Related guidance:

A guide to insulin treated diabetes and driving (DVLA)

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)		Rationale for decision / comments
Short acting:First line
Trurapi® insulin aspart






Insulin aspart
NovoRapid®






Fast acting insulin aspart
as FiASP®		100units/ml solution for injection,
3ml cartridges x5 - £19.82
3ml pre-filled Solostar pens x5 - £21.42
10ml vials x1 - £11.97




3ml Penfill cartridge: £28.31 (5)
3ml Flexpen p/f pen: £30.60 (5)
3ml Flextouch p/f pen: £32.13 (5)
10ml vial: £14.08 (1)
1.6ml Pumpcart cartridge: £15.10 (5)



3ml Penfill cartridges=£28.31 (5)
3ml FlexTouch pre-filled pen=£30.60 (5)
10ml vial=£14.08.		Trurapi has bioequivalence data to Novorapid as and as a cost effective biosimilar has the
potential to save the NHS in Somerset ~£250k per year if we switched all patients to Trurapi

NICE 2021- Offer rapid‑acting insulin analogues that are injected before meals, rather than rapid‑acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes.
Do not advise routine use of rapid‑acting insulin analogues after meals for adults with type 1 diabetes. [2015]
If an adult with type 1 diabetes has a strong preference for an alternative mealtime insulin, respect their wishes and offer the preferred insulin.

Prefilled pens are around £2-3 more expensive per 5 and should be used only when patient choice demands.


For Onset, duration of action and peak activity of insulins in hours (approx) please see MIMS table below
Admelog® (insulin lispro U100)▼ (previously known as Insulin Lispro Sanofi®)
Humalog® biosimilar but the cartridges are not interchangeable

Insulin Lispro
Humalog®		3ml cartridge: £21.23 (5)
3ml pre-filled pen: £22.10 (5)
10ml vial: £14.12 (1)





3ml cartridge: £28.31 (5)
10ml vial: £16.61 (1)
Soluble insulin
Human Actrapid®

Insuman Rapid®

Humulin S®		10ml vial: £7.48 (1)

3ml cartridge: £17.50 (5)

3ml cartridge: £19.08 (5)
10ml vial: £15.68 (1)
Insulin glulisine
Apidra®		Solostar 3ml pf inj. device: £28.30 (5)
3ml cartridge: £28.30 (5)
10ml vial: £16.00 (1)
Intermediate acting:Biphasic isophane insulin


Insuman Comb 25®



Insuman Comb 50®

Humulin M3®		for AllStar Pro, Autopen 24 and JuniorSTAR
5 x 3ml cartridge=£17.50
5 x 3ml SoloStar pre-filled pen=£19.80 (for use with BD pen needles, Clickfine, Penfine, Insupen, Tricare or Unifine).

5 x 3ml cartridge=£17.50

3ml cartridge: £19.08 (5)
3ml kwikpen: £21.70 (5)
10ml vial: £15.68 (1)
Biphasic insulin
aspart
NovoMix 30®		3ml cartridge: £28.79 (5)
Biphasic Insulin
lispro
Humalog Mix25®

Humalog Mix50®		3ml cartridge: £29.46 (5)
3ml kwikpen: £30.98 (5)
10ml vial: £16.61 (1)

3ml cartridge: £29.46 (5)
3ml kwikpen: £30.98 (5)
Isophane insulin
Insuman Basal®


Human Insulatard®



Humulin I®		3ml cartridge: £17.50 (5)
3ml pf inj. device: £19.80 (5)
5ml vial: £5.61 (1)

3ml cartridge: £22.90 (5)

10ml vial: £7.48 (1)

3ml cartridge: £19.08 (5)
3ml kwikpen: £21.70 (5)
10ml vial: £15.68 (1)
Long acting:Insulin detemir
Levemir®		3ml cartridge :£42.00 (5)NICE guidance 2021 says: Offer twice‑daily insulin detemir as basal insulin therapy for adults with type 1 diabetes

