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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
Humulin® M3 (Biphasic Isophane Insulin )
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First Choice 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen®)
 
Insuman® Comb 25 (Biphasic Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)
 
Insuman® Comb 15 (Biphasic Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
 
Insuman® Comb 50 (Biphasic Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
 
Humalog® Mix25 (Biphasic Insulin Lispro)
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Formulary 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen® )

 
   
Humalog® Mix50 (Biphasic Insulin Lispro)
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Formulary 3ml cartridge (via Humapen® Luxura device)
3ml disposable prefilled pen (Kwikpen®)
 
   
Hypurin® Porcine 30/70 Mix (Biphasic Isophane Insulin)
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Formulary 3ml cartridge (for Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
NovoMix® 30 (Biphasic Insulin Aspart)
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Formulary 3ml cartridge (via Novopen® 4 device)
3ml prefilled disposable pen (Flexpen®)

 
   
06.01.01.02  Expand sub section  Intermediate-acting Insulin
Insuman® Basal (Isophane Insulin)
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First Choice 3ml cartridge (via ClikSTAR® or Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)
 
Insulatard® (Isophane Insulin)
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Formulary 3ml cartridge (via Novopen®4)
3ml prefilled disposable pen (Innolet®)
 
   
Humulin® I (Isophane Insulin)
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Formulary 3ml cartridge (via Humapen® Luxura device)
3ml prefilled disposable pen (Kwikpen®)
 
   
Hypurin® Bovine Isophane (Isophane Insulin)
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Formulary 3ml cartridges (via Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
Hypurin® Porcine Isophane (Isophane Insulin)
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Formulary 3ml cartridge (via Autopen® Classic)

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal insulin
 
   
Hypurin®Bovine Lente (Insulin Zinc suspension)
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Formulary 10ml vial

• Some long-standing type 1 diabetic patients may be on animal insulin.
• Patients need not be transferred to human insulin unless clinical need dictates
• Human insulin and analogues should be used in preference to animal 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 Autopen®24 devices)
3ml prefilled disposable pen (Solostar®)

 
   
Toujeo® (Insulin Glargine 300units/mL)
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Formulary

1.5ml prefilled disposable pen (Solostar®)

**HIGH-STRENGTH INSULIN PRODUCT** See guidance below

Restricted Item Only to be used in line with GMMMMG recommendations

 
Link  Educational risk-minimisation materials
Link  GMMMG Recommendation: Insulin Glargine – Toujeo® (300 units/mL)
Link  PAT Policy for the Management of High Strength Insulin in the Hospital Setting
   
Levemir® (Insulin Detemir)
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Formulary 3ml cartridges (via Novopen®4 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** 
   
 ....
 Non Formulary Items
Biphasic Isophane Insulin  (Mixtard® 30)

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Non Formulary DISCONTINUED
 
Insulin degludec  (Tresiba®)
(200units/mL)

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Non Formulary **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**
 
Insulin degludec with insulin aspart  (DegludecPlus)

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Non Formulary
 
Isophane Insulin  (Pork Insulatard®)

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Non Formulary
 
Protamine Zinc Insulin  (Hypurin® Bovine Protamine Zinc)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

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.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

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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