experienced healthcare team. Some insulin preparations
are not recommended for use in subcutaneous insulin
infusion pumps—may precipitate in catheter or needle—
▶ With intravenous use For intravenous infusion give
continuously in Sodium chloride 0.9%. Adsorbed to some
extent by plastic infusion set; ensure insulin is not
injected into ’dead space’ of injection port of the infusion
l PRESCRIBING AND DISPENSING INFORMATION A sterile
solution of insulin (i.e. bovine or porcine) or of human
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Continuous subcutaneous insulin infusion for the treatment of
diabetes mellitus (type 1) (July 2008) NICE TA151
Continuous subcutaneous insulin infusion is
recommended as an option in adults and children over
12 years with type 1 diabetes:
. who suffer repeated or unpredictable hypoglycaemia,
whilst attempting to achieve optimal glycaemic control
with multiple-injection regimens, or
. whose glycaemic control remains inadequate (HbA1c
insulin analogues where appropriate).
Continuous subcutaneous insulin infusion is also
recommended as an option for children under 12 years
with type 1 diabetes for whom multiple-injection regimens
are considered impractical or inappropriate. Children on
insulin pumps should undergo a trial of multiple-injection
therapy between the ages of 12 and 18 years.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
injection, solution for infusion
Insulin human (as Insulin soluble human) 100 unit per
1 ml Actrapid 100units/ml solution for injection 10ml vials | 1 vial P £7.48 DT = £15.68
▶ Humulin R (Imported (United States))
Insulin human 500 unit per 1 ml Humulin R 500units/ml solution
for injection 20ml vials | 1 vial P s
Humulin R KwikPen 500units/ml solution for injection 3ml pre-filled
pen | 2 pre-filled disposable injection P s
▶ Humulin S (Eli Lilly and Company Ltd)
Insulin human (as Insulin soluble human) 100 unit per
1 ml Humulin S 100units/ml solution for injection 10ml vials | 1 vial P £15.68 DT = £15.68
Humulin S 100units/ml solution for injection 3ml cartridges | 5 cartridge P £19.08 DT = £19.08
▶ Hypurin Bovine Neutral (Wockhardt UK Ltd)
Insulin bovine (as Insulin soluble bovine) 100 unit per
1 ml Hypurin Bovine Neutral 100units/ml solution for injection 10ml
vials | 1 vial P £27.72 DT = £27.72
Hypurin Bovine Neutral 100units/ml solution for injection 3ml
cartridges | 5 cartridge P £41.58 DT = £41.58
▶ Hypurin Porcine Neutral (Wockhardt UK Ltd)
Insulin porcine (as Insulin soluble porcine) 100 unit per
1 ml Hypurin Porcine Neutral 100units/ml solution for injection 10ml
vials | 1 vial P £33.80 DT = £31.30
Hypurin Porcine Neutral 100units/ml solution for injection 3ml
cartridges | 5 cartridge P £50.71 DT = £46.95
Insulin human 100 unit per 1 ml Insuman Infusat 100units/ml
solution for injection 3.15ml cartridges | 5 cartridge P £250.00
Insuman Infusat 100units/ml solution for injection 10ml vials | 3 vial P £250.00
Insulin human (as Insulin soluble human) 100 unit per
1 ml Insuman Rapid 100units/ml solution for injection 3ml cartridges
| 5 cartridge P £17.50 DT = £19.08
(Recombinant human insulin analogue—short
▶ BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INFUSION,
OR BY CONTINUOUS SUBCUTANEOUS INFUSION
▶ Adult: According to requirements
▶ Child 2–17 years: Administer immediately before meals
or when necessary shortly after meals, according to
▶ Adult: Administer immediately before meals or when
necessary shortly after meals, according to
▶ BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION,
▶ Child 2–17 years: According to requirements
▶ Adult: According to requirements
l INTERACTIONS → Appendix 1: insulins
▶ Uncommon Refraction disorder. skin reactions
l PREGNANCY Not known to be harmful—may be used
l BREAST FEEDING Not known to be harmful—may be used
l DIRECTIONS FOR ADMINISTRATION Short-acting injectable
insulins can be given by continuous subcutaneous infusion
using a portable infusion pump. This device delivers a
continuous basal insulin infusion and patient-activated
bolus doses at meal times. This technique can be useful for
patients who suffer recurrent hypoglycaemia or marked
morning rise in blood-glucose concentration despite
optimised multiple-injection regimens. Patients on
subcutaneous insulin infusion must be highly motivated,
able to monitor their blood-glucose concentration, and
have expert training, advice and supervision from an
▶ With intravenous use in adults For intravenous infusion, give
continuously in Glucose 5% or Sodium chloride 0.9%;
dilute to 0.05-1 unit/mL with infusion fluid; adsorbed to
some extent by plastics of infusion set.
▶ With intravenous use in children For intravenous infusion,
dilute to a concentration of 0.05–1 unit/mL with Glucose
5% or Sodium Chloride 0.9% and mix thoroughly; insulin
may be adsorbed by plastics, flush giving set with 5 mL of
infusion fluid containing insulin.
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Continuous subcutaneous insulin infusion for the treatment of
diabetes mellitus (type 1) (July 2008) NICE TA151
Continuous subcutaneous insulin infusion is
recommended as an option in adults and children over
12 years with type 1 diabetes:
. who suffer repeated or unpredictable hypoglycaemia,
whilst attempting to achieve optimal glycaemic control
with multiple-injection regimens, or
. whose glycaemic control remains inadequate (HbA1c
insulin analogues where appropriate).
Continuous subcutaneous insulin infusion is also
recommended as an option for children under 12 years
with type 1 diabetes for whom multiple-injection regimens
are considered impractical or inappropriate. Children on
insulin pumps should undergo a trial of multiple-injection
therapy between the ages of 12 and 18 years.
Scottish Medicines Consortium (SMC) decisions
▶ In adults The Scottish Medicines Consortium has advised
(April 2017) that insulin aspart (Fiasp ®) is accepted for use
within NHS Scotland for the treatment of diabetes mellitus
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Insulin aspart 100 unit per 1 ml Fiasp 100units/ml solution for
injection 10ml vials | 1 vial P £14.08 DT = £14.08
▶ Fiasp FlexTouch (Novo Nordisk Ltd) A
Insulin aspart 100 unit per 1 ml Fiasp FlexTouch 100units/ml
solution for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £30.60 DT = £30.60
▶ Fiasp Penfill (Novo Nordisk Ltd) A
Insulin aspart 100 unit per 1 ml Fiasp Penfill 100units/ml solution
for injection 3ml cartridges | 5 cartridge P £28.31 DT = £28.31
▶ NovoRapid (Novo Nordisk Ltd)
Insulin aspart 100 unit per 1 ml NovoRapid 100units/ml solution for
injection 10ml vials | 1 vial P £14.08 DT = £14.08
▶ NovoRapid FlexPen (Novo Nordisk Ltd)
Insulin aspart 100 unit per 1 ml NovoRapid FlexPen 100units/ml
solution for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £30.60 DT = £30.60
▶ NovoRapid FlexTouch (Novo Nordisk Ltd)
Insulin aspart 100 unit per 1 ml NovoRapid FlexTouch 100units/ml
solution for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £32.13 DT = £30.60
▶ NovoRapid Penfill (Novo Nordisk Ltd)
Insulin aspart 100 unit per 1 ml NovoRapid Penfill 100units/ml
solution for injection 3ml cartridges | 5 cartridge P £28.31 DT =
▶ NovoRapid PumpCart (Novo Nordisk Ltd)
Insulin aspart 100 unit per 1 ml NovoRapid PumpCart 100units/ml
solution for injection 1.6ml cartridges | 5 cartridge P £15.10 DT =
(Recombinant human insulin analogue—short
▶ Child: Administer immediately before meals or when
necessary shortly after meals, according to
▶ Adult: Administer immediately before meals or when
necessary shortly after meals, according to
▶ BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION
▶ Child: According to requirements
▶ Adult: According to requirements
▶ In children Not licensed for children under 6 years.
l INTERACTIONS → Appendix 1: insulins
l DIRECTIONS FOR ADMINISTRATION Short-acting injectable
insulins can be given by continuous subcutaneous infusion
using a portable infusion pump. This device delivers a
continuous basal insulin infusion and patient-activated
bolus doses at meal times. This technique can be useful for
patients who suffer recurrent hypoglycaemia or marked
morning rise in blood-glucose concentration despite
optimised multiple-injection regimens. Patients on
subcutaneous insulin infusion must be highly motivated,
able to monitor their blood-glucose concentration, and
have expert training, advice and supervision from an
▶ With intravenous use in adults For intravenous infusion
(Apidra ®), give continuously in Sodium chloride 0.9%;
dilute to 1 unit/mL with infusion fluid; use a co-extruded
polyolefin/polyamide plastic infusion bag with a dedicated
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Continuous subcutaneous insulin infusion for the treatment of
diabetes mellitus (type 1) (July 2008) NICE TA151
Continuous subcutaneous insulin infusion is
recommended as an option in adults and children over
12 years with type 1 diabetes:
. who suffer repeated or unpredictable hypoglycaemia,
whilst attempting to achieve optimal glycaemic control
with multiple-injection regimens, or
. whose glycaemic control remains inadequate (HbA1c
insulin analogues where appropriate).
