Insulin Ward Stock- In-patient Insulin Use and Supply
Diabetes & endocrinology
On admission to hospital, insulin should be prescribed on HEPMA and the insulin prescription sheet.
The majority of patients with diabetes are treated using a small number of insulin preparations. Patients admitted as emergencies to in-patient sites may not have their usual prescribed insulin on their person.
To facilitate safe insulin use, the following advice is provided:
- Patients bringing their own supply, and who are able to administer their own insulin, should do so.
- Patients who do not bring, or who cannot administer their own insulin, should receive ward stock alternative as follows:
|
Duration of action and time given |
Rapid 10 -15 minutes before food |
Short 15 - 30 minutes before food |
Intermediate Same time every day |
Long Same time every day |
Fixed Mixture 15 - 30 minutes before food |
|
Patient’s usual insulin |
Novorapid Apidra Fiasp Humalog |
Actrapid Humulin S Insuman Rapid |
Insulatard Humulin I |
Lantus Abasaglar Tresiba |
Humulin M3 Humalog Mix 25 Humalog Mix 50 Novomix 30 |
|
Ward stock alternative |
Novorapid (Vial) |
Actrapid (Vial) |
Insulatard (Vial) |
Lantus (Vial) |
Humulin M3 (Kwikpen with safety pen needle) |
The appropriate ward stock insulin can be prescribed and substituted on a unit-for-unit basis (except Toujeo and Xultophy – see below) with the patient’s usual insulin, until this can be supplied or the patient can self-administer their own insulin.
- Toujeo: can be changed to Lantus but the dose should be reduced by 20% to reduce the 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.
Points to remember:
- Insulin must be prescribed by BRAND name.
- All insulin administered from a pen device is patient specific and therefore should be labelled on a patient specific basis.
- If the patient doesn’t have their insulin in with them, order from pharmacy on an Individualised Patient Supply Form (IPS) or a HEPMA electronic order. Until this patient specific supply is available, follow the guidelines above.
- Labelled insulin supply can be sent home with the patient on discharge.
- In the out of hours period, when pharmacy is closed, ward-based supply can be used. Please note mixed insulin is only available as a pen formulation, therefore is held in key locations, not every ward. If a Humulin M3 pen is obtained in the out of hours period, then please affix a patient name sticker and put this in the patients pod locker. The next working day, a patient specific labelled supply of insulin must be obtained from pharmacy.
- Before opening, all insulin preparations should be stored in the fridge. Once open, they are stable at room temperature. All insulin should be marked with the date of first use and disposed of 4 weeks after opening.
- When administering insulin via a pen device, a safety pen needle must be used.
- Under no circumstances should insulin be drawn up into a syringe from an insulin pen device or cartridge.
PLEASE REMEMBER TO DISCHARGE THE PATIENT ON THEIR USUAL INSULIN IF THEY HAVE BEEN GIVEN A TEMPORARY ALTERNATIVE DURING THEIR IN-PATIENT STAY.