First reference Hyperglycaemia in the Community guidelines in MCN Handbook
What should be advised if someone runs out of insulin out of hours?
Type 1 diabetes
- If the person has no long acting insulin (examples: Lantus, Levemir, Tresiba, Toujeo)
- Source long acting insulin within 24 hours of last long acting insulin injection via pharmacy/GP
- Rapid /short acting insulin (examples: Novorapid, Humalog/ Actrapid) can be administered in small doses 4 hourly until long acting insulin is sourced
- Refer to Sick Day Rules
- Check blood glucose and ketones, keep hydrated with sugar free fluids
- If the person has no rapid /short acting insulin (examples: Novorapid, Humalog/ Actrapid)
- Reduce carbohydrate intake until insulin is sourced and attend pharmacy as soon as possible and / or GP for prescription
- Continue long acting basal insulin
- If the person is using Continuous Subcutaneous Insulin Infusion pump
NB all people using insulin pump therapy should keep a supply of in date insulin pens for use in the event of pump failure. A person using pump therapy will have no basal insulin circulating as pumps are used with very small doses of rapid acting insulin. Thus, there is high risk of Diabetic Ketoacidosis (DKA)
- Source rapid/short acting insulin to use with pump (examples: Novorapid/Humalog) immediately due to high risk of DKA. A 10ml vial of rapid acting insulin is required to use with pump therapy (examples: novorapid,humalog)
- In the event of pump failure the person will require insulin pens and pen needles to deliver insulin (examples: Novorapid Flexpen, Lantus Solostar) with BD 4mm VIVA insulin pen needles
- Alternatively, insulin syringes can be used with 10 ml vial of insulin normally used with pump if pen devices are not available
- If the person has no insulin supply at all – refer to Emergency department high risk of DKA
Type 2 diabetes
- Detect/exclude risk of DKA
- Source insulin within 24 hours via pharmacy / GP
- Reduce carbohydrate intake
- Check blood glucose, keep hydrated with sugar free fluids
- Refer to sick day rules
Pancreatic Pathology - As Type 1 info
Type 1 Pregnant - Admit to hospital
Gestational Diabetes - As Type 1 info
Information on alternative insulins, if patient’s usual insulin is not available, can be found in the MCN website