Recommended stock items in the Acute Medicine Unit and Ward 4, Ninewells Hospital and Ward 4 Perth Royal Infirmary
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Insulin Preparation
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Device/vial to be kept in stock
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Novorapid
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10ml vial
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Lantus
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10ml vial
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Insulatard
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10ml vial
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Humulin M3
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10ml vial
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Actrapid
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10ml vial
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DO NOT OMIT INSULIN: If routine insulin preparation is unknown on admission then prescribe a suitable alternative.
Insulin time action profiles
NB New high strength insulin preparations (200 units, 300 units and 500 units/ml ) in pen devices are now available. These preparations have prolonged time action profiles. Administration guidance with these preparations must be adhered to prevent overdosing.
Temporary Alternative Insulin Preparation List
For emergency use when ‘usual’ insulin is not available is listed below. Dose adjustment may be required depending on current diagnosis, oral intake and glycaemic control.
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For patient normally prescribed
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Suitable temporary alternative insulin preparation from stock
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Humalog Mix 25
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Humulin M3
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Humalog Mix 50
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Humulin M3
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Humalog, Apidra,Fiasp
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Novorapid
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Humulin I or Levemir
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Insulatard
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Hypurin Porcine Neutral
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Actrapid
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Hypurin Porcine Isophane
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Insulatard
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Hypurin Porcine 30/70
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Humulin M3
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Insuman Combi 15
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Insulatard
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Insuman Combi 25
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Humulin M3
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Abasaglar
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Lantus
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Toujeo (300 units/ml)
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Lantus
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Tresiba (100 units/ml or 200 units/ml)
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Lantus
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Humulin R (500 units/ml)
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* |
Humulin R (in kwikpen) dose/s can be used as a reference but individual assessment is required.
If preparation is unavailable convert to basal bolus regimen with Actrapid and Insulatard or BD biphasic mixture 0.5unit/kg/24 hrs is a reasonable starting point.
Practical and safety advice
- Blood glucose monitoring will identify efficacy of treatment
- Check for ketones at diagnosis of diabetes. Check ketones in patients who are acutely unwell, vomiting, and/or during pregnancy irrespective of BG level. An elevated ketone result identifies the risk of Diabetic Ketoacidosis (DKA)
- Insulin pen devices and cartridges of insulin are designed for ‘self use’ only unless used with an insulin safety pen needle.
- Nursing staff must use an insulin syringe to administer prescribed insulin from a vial if the person is not able to self administer injection or use a safety pen needle with a pen device. BD 5mm Autoshield needles are available in wards and are ordered via Pecos.
- If a patient is unable to administer their own insulin and the preparation does not come in a vial, a suitable alternative insulin preparation should be prescribed.
- Please be aware that dose adjustments are sometimes necessary when using alternative insulin preparations - review blood glucose monitoring to identify efficacy of management.
- Insulin syringes must NEVER be used to extract insulin from a prefilled insulin device or cartridge. The plunger mechanism of the device will be adversely affected if insulin is extracted using a syringe and will not deliver insulin accurately thereafter.
- Devices used for self administration in hospital must be suitably labelled with patient identification and stored in patients own drug (POD) locker.
- Do not store 'in-use' pen devices in the ward fridge.
- Cartridges are not interchangeable with different pen devices.
Contact details for diabetes team:
Ninewells Hospital:
Specialist Registrar Diabetes bleep 5416,
Diabetes Specialist Nurse Ext. 36009 bleep 4872
Perth Royal Infirmary
Diabetes Specialist Nurse Ext 13976 bleep 5288