Tayside Diabetes MCN Handbook
Insulin Preparations and Alternatives

Recommended stock items in the Acute Medicine Unit and Ward 4, Ninewells Hospital and Ward 4 Perth Royal Infirmary

Insulin Preparation

Device/vial to be kept in stock

Novorapid

10ml vial

Lantus

10ml vial

Insulatard

10ml vial

Humulin M3

10ml vial

Actrapid

10ml vial

 

 

 

 

 

 

 

 

 

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, condition and glycaemic control.

 

For patient normally prescribed

Suitable temporary alternative insulin preparation from stock

Humalog Mix 25

Humulin M3

Humalog Mix 50

Humulin M3

Humalog, Apidra

Novorapid

Humulin I or Levemir

Insulatard

Hypurin Porcine Neutral

Actrapid

Hypurin Porcine Isophane

Insulatard

Hypurin Porcine 30/70

Humulin M3

Insuman Combi 15

Insulatard

Insuman Combi 25

Humulin M3

Abasaglar

Lantus

Toujeo (300 units/ml)

Lantus

Tresiba (100 units/ml)

Lantus

Humulin R (500 units/ml)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No dose adjustment is required to change from Tresiba or Toujeo to Lantus

Humulin R Kwik Pen doses can be used as a reference but individual assessment is required.

Conversion to basal bolus regimen with Actrapid and Insulatard or BD biphasic mixture 0.5 unit/kg/24 hours 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)], a life threatening metabolic emergency.  
  • Insulin pen devices and cartridges of insulin are designed for ‘self use’ only.
  • 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' per 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 13476 bleep 5288