety feature is activated
Lancets

Apollo twist lancets

Glucoject Plus lancets

Agamatrix Ultra-thin lancets

Glucozen

Fastclix

GlucoRx



0.36mm/28 gauge. 200=£4.50.

0.20mm/33 gauge. 200=£5.50.

0.35mm/28 gauge, 200=£5.43.
0.20mm/33 gauge, 200=£7.17.
0.36mm/28G Pack of 200:£4.99

0.3mm /30G lancets Pack of 204:£5.90

0.31mm /30G Lancet Pack of 200: £5.50
Aim to prescribe lancets below £3 per 100

Apollo twist and Glucoject PLUS lancets are considered compatible with all marketed finger pricking devices
GlucoRx 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