Continuous subcutaneous insulin infusion is also
recommended as an option for children under 12 years
with type 1 diabetes for whom multiple-injection regimens
are considered impractical or inappropriate. Children on
insulin pumps should undergo a trial of multiple-injection
therapy between the ages of 12 and 18 years.
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (October
2008) that Apidra ® is accepted for restricted use within
NHS Scotland for the treatment of adults and children over
6 years with diabetes mellitus in whom the use of a shortacting insulin analogue is appropriate.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Insulin glulisine 100 unit per 1 ml Apidra 100units/ml solution for
injection 3ml cartridges | 5 cartridge P £28.30 DT = £28.30
Apidra 100units/ml solution for injection 10ml vials | 1 vial P £16.00 DT = £16.00
Insulin glulisine 100 unit per 1 ml Apidra 100units/ml solution for
injection 3ml pre-filled SoloStar pen | 5 pre-filled disposable
injection P £28.30 DT = £28.30
(Recombinant human insulin analogue—short
▶ Child 2–17 years: Administer shortly before meals or
when necessary shortly after meals, according to
▶ Adult: Administer shortly before meals or when
necessary shortly after meals, according to
▶ BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION,
▶ Child 2–17 years: According to requirements
▶ Adult: According to requirements
▶ In children Not licensed for use in children under 2 years.
l CAUTIONS Children under 12 years (use only if benefit
likely compared to soluble insulin)
714 Diabetes mellitus and hypoglycaemia BNF 78
l INTERACTIONS → Appendix 1: insulins
l PREGNANCY Not known to be harmful—may be used
l BREAST FEEDING Not known to be harmful—may be used
l DIRECTIONS FOR ADMINISTRATION Short-acting injectable
insulins can be given by continuous subcutaneous infusion
using a portable infusion pump. This device delivers a
continuous basal insulin infusion and patient-activated
bolus doses at meal times. This technique can be useful for
patients who suffer recurrent hypoglycaemia or marked
morning rise in blood-glucose concentration despite
optimised multiple-injection regimens (see also NICE
guidance, below). Patients on subcutaneous insulin
infusion must be highly motivated, able to monitor their
blood-glucose concentration, and have expert training,
advice and supervision from an experienced healthcare
▶ With intravenous use in adults For intravenous infusion give
continuously in Glucose 5% or Sodium chloride 0.9%.
Adsorbed to some extent by plastics of infusion set.
▶ With intravenous use in children For intravenous infusion,
dilute to a concentration of 0.1–1 unit/mL with Glucose
5% or Sodium Chloride 0.9% and mix thoroughly; insulin
may be adsorbed by plastics, flush giving set with 5 mL of
infusion fluid containing insulin.
l PRESCRIBING AND DISPENSING INFORMATION Insulin
lispro is a biological medicine. Biological medicines must
be prescribed and dispensed by brand name, see Biological
medicines and Biosimilar medicines, under Guidance on
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Continuous subcutaneous insulin infusion for the treatment of
diabetes mellitus (type 1) (July 2008) NICE TA151
Continuous subcutaneous insulin infusion is
recommended as an option in adults and children over
12 years with type 1 diabetes:
. who suffer repeated or unpredictable hypoglycaemia,
whilst attempting to achieve optimal glycaemic control
with multiple-injection regimens, or
. whose glycaemic control remains inadequate (HbA1c
insulin analogues where appropriate).
