For patients who require more than 80 units of insulin glargine per day and who are troubled by nocturnal hypos. Transfer to Primary Care should not happen until specialists can demonstrate reduction in nocturnal hypos (e.g. after 3-4 months).
First line glargine for new patients initiated on insulin glargine 100 units/mL.
Prescribe by brand
Isophane Insulin (Humulin® I)
Isophane Insulin (Insulatard®)
Isophane Insulin (Insuman® Basal)
Insulin degludec 100 units/mL (Tresiba®)
To avoid the use of an insulin pump in patients with Type 1 diabetes who have nocturnal/severe hypoglycaemia as defined in NICE TA 151 OR recurrent DKA despite good compliance with current insulin regime
The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.
The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.
Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.
Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.
Medicines for initiation and maintenance prescribing by Specialists only
Non-formulary medicines- medicines not recommended for routine primary care prescribing.
Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.