Diabetes Mellitus - type 1
Patients commencing blood glucose lowering agents may need to inform the DVLA and their vehicle insurance company. Advise patients to check with their insurer and the DVLA website.
Choice of insulin prescribed is guided by the duration of action and regime choice and patient choice regarding device types. The following indicates preferred choices where all things are equal regarding device choice.
In children, insulin should be initiated on specialist advice only. Whatever insulin regimen is chosen it must be supported by comprehensive education appropriate for the age, maturity and individual needs of the child and family.
SIGN 116 & 154: Management of diabetes NICE NG17: Type 1 Diabetes NICE NG18: Diabetes in children and young people ISPAD: Child and adolescent diabetes guidelines
Insulin aspart (Trurapi or NovoRapid).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro (Admelog or Humalog).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin glulisine (Apidra).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin aspart (Fiasp) has a faster onset of action than NovoRapid and care should be taken when prescribing.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro (Lyumjev) has a faster onset of action than Admelog or Humalog and care should be taken when prescribing.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin aspart (Fiasp) has a faster onset of action than Novorapid and may be useful in patients failing to achieve glycaemic control with current fast acting insulin.
- Insulin lispro (Lyumjev) has a faster onset of action than Admelog or Humalog and may be useful in patients failing to achieve glycaemic control with current fast acting insulin.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
History Notes
06/02/2025
NovoRapid FlexTouch 100units/ml solution for injection 3ml pre-filled pens discontinued, ERWG Jan 25
21/08/2024
Addition of Trurapi, ERWG July 24.
04/07/2024
InnoLet products discontinued, ERWG May 2024.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
16/02/2022
East Region Formulary content agreed.
Insulin soluble human (Actrapid).
Dosing is individual and determined in accordance with the needs of the patient.
Insulin soluble human (Humulin S).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
History Notes
04/07/2024
InnoLet products discontinued, ERWG May 2024.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
16/02/2022
East Region Formulary content agreed.
Long acting insulin (taken at the same time every day). Insulin Glargine is available as different branded products. It is important that these are prescribed by brand name to ensure the patient receives the intended product. Current formulary product choices are Lantus, Abasaglar or Toujeo.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Dosing is individual and determined in accordance with the needs of the patient. The dose should be administered once daily at any time but at the same time each day.
Insulin detemir (Levemir).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin degludec (Tresiba). [Sept 2024 - Current supply shortage for Tresiba FlexTouch 100units/ml solution for injection prefilled pens, see prescribing notes for signposts to guidance.]
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Toujeo is a high strength formulation of insulin glargine with a flatter profile. Approved for use following specialist initiation or recommendation. Can be useful in people experiencing hypoglycaemia on basal insulins.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
- September 2024 Tresiba (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens are currently in short supply refer to the Medicine Supply Alert Notice (MSAN) on the NHS Scotland Publications website.
History Notes
26/09/2024
Addition of link to MSAN (2023)09 Tresiba (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens
04/07/2024
InnoLet products discontinued, ERWG May 2024.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
16/02/2022
East Region Formulary content agreed.
Insulin isophane human (Insulatard). Intermediate acting insulin (taken at the same time every day).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin isophane human (Humulin I). Intermediate acting insulin (taken at the same time every day).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
History Notes
04/07/2024
InnoLet products discontinued, ERWG May 2024.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
16/02/2022
East Region Formulary content agreed.
Insulin isophane biphasic human (Humulin M3).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro biphasic (Humalog Mix25). Humalog Mix comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin aspart biphasic (NovoMix 30).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro biphasic (Humalog Mix50). Humalog Mix comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Insulin lispro biphasic (Humalog Mix) comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
History Notes
04/07/2024
InnoLet products discontinued, ERWG May 2024.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
16/02/2022
East Region Formulary content agreed.
Insulin aspart (NovoRapid or Trurapi). Take 5-15 minutes before food or CSII (Continuous subcutaneous insulin infusion or insulin pumps).
Trurapi is compatible with Allstar pro or juniorstar reusable pen.
Novorapid Penfill is compatible with Novopen insulin delivery systems.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro (Humalog).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin glulisine (Apidra).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin aspart (Fiasp) has a faster onset of action than NovoRapid and care should be taken when prescribing.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Type of insulin, device and needle size should be specified. Care should be taken to write the brand name in full to avoid errors.
- The majority of children and young people use 4mm length needles; due to individual patient variability other needle sizes may be prescribed.
- Patients should not be changed from the insulin that they are currently receiving without specialist advice.
- Prepubertal children [outside the partial remission phase] usually require 0.7-0.9 units of insulin/kg/day. During puberty, requirements may rise to 1.3 units of insulin/kg/day.
- Insulin is available in 3ml cartridges, 10ml vials and 3ml disposable pens. The majority of paediatric patients are prescribed 3ml cartridges to be used with pen devices. Pen devices include half unit pens and unit pens. For patients on pen devices with cartridges care should be taken to ensure that compatible cartridges are prescribed. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
- Patients on continuous subcutaneous insulin infusion (CSII, insulin pumps) will normally be prescribed 10ml insulin vials. Selected pump devices use prefilled pump cartridges - details will be highlighted in individual patient correspondence.
History Notes
06/02/2025
NovoRapid FlexTouch 100units/ml solution for injection 3ml pre-filled pens discontinued, ERWG Jan 25
21/08/2024
Addition of Trurapi, ERWG July 24.
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
29/02/2024
East Region Formulary content agreed.
