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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 6 - Endocrine system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
06.01.01.01 Short-acting insulins
MHRA Drug Safety Update: Insulins (all types): risk of cutaneous amyloidosis at injection site (Sept 2020) NICE TA151: Insulin pumps NICE TA53: Diabetes (types 1 and 2) - long acting insulin analogues

Insulin aspart biosimilar Pre-filled pen (Trurapi®)

GREEN
First Choice

First choice for new patients. 

Cost effective vs Novorapid

For patients switching from Novorapid to Trurapi: Close glucose monitoring during transfer and initial weeks is recommended

 

Entry reviewed: November 2022

BNF BNFc SPC

Insulin Aspart (Novorapid®)
(100units/mL )

GREEN
Formulary

NovoRapid® (10mL vial, 3mL cartridge)
NovoRapid® FlexPen prefilled disposable injection device.

 

How to recycle pens using PenCycle®

BNF BNFc SPC

Insulin Aspart® (Fiasp)
(Injection)

Amber SPA
Formulary

NOTE: Prescribe all insulins by brand
Fiasp® (10mL vial)
Fiasp® Penfill (3mL cartridge)


Fiasp® is a new formulation of insulin aspart with a much faster onset of action. It can be given 2 minutes before a meal instead of the 20 minutes required for current fast acting insulins.


For patients with a rapid post-prandial rise in BG:
· Type 1 on CSII pump
· Type 1 on basal bolus needing tight control or has rapid post-meal blood glucose rise
· Pregnant women with diabetes

 NB: Fiasp® FlexTouch (3mL prefilled pen) - DISCONTINUED. Prescribe as cartridges.

How to recycle pens using PenCycle®

BNF BNFc SPC

Insulin Glulisine
(100units/mL)

GREEN
Formulary
Apidra® (10mL vial, 3mL cartridge)
Apidra® Solostar (3mL prefilled disposable injection device)

BNF BNFc SPC

Insulin Lispro
(100 units/ml)

GREEN
Formulary
Humalog® (10mL vial, 3mL cartridge)
Humalog® KwikPen (3mL prefilled disposable injection device)
BNF BNFc SPC

Insulin Lispro (200 units/ml)

Amber SPA
Formulary

Humalog® KwikPen (3mL prefilled disposable injection device)

Specialist Diabetes Team initiation in adult patients requiring a minimum of 40 units of insulin per dose.

 

BNF BNFc SPC
JPC Bulletin 240 (June 2016): High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error - Safety Reminder

Insulin Lispro (Lyumjev®)
(100 units/ml, 200 units/ml)

Amber SPA
Formulary

Lyumjev is a new faster acting insulin for adults only

  • The JPC supported the use of Insulin Lyumjev® as a treatment option for the same group of patients as Fiasp® with the exception that Insulin Lyumjev® is for adult patients only.

Specialist initiation- It is not recommended for routine use.

. It can be given 0-2 minutes before a meal instead of the 20 minutes required for current fast acting insulins.

For patients with a rapid post-prandial rise in BG:

· Type 1 on CSII pump

· Type 1 on basal bolus needing tight control or has rapid post-meal blood glucose rise

· Pregnant women with diabetes

BNF BNFc SPC

Insulin Lispro 100 units/ml
(0.5 unit pens)

Amber SPA
Formulary

Humalog® Junior Kwikpen For use in young children who need dosing in 0.5 unit increments.

BNF BNFc SPC

Insulin soluble (HUMAN)
(100units/mL)

GREEN
Formulary

Actrapid® (10mL vial)
Humulin S® (10mL vial, 3mL cartridge)

Humulin S vials are due to be discontinued by May 2026 - switch to cartridges

BNF BNFc SPC
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.