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 Formulary Chapter 6: Endocrine system - Full Chapter
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06.01.01.02  Expand sub section  Intermediate- and long-acting insulins
 note 

Any decision to commence an insulin analogue needs to be balanced carefully against the lack of long term safety data and increased prescribing costs (see NPC document ‘Key Therapeutic Topics’ for full information); http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf

The NICE guideline on type 2 diabetes; NICE CG87: Type 2 diabetes recommends that, when insulin therapy is necessary, human NPH (isophane) insulin (e.g. Insulatard®, Humulin I® or Insuman® Basal) is the preferred option. Long-acting insulin analogues have a role in some patients, and can be considered for those who fall into specific categories e.g. those who require assistance from a carer or healthcare professional to administer their insulin injections, or those with problematic hypoglycaemia. However, for most people with type 2 diabetes, long-acting insulin analogues offer no significant advantage over human NPH insulin and are much more expensive.

06.01.01.02  Expand sub section  Biphasic insulins
06.01.01.02  Expand sub section  Intermediate-acting Insulin
06.01.01.02  Expand sub section  Long-acting Insulin Analogues
Abasaglar (Insulin glargine)

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First Choice
Green
3mL pre-filled disposible pen (KwikPen)
3mL cartridge

**First line insulin glargine in NEW PATIENTS**
 
Lantus (Insulin Glargine)

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Formulary 3ml cartridge (via ClikSTAR or Autopen24 devices)
3ml prefilled disposable pen (Solostar)

 
Levemir (Insulin Detemir)

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Formulary 3ml cartridges (via Novopen4 device)
3ml prefilled disposable pen (Flexpen or Innolet)
 
Tresiba (Insulin degludec)
(100units/mL)

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Formulary 3ml cartridges (via Novo Nordisk devices)
3ml pre-filled disposable pen (Flextouch)

**Only the 100units/mL strength has been approved by the Division of Medicine. Use of the 200units/ml strength requires named-patient approval from Medical D&T Committee Chair**
 
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Key
note Notes First Choice Item First Choice item
Section Title Section Title (top level) Non Formulary Item Non Formulary section
Section Title Section Title (sub level)
Cytotoxic Drug
Cytotoxic Drug
Restricted Drug
Restricted Drug
CD
Controlled Drug
Unlicensed Drug
Unlicensed
High Cost Medicine
High Cost Medicine
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Link to SPCs
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Link to adult BNF
Track Changes
Display tracking information
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Link to children's BNF
Cancer Drugs Fund
Cancer Drugs Fund
   

 

Traffic Light Status Information

Status Description
  Amber   Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   
  Black   These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  
  Green   Not used   
  Green 1   Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   
  Green 2   Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  
  Green 3   Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  
  Red   Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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