For patients who require more than 80 units of insulin glargine per day and who suffer problematic hypoglycaemia. Transfer to Primary Care should not happen until specialist can demonstrate a reduction in problematic hypoglycaemia (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 suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.
Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.
Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.
Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.
Medicines for initiation and maintenance prescribing by Specialists only.
Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.
Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.
The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.