Insulin soluble human (Actrapid). Taken 15-30 minutes before food.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin soluble human (Humulin S). Taken 15-30 minutes before food.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Type of insulin, device and needle size should be specified. Care should be taken to write the brand name in full to avoid errors.
- The majority of children and young people use 4mm length needles; due to individual patient variability other needle sizes may be prescribed.
- Patients should not be changed from the insulin that they are currently receiving without specialist advice.
- Prepubertal children [outside the partial remission phase] usually require 0.7-0.9 units of insulin/kg/day. During puberty, requirements may rise to 1.3 units of insulin/kg/day.
- Insulin is available in 3ml cartridges, 10ml vials and 3ml disposable pens. The majority of paediatric patients are prescribed 3ml cartridges to be used with pen devices. Pen devices include half unit pens and unit pens. For patients on pen devices with cartridges care should be taken to ensure that compatible cartridges are prescribed. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- The majority of paediatric patients are prescribed 3ml cartridges to be used with pen devices. Pen devices include half unit pens and unit pens. For patients on pen devices with cartridges care should be taken to ensure that compatible cartridges are prescribed.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
- Patients on continuous subcutaneous insulin infusion (CSII, insulin pumps) will normally be prescribed 10ml insulin vials. Selected pump devices use prefilled pump cartridges - details will be highlighted in individual patient correspondence.
History Notes
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
29/02/2024
East Region Formulary content agreed.
Long acting insulin (taken at the same time every day).
Insulin degludec (Tresiba).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin detemir (Levemir).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin glargine is available as different branded products, some are biosimilars. It is important that they are prescribed by brand name to ensure the patient receives the intended product. Current formulary product choices are Lantus or Abasaglar.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Toujeo is non-formulary and should not be prescribed, it is not a bioequivalent for other insulin glargines. There is a safety issue if doses are swapped on a unit per unit basis.
- Type of insulin, device and needle size should be specified. Care should be taken to write the brand name in full to avoid errors.
- The majority of children and young people use 4mm length needles; due to individual patient variability other needle sizes may be prescribed.
- Patients should not be changed from the insulin that they are currently receiving without specialist advice.
- Prepubertal children [outside the partial remission phase] usually require 0.7-0.9 units of insulin/kg/day. During puberty, requirements may rise to 1.3 units of insulin/kg/day.
- Insulin is available in 3ml cartridges, 10ml vials and 3ml disposable pens. The majority of paediatric patients are prescribed 3ml cartridges to be used with pen devices. Pen devices include half unit pens and unit pens. For patients on pen devices with cartridges care should be taken to ensure that compatible cartridges are prescribed.
- Insulin degludec is a long-acting insulin analogue. It is approved for use on specialist advice only. Insulin degludec is available in two strengths, only the 100units/ml cartridges are used in children’s services, therefore care must be taken to ensure the correct product is prescribed.
History Notes
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
02/07/2024
Innolet devices discontinued, ERWG May 24.
29/02/2024
East Region Formulary content agreed.
Insulin isophane biphasic human (Humulin M3). Fixed mixture insulin (taken up to 30 minutes before food).
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin isophane human (Humalog Mix25). Analogue insulin (taken up to 15 minutes before food). Humalog Mix comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Insulin aspart biphasic (NovoMix 30). Analogue insulin (taken up to 15 minutes before food).
Dosing is individual and determined in accordance with the needs of the patient.
Insulin lispro biphasic (Humalog Mix50). Analogue insulin (taken up to 15 minutes before food). Humalog Mix comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
Dosing is individual and determined in accordance with the needs of the patient.
Dosing is individual and determined in accordance with the needs of the patient.
Prescribing Notes:
- Insulin lispro biphasic (Humalog Mix) comes in different mixtures of insulin lispro and insulin lispro protamine, prescribers should ensure the correct mixture is selected.
- Choice depends on the particular needs of the individual patient, taking into account lifestyle, age, preference and capabilities. Patients should not be changed from the insulin that they are currently receiving without advice from a specialist or a clinician with the appropriate skills and expertise.
- Type of insulin, device and needle gauge and length should be specified. Care should be taken to write the brand name in full to avoid errors such as, for example, administration of Humalog in place of Humalog Mix25 or Humalog Mix50. In order to avoid dosing errors, when writing prescriptions for insulin the dose should always be written as ‘units’. Abbreviations such as ‘U’ or ‘IU’ should be avoided.
- Insulin is available in 3ml cartridges, 10ml vials, 3ml disposable pens. Not all insulin cartridges fit all pens, see Diabetes UK Meds + Kit information.
- The majority of paediatric patients are prescribed 3ml cartridges to be used with pen devices. Pen devices include half unit pens and unit pens. For patients on pen devices with cartridges care should be taken to ensure that compatible cartridges are prescribed.
- Remind patients to rotate injection sites within the same body region. Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. For further advice, see MHRA Drug Safety Update September 2020.
- Insulin should not be withdrawn from cartridges/penfills for administration. Insulin should be administered from 10ml vial, prefilled pen or from cartridge-loaded pen as appropriate for individual patients.
- The majority of children and young people use 4mm length needles; due to individual patient variability other needle sizes may be prescribed.
- Patients should not be changed from the insulin that they are currently receiving without specialist advice.
- Prepubertal children [outside the partial remission phase] usually require 0.7-0.9 units of insulin/kg/day. During puberty, requirements may rise to 1.3 units of insulin/kg/day.
History Notes
04/07/2024
B-D Safe Clip discontinued, ERWG July 24.
02/07/2024
Innolet devices discontinued, ERWG May 24.
29/02/2024
East Region Formulary content agreed.