Continuous subcutaneous insulin infusion is also
recommended as an option for children under 12 years
with type 1 diabetes for whom multiple-injection regimens
are considered impractical or inappropriate. Children on
insulin pumps should undergo a trial of multiple-injection
therapy between the ages of 12 and 18 years.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Insulin lispro (non-proprietary) A
Insulin lispro 100 unit per 1 ml Insulin lispro Sanofi 100units/ml
solution for injection 3ml cartridges | 5 cartridge P £24.06 DT =
Insulin lispro Sanofi 100units/ml solution for injection 3ml pre-filled
pen | 5 pre-filled disposable injection P £25.04 DT = £29.46
Insulin lispro Sanofi 100units/ml solution for injection 10ml vials | 1 vial P £14.12 DT = £16.61
▶ Humalog (Eli Lilly and Company Ltd)
Insulin lispro 100 unit per 1 ml Humalog 100units/ml solution for
injection 10ml vials | 1 vial P £16.61 DT = £16.61
Humalog 100units/ml solution for injection 3ml cartridges | 5 cartridge P £28.31 DT = £28.31
▶ Humalog Junior KwikPen (Eli Lilly and Company Ltd)
Insulin lispro 100 unit per 1 ml Humalog Junior KwikPen
100units/ml solution for injection 3ml pre-filled pen | 5 pre-filled
disposable injection P £29.46 DT = £29.46
▶ Humalog KwikPen (Eli Lilly and Company Ltd)
Insulin lispro 100 unit per 1 ml Humalog KwikPen 100units/ml
solution for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £29.46 DT = £29.46
Insulin lispro 200 unit per 1 ml Humalog KwikPen 200units/ml
solution for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £58.92 DT = £58.92
INSULINS › INTERMEDIATE-ACTING
(Biphasic Isophane Insulin Injection— intermediate
▶ Child: According to requirements
▶ Adult: According to requirements
l INTERACTIONS → Appendix 1: insulins
▶ Rare or very rare Angioedema
▶ Frequency not known Hypokalaemia . weight increased
l PRESCRIBING AND DISPENSING INFORMATION A sterile
buffered suspension of either porcine or human insulin
complexed with protamine sulfate (or another suitable
protamine) in a solution of insulin of the same species.
Check product container—the proportions of the two
components should be checked carefully (the order in
which the proportions are stated may not be the same in
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Humulin M3 (Eli Lilly and Company Ltd)
Insulin human (as Insulin soluble human) 30 unit per 1 ml,
Insulin human (as Insulin isophane human) 70 unit per
1 ml Humulin M3 100units/ml suspension for injection 3ml cartridges
| 5 cartridge P £19.08 DT = £19.08
Humulin M3 100units/ml suspension for injection 10ml vials | 1 vial P £15.68 DT = £15.68
▶ Humulin M3 KwikPen (Eli Lilly and Company Ltd)
Insulin human (as Insulin soluble human) 30 unit per 1 ml,
Insulin human (as Insulin isophane human) 70 unit per
1 ml Humulin M3 KwikPen 100units/ml suspension for injection 3ml
pre-filled pen | 5 pre-filled disposable injection P £21.70 DT =
▶ Hypurin Porcine 30/70 Mix (Wockhardt UK Ltd)
Insulin porcine (as Insulin soluble porcine) 30 unit per 1 ml,
Insulin porcine (as Insulin isophane porcine) 70 unit per
1 ml Hypurin Porcine 30/70 Mix 100units/ml suspension for injection
3ml cartridges | 5 cartridge P £50.71 DT = £46.95
Hypurin Porcine 30/70 Mix 100units/ml suspension for injection 10ml
vials | 1 vial P £33.80 DT = £31.30
Insulin human (as Insulin soluble human) 15 unit per 1 ml, Insulin
human (as Insulin isophane human) 85 unit per 1 ml Insuman
Comb 15 100units/ml suspension for injection 3ml cartridges |
5 cartridge P £17.50 DT = £17.50
Insulin human (as Insulin soluble human) 25 unit per 1 ml, Insulin
human (as Insulin isophane human) 75 unit per 1 ml Insuman
Comb 25 100units/ml suspension for injection 5ml vials | 1 vial P £5.61
Insuman Comb 25 100units/ml suspension for injection 3ml pre-filled
SoloStar pen | 5 pre-filled disposable injection P £19.80 DT =
Insuman Comb 25 100units/ml suspension for injection 3ml cartridges
| 5 cartridge P £17.50 DT = £17.50
Insulin human (as Insulin isophane human) 50 unit per 1 ml,
Insulin human (as Insulin soluble human) 50 unit per
1 ml Insuman Comb 50 100units/ml suspension for injection 3ml
cartridges | 5 cartridge P £17.50 DT = £17.50
(Isophane Insulin Injection; Isophane Protamine
Insulin Injection; Isophane Insulin (NPH)—
▶ Child: According to requirements
▶ Adult: According to requirements
l INTERACTIONS → Appendix 1: insulins
l PREGNANCY Recommended where longer-acting insulins
l PRESCRIBING AND DISPENSING INFORMATION A sterile
suspension of bovine or porcine insulin or of human
insulin in the form of a complex obtained by the addition
of protamine sulfate or another suitable protamine.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Humulin I (Eli Lilly and Company Ltd)
Insulin human (as Insulin isophane human) 100 unit per
1 ml Humulin I 100units/ml suspension for injection 10ml vials |
Humulin I 100units/ml suspension for injection 3ml cartridges | 5 cartridge P £19.08 DT = £19.08
▶ Humulin I KwikPen (Eli Lilly and Company Ltd)
Insulin human (as Insulin isophane human) 100 unit per
▶ Hypurin Porcine Isophane (Wockhardt UK Ltd)
Insulin porcine (as Insulin isophane porcine) 100 unit per
1 ml Hypurin Porcine Isophane 100units/ml suspension for injection
3ml cartridges | 5 cartridge P £50.71 DT = £46.95
Hypurin Porcine Isophane 100units/ml suspension for injection 10ml
vials | 1 vial P £33.80 DT = £31.30
▶ Insulatard (Novo Nordisk Ltd)
Insulin human (as Insulin isophane human) 100 unit per
1 ml Insulatard 100units/ml suspension for injection 10ml vials | 1 vial P £7.48 DT = £15.68
▶ Insulatard InnoLet (Novo Nordisk Ltd)
Insulin human (as Insulin isophane human) 100 unit per
▶ Insulatard Penfill (Novo Nordisk Ltd)
Insulin human (as Insulin isophane human) 100 unit per
1 ml Insulatard Penfill 100units/ml suspension for injection 3ml
cartridges | 5 cartridge P £22.90 DT = £19.08
Insulin human (as Insulin isophane human) 100 unit per
1 ml Insuman Basal 100units/ml suspension for injection 5ml vials | 1 vial P £5.61
Insuman Basal 100units/ml suspension for injection 3ml cartridges |
5 cartridge P £17.50 DT = £19.08
▶ Insuman Basal SoloStar (Sanofi)
Insulin human (as Insulin isophane human) 100 unit per
INSULINS › INTERMEDIATE-ACTING
▶ Child: Administer up to 10 minutes before or soon after
a meal, according to requirements
▶ Adult: Administer up to 10 minutes before or soon after
a meal, according to requirements
l INTERACTIONS → Appendix 1: insulins
l PRESCRIBING AND DISPENSING INFORMATION Check
product container—the proportions of the two
components should be checked carefully (the order in
which the proportions are stated may not be the same in
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ NovoMix 30 FlexPen (Novo Nordisk Ltd)
Insulin aspart 30 unit per 1 ml, Insulin aspart (as Insulin aspart
protamine) 70 unit per 1 ml NovoMix 30 FlexPen 100units/ml
suspension for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £29.89 DT = £29.89
▶ NovoMix 30 Penfill (Novo Nordisk Ltd)
Insulin aspart 30 unit per 1 ml, Insulin aspart (as Insulin aspart
protamine) 70 unit per 1 ml NovoMix 30 Penfill 100units/ml
suspension for injection 3ml cartridges | 5 cartridge P £28.79 DT
▶ Child: Administer up to 15 minutes before or soon after
a meal, according to requirements
▶ Adult: Administer up to 15 minutes before or soon after
a meal, according to requirements
l CAUTIONS Children under 12 years (use only if benefit
likely compared to soluble insulin)
l INTERACTIONS → Appendix 1: insulins
l PRESCRIBING AND DISPENSING INFORMATION Check
product container—the proportions of the two
components should be checked carefully (the order in
which the proportions are stated may not be the same in
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Humalog Mix25 (Eli Lilly and Company Ltd)
Insulin lispro 25 unit per 1 ml, Insulin lispro (as Insulin lispro
protamine) 75 unit per 1 ml Humalog Mix25 100units/ml suspension
for injection 10ml vials | 1 vial P £16.61 DT = £16.61
Humalog Mix25 100units/ml suspension for injection 3ml cartridges | 5 cartridge P £29.46 DT = £29.46
▶ Humalog Mix25 KwikPen (Eli Lilly and Company Ltd)
Insulin lispro 25 unit per 1 ml, Insulin lispro (as Insulin lispro
protamine) 75 unit per 1 ml Humalog Mix25 KwikPen 100units/ml
suspension for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £30.98 DT = £30.98
716 Diabetes mellitus and hypoglycaemia BNF 78
▶ Humalog Mix50 (Eli Lilly and Company Ltd)
Insulin lispro 50 unit per 1 ml, Insulin lispro (as Insulin lispro
protamine) 50 unit per 1 ml Humalog Mix50 100units/ml
suspension for injection 3ml cartridges | 5 cartridge P £29.46 DT
▶ Humalog Mix50 KwikPen (Eli Lilly and Company Ltd)
Insulin lispro 50 unit per 1 ml, Insulin lispro (as Insulin lispro
protamine) 50 unit per 1 ml Humalog Mix50 KwikPen 100units/ml
suspension for injection 3ml pre-filled pen | 5 pre-filled disposable
injection P £30.98 DT = £30.98
(Recombinant human insulin analogue—long
▶ Child 1–17 years: Dose to be given according to
▶ Adult: Dose to be given according to requirements
l INTERACTIONS → Appendix 1: insulins
l PREGNANCY Evidence of the safety of long-acting insulin
analogues in pregnancy is limited, therefore isophane
insulin is recommended where longer-acting insulins are
needed; insulin detemir may also be considered.