Do not change to detemir if existing regime is achieving HbA1c targets for the patient
Insulin glargine
High strength
as Toujeo®
300 units/ml soln		3 x 1.5ml SoloStar pre-filled pen = £32.14
3 x 3ml DoubleStar pre-filled pen = £64.27		Important- The potency of this medicinal product is stated in units. These units are exclusive to Toujeo and are not the same as IU or the units used to express the potency of other insulin analogues. For conversion see http://www.medicines.org.uk/emc/medicine/30586
Toujeo now licensed down to 6 years of age
Insulin Glargine
Semglee®
Biosimilar insulin glargine 100 units/mL pre-filled pens

Abasaglar®
Biosimilar insulin glargine 100 units/mL cartridges & pre-filled pens

Lantus®
Insulin glargine 100 units/mL		3ml pre-filled pen: £29.99 (5)




3ml cartridge: £35.28 (5) for Autopen Classic or HumaPen ranges
3ml KwikPen: £35.28 (5)


3ml cartridge: £37.77 (5)
3ml Solostar pre-filled pen: £37.77 (5)
10ml vial: £27.92 (1)		NICE July 2021 -once-daily insulin glargine (100 units/ml) if insulin detemir is not tolerated or the person has a strong preference for once‑daily basal injections
Insulin degludec
Tresiba®		100 units/ml
5 x 3ml Penfill cartridges=£46.60 (for NovoPen 5 or NovoPen Echo;
5 x 3ml FlexTouch pre-filled pen=£46.60 (for use with NovoFine or NovoTwist needles).
200 units/ml soln:
3 x 3ml FlexTouch pre-filled pen=£55.92 (for use with NovoFine or NovoTwist needles).		NICE 2021 offer once-daily insulin degludec (100 units/ml) if there is a particular concern about nocturnal hypoglycaemia

NICE 2021 offer once-daily ultra-long-acting insulin such as degludec (100 units/ml) for people who need help from a carer or healthcare professional to administer injections.
Insulin/ GLP-1 combinationDegludec/ liraglutide as Xultophy ▼100iu/3.6mg per ml, 3 x 3ml pre-filled pen=£95.53 (for use with NovoFine or NovoTwist needles).Xultophy is AMBER with the hand over to GP prescribing after 3 months successful treatment for patients stabilised in secondary care.
Insulin glargine plus Lixisenatide as Suliqua® ▼100iu/33 microgram per ml, 3 x 3ml SoloStar pre-filled pen = £48.60
100iu/50 microgram per ml, 3 x 3ml SoloStar pre-filled pen = £67.50		With metformin for type II diabetes inadequately controlled by metformin alone
or metformin in combination with another oral hypoglycaemic or basal insulin.

Suliqua is Traffic Light Status AMBER
Treatments for hypoglycaemiaYourGLUCO

Glucoboost

Rapilose

Lift
Hypodermic equipmentChoice of needle & lancet may be governed by specific insulin prescribed and injection technique. Pen needles priced at <£4.10 per 100 and lancets at <£3.00 will be formulary approved.
Insulin pen needles4mm needles are considered to be the safest pen needle for adults and children regardless of age, gender and Body Mass Index (BMI).
Therefore, the most cost effective 4mm needle should be prescribed.
For patients currently using 8mm or 12mm pen needles, it is advisable to change to a shorter needle length (6mm or less) but only after discussion with a healthcare professional, to ensure they receive advice on the correct injection technique.
First line
Apollo BV®


Insupen Original®




Microdot Max®

GlucoRx Carepoint®



GlucoRx Carepoint Ultra®

Neon GreenFine®






BD Viva®


Omnican Fine®



Tricare®		4mm/32G: £2.45 (100)
5mm/31G: £2.45 (100)

4mm/32G: £2.49 (100)
4mm/33G: £2.49 (100)
5mm/31G: £2.49 (100)
6mm/31G: £2.49 (100)
6mm/32G: £2.49 (100)

4mm/32G: £2.74 (100)

4mm/31G: £2.75 (100)
5mm/31G: £2.75 (100)
6mm/31G: £2.75 (100)

4mm/32G: £2.75 (100)

4mm/32G: £2.75 (100)
5mm/31G: £2.75 (100)
6mm/31G: £2.75 (100)



4mm/32G: £3.64 (90)
5mm/31G: £3.64 (90)

4mm/32G: £3.95 (100)
5mm/32G: £3.95 (100)
6mm/32G: £3.95 (100)

