The NICE guideline on type 2 diabetes; NICE CG87: Type 2 diabetesrecommends 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.
• 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
Insulin degludec with insulin aspart (DegludecPlus)
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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.
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.
Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.
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.
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.
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.
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.