l PRESCRIBING AND DISPENSING INFORMATION Insulin
degludec (Tresiba ®) is available in strengths of
100 units/mL (allows 1-unit dose adjustment) and
200 units/mL (allows 2-unit dose adjustment)—ensure
l NATIONAL FUNDING/ACCESS DECISIONS
All Wales Medicines Strategy Group (AWMSG) decisions
▶ In adults The All Wales Medicines Strategy Group has
advised (October 2016) that insulin degludec (Tresiba ®) is
recommended as an option for restricted use within NHS
Wales for the treatment of diabetes mellitus in adult
patients where treatment with a basal insulin analogue is
▶ In children The All Wales Medicines Strategy Group has
advised (October 2016) that insulin degludec (Tresiba ®) is
not recommended for use within NHS Wales for the
treatment of diabetes mellitus in adolescents and children
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Tresiba FlexTouch (Novo Nordisk Ltd)
Insulin human (as Insulin degludec) 100 unit per 1 ml Tresiba
Insulin human (as Insulin degludec) 200 unit per 1 ml Tresiba
▶ Tresiba Penfill (Novo Nordisk Ltd)
Insulin human (as Insulin degludec) 100 unit per 1 ml Tresiba
Penfill 100units/ml solution for injection 3ml cartridges | 5 cartridge P £46.60 DT = £46.60
Insulin degludec with liraglutide
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, insulin degludec above, liraglutide p. 699.
As add-on to oral antidiabetics in type 2 diabetes mellitus
not controlled by oral antidiabetics alone
▶ Adult: Initially 10 dose-steps once daily, adjusted
according to response; maximum 50 dose-steps per day
When transferring from basal insulin in type 2 diabetes
mellitus not controlled by oral antidiabetics in
combination with basal insulin
▶ Adult: Initially 16 dose-steps once daily, adjusted
according to response; maximum 50 dose-steps per day
l INTERACTIONS → Appendix 1: insulins . liraglutide
l PATIENT AND CARER ADVICE Counselling advised on
administration. Show container to patient and confirm
that patient is expecting the version dispensed.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (October
2015) that insulin degludec with liraglutide (Xultophy ®) is
accepted for restricted use within NHS Scotland for the
treatment of type 2 diabetes mellitus to improve glycaemic
control in combination with oral glucose-lowering
medicinal products when these alone or combined with a
GLP-1 receptor agonist or with basal insulin do not
provide adequate glycaemic control.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Xultophy (Novo Nordisk Ltd) A
Liraglutide 3.6 mg per 1 ml, Insulin human (as Insulin degludec)
100 unit per 1 ml Xultophy 100units/ml / 3.6mg/ml solution for
injection 3ml pre-filled pen | 3 pre-filled disposable injection P £95.53 DT = £95.53
(Recombinant human insulin analogue—long
▶ Child 2–17 years: According to requirements
▶ Adult: According to requirements
l INTERACTIONS → Appendix 1: insulins
▶ Uncommon Refraction disorder
l PREGNANCY Evidence of the safety of long-acting insulin
analogues in pregnancy is limited, therefore isophane
insulin p. 716 is recommended where longer-acting
insulins are needed; insulin detemir may also be
considered where longer-acting insulins are needed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Levemir FlexPen (Novo Nordisk Ltd)
Insulin human (as Insulin detemir) 100 unit per 1 ml Levemir
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