4mm/31G: £3.95(100)
5mm/31G: £3.95 (100)
6mm/31G: £3.95 (100)		First line pen needles meet the scorecard requirement of below £4.10 per 100
All first line needles are compatible with mainstream brands of insulin pen

https://www.glucorx.co.uk/wp-content/uploads/pdf/GlucoRx FinePoint Compatibility Chart.pdf
Second lineNeon Verifine®4mm/31G: £4.50 (100)
5mm/31G: £4.50 (100)
6mm/31G: £4.50 (100)
GlucoRx FinePoint®4mm/31 gauge: £4.50 (100)
5mm/31 gauge: £4.50 (100)
6mm/31 gauge: £4.50 (100)
GlucoRx Finepoint Ultra®4mm/32 gauge: £4.95 (100)
Microdot droplet®4mm/32G: £5.95 (100)
6mm/31G: £5.95 (100)
Glucoject 4mm/32 gauge: 100=£5.95.
5mm/31 gauge: 100=£5.95.
6mm/31 gauge: 100=£5.95.
Safety needlesFirst line:
Apollo Pro-Shield Safety Insulin Pen Needle

Microdot Max Safety Needles

GlucoRx Safety Needles		4mm/31G: £9.95 (100)
5mm/30G: £9.95 (100)
8mm/30G: £9.95 (100)

5mm/30G: £12.89 (100)

5mm/30G: £12.95 (100)
Only for patients who have their insulin administered by healthcare assistants, nurses, carers etc to help prevent needlestick injuries:


 Shield automatically locks after injection to help prevent accidental needlestick injuries
 Metal tabs provide visual confirmation that the safety feature is activated
LancetsApollo Twist®0.36mm/28gauge: £3.80 (200)
0.3mm/30gauge: £3.80 (200)
GlucoRx®0.31mm/30gauge: £4.50 (200)
Comfort Twist®0.32mm/30gauge: £2.69 (100)
Ultra-Thin®0.35mm/28gauge: £5.43 (200)
0.2mm/33gauge: £5.43 (200)
On Call®0.46mm/26gauge: £2.75 (100)
0.3mm/30gauge: £2.75 (100)
4SURE®0.32mm/30gauge: £2.90 (100)
0.195mm/33gauge: £2.90 (100)
TRUEplus®0.36mm/28gauge: £2.90 (100)
0.32mm/30gauge: £2.90 (100)
0.36mm/28gauge: £2.90 (100)
CareSens®0.36mm/28gauge: £2.95 (100)
0.31mm/30gauge: £2.95 (100)
Microlet®0.5mm/28gauge: £2.99 (100)
Greenlan®0.35mm/28gauge: £3.00 (100)
Glucoject®0.2mm/33gauge: £3.77 (100)
GlucoZen®0.36mm/28gauge: £4.99 (200)
Safety lancetsApollo BV Safety Lancet®1.8mm/26gauge: £2.75 (100)
1.8mm/28gauge: £2.75 (100)
1.8mm/30gauge: £2.75 (100)
Neon Verifine safety®1.8mm/28gauge: £2.99 (100)
1.8mm/30gauge: £2.99 (100)
Apollo pressure-activated safety®1.8mm/26gauge: £4.50 (100)
1.8mm/28gauge: £4.50 (100)
Apollo Tri-Plus Adjustable Safety Lancets1.3/1.8/2.3mm/23gauge: £9.95 (200)
1.3/1.8/2.3mm/28gauge: £9.95 (200)
GlucoRx safety®2.2mm/23gauge: £5.50 (100)
1.8mm/26gauge: £5.50 (100)
1.8mm/28gauge: £5.50 (100)
1.6mm/30gauge: £5.50 (100)
This section specifically covers drugs used for management of blood glucose, however the majority of patients with diabetes should be considered to be at high risk of CVD and hence should also be prescribed Atorvastatin 20mg for primary prevention (unless C/I). For secondary prevention guidance see lipid regulation
ATT meta-analysis : Aspirin for primary prevention of CVD
Aspirin is not licensed for the primary prevention of vascular events but there remains the possibility that for particular sub-groups of individuals at higher CV risk (including conditions such as diabetes) the risk: benefit of aspirin is favourable. Until more evidence is available, the use of Aspirin 75mg for patients with diabetes should be based on an individual risk assessment.

MIMS table: Insulin Preparations