Adult inpatient insulin use and supply
NHS Borders clinical guidelines
Warning
- Patients bringing their own supply, and able to administer their own insulin, should do so.
- Patients who do not bring their own insulin, or who cannot administer their own, should receive ward stock as follows:
| Duration of action | Time of supply | Patient's usual insulin | Ward stock alternative (10ml vial) |
|
Rapid |
Up to 15 minutes before food |
Novorapid Apidra Fiasp Humalog |
Novorapid |
|
Short |
15-30 minutes before food |
Actrapid Humulin S |
Actrapid |
| Long |
Same time every day |
Lantus Abasaglar
|
Lantus |
| Intermediate |
Same time every day |
Insulatard Humulin I Levemir |
Insulatard |
| Fixed mixture |
Up to 30 minutes before food |
Humulin M3 Humalog Mix 25 Humalog Mix 50 Novomix 30 |
Humulin M3 |
Points to remember:
- Boxes containing the “ward stock alternative insulins” are held in wards 4,6,7 and emergency drug cupboard
- All insulin vials should be marked with the date of first use and within BGH, all vials expire 4 weeks after first use
- Pen devices are for patient use only
- Patients prescribed an alternative to their normal insulin on admission should have DSN review & follow up plan
- Under no circumstances should insulin cartridges be used for drawing up insulin into a syringe
- Ward stock insulin should be prescribed on a unit for unit basis (of the patient’s normal insulin dose), unless otherwise stated
- Toujeo: can be changed to Lantus and dose should be reduced by 20% to reduce risk of hypoglycaemia, with close monitoring of blood glucose
- Xultophy: administered as dose steps, e.g. one dose step will contain 1 unit of insulin Degludec and 0.036 mg of the GLP-1 Liraglutide
- Patients on Xultophy can be prescribed Lantus on a one dose step to one unit basis
- Humalog 200 units/ml: can be changed unit for unit to Novorapid (eg 80 units of Humalog 200 could be changed to 80 units of Novorapid)