Short/rapid-acting insulins
NHS Improvement Patient Safety Alert
November 2016: Risk of severe harm and death due to withdrawing insulin from pen devices. A patient safety alert has been issued to warn NHS providers of the risk of severe harm and death if an insulin needle and syringe is used to administer insulin withdrawn directly from a pen device or replacement cartridge.
Drug Safety Update
October 2024: Insulin pumps and continuous glucose monitoring (CGM) equipment: guidance for users on reporting suspected adverse incidents and safety concerns to the MHRA’s Yellow Card scheme
June 2022: Roche Accu-Chek Insight insulin pump with NovoRapid PumpCart insulin cartridges: alert following cases of insulin leakage
September 2020: Insulins (all types): risk of cutaneous amyloidosis at injection site
April 2015: High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error
SUPPLY ISSUE: A Medicine Supply Notification (MSN) was issued on the 4th March 2024 on the shortage of Fiasp® (insulin aspart) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens. The shortage started on 1st April 2024, and on 26th November 2024 the anticipated resupply date has been updated to 2nd January 2026.
Please see the SPS medicines supply tool (free subscription required) for further information, actions and advice on alternatives and the current anticipated re-supply date.
Please do not initiate new patients on Fiasp® (insulin aspart) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens for the duration of the shortage.
NovoRapid® (insulin aspart) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens are being discontinued. Stock is anticipated to be exhausted by March 2025.
Please do not initiate new patients on NovoRapid® (insulin aspart) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens.
The recommendation in Kent and Medway is that patients currently prescribed NovoRapid® FlexTouch® pens are pro-actively reviewed and switched to Trurapi®, where clinically suitable in line with NICE guidelines on an individual patient basis. Please see here on the SPS Medicines Supply Tool for more information and actions.
NICE guidance
NG17 Type 1 diabetes in adults : diagnosis and management, updated August 2022
NG28 Type 2 diabetes in adults: diagnosis and management, updated June 2022
NG3 Diabetes in pregnancy: management from preconception to the postnatal period, updated December 2020
Local Guidance
See here for local Kent & Medway diabetes & insulin prescribing guidance
All short acting insulins may be administered by continuous subcutaneous infusion using an infusion pump or by IV injection/infusion.
It is recommended that when prescribing insulins the word "unit" is not abbreviated.
Discontinuations
Hypurin Porcine insulins:
The following vials of Hypurin Porcine insulins have been discontinued (stock/supply exhaustion dates of these products can be found on the SPS Medicines Supply Tool (link below):
- Hypurin Porcine Isophane (insulin isophane porcine) 100units/ml suspension for injection 10ml vials
- Hypurin Porcine 30/70 Mix (insulin isophane biphasic porcine 30/70) 100units/ml suspension for injection 10ml vials
- Hypurin Porcine Neutral (insulin soluble porcine) 100units/ml solution for injection 10ml vials
Please see the following on the SPS Medicines Supply Tool which outlines national advice and actions, which should be read in full. For example, new patients should not be initiated on vials of Hypurin Porcine insulins and existing patients will need to be reviewed and switched to an alternative preparation (e.g. cartridges) as per the actions.
Admelog (insulin lispro):
The following preparations of Admelog (insulin lispro) are being discontinued from 14th March 2026:
- Admelog 100units/ml solution for injection 10ml vials
- Admelog 100units/ml solution for injection 3ml cartridges
- Admelog 100units/ml solution for injection 3ml pre-filled pens
Please note that the whole range available in the UK i.e. all preparations of Admelog, a biosimilar insulin, are being discontinued.
Stock/supply exhaustion dates of the individual products can be found on the SPS Medicines Supply Tool (link below).
Please see the following on the SPS Medicines Supply Tool which outlines national advice and actions, which should be read in full.
For example, new patients should not be initiated on Admelog and existing patients will need to be reviewed and switched to an alternative as per the actions.
Humulin/Humalog insulins:
The following vials of insulins have been discontinued (stock/supply exhaustion dates of these products can be found on the SPS Medicines Supply Tool (link below):
- Humulin S 100units/ml solution for injection 10ml vials
- Humalog Mix25 100units/ml suspension for injection10ml vials
- Humulin M3 100units/ml suspension for injection 10ml vials
- Humulin I 100units/ml suspension for injection 10ml vials
Please see the following on the SPS Medicines Supply Tool which outlines national advice and actions, which should be read in full. For example, new patients should not be initiated on these vials and existing patients will need to be reviewed and switched to an alternative preparation (e.g. cartridges, KwikPens) as per the actions
New patients should be started on Trurapi. Where clinically suitable in line with NICE guidelines on an individual patient basis, patients can be switched from originator product to Trurapi as a shared decision with a patient, with close glucose monitoring where this decision is made.
| Pack |
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| 1 vial |
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| 5 cartridge |
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| 5 pre-filled disposable injection |
| Pack |
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| 1 vial |
| Pack |
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| 5 pre-filled disposable injection |
| Pack |
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| 5 cartridge |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 pre-filled disposable injection |
| Pack |
|---|
| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
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| 1 vial |
| Pack |
|---|
| 5 cartridge |
| Pack |
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| 5 pre-filled disposable injection |
Caution: High strength
| Pack |
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| 5 pre-filled disposable injection |
Second line option for the treatment of diabetes mellitus in adults who are suitable for Humalog® and their diabetes cannot be adequately managed with Humalog choices and at least one of the following applies:
- Where the prescriber believes a faster onset of action would be beneficial to the patient
- Where a patient requires ‘tight’ control of blood sugar levels
- Where a patient has rapid post-meal increase in blood sugar levels
Caution in prescribing & dispensing: there are 2 strengths available - to avoid errors, the brand, strength and device must be clear and in line with MHRA guidance. Specialist letters should also make this clear.
| Pack |
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| 1 vial |
| Pack |
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| 5 cartridge |
This device allows half unit dose titration of insulin which may be useful to optimise glucose control.
| Pack |
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| 5 pre-filled disposable injection |
| Pack |
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| 5 pre-filled disposable injection |
| Pack |
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| 5 pre-filled disposable injection |
| Pack |
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| 1 vial |
| Pack |
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| 5 pre-filled disposable injection |
| Pack |
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| 5 cartridge |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary