Quality Care - everyone, everytime
 

6.1 Drugs used in Diabetes

 

NICE Guidelines (NG7) Preventing excess weight gain

 Guidance and Resources for Diabetes and other endocrinal, nutitional and metabolic conditions

Trust Guidance

Insulin Passport

Guidelines for self monitoring of blood for glucose by people with diabetes

Guideline for the hospital management of hypoglycaemia in adult patients with diabetes mellitus

Insulins are available as vials and 3ml pen cartridges and disposable pens except where indicated

Long term insulins are initiated on specialist advice. Choice depends on patient particular needs, lifestyle, age, preference, and capabilities.

6.1.1 Insulins

  Type 1 diabetes in adults:diagnosis and management   Aug 15  

6.1.1.1 Short acting insulins

1st       HUMULIN S     
2nd     HUMAN ACTRAPID   (as vials only) 
      HYPURIN PORCINE NEUTRAL   (for existing patients only)
      HYPURIN BOVINE NEUTRAL   (for existing patients only)

Rapid acting analogues

1st        INSULIN ASPART       
1st     INSULIN LISPRO     
1st     INSULIN GLULISINE (Apidra)     

6.1.1.2 Intermediate and Long-acting Insulins

Intermediate Insulins (Isophane Insulin)

        INSUMAN BASAL     
      HUMAN INSULATARD    
      HUMULIN I    

Long-acting analogues

        INSULIN DETEMIR      
      INSULIN GLARGINE    
      INSULIN DEGLUDEC    

Mixed preparations - Consider cost for 1st choice when initiating

1st        HUMALOG MIX 25     
1st     HUMALOG MIX 50    
1st     NOVOMIX 30    
2nd     HUMULIN M3     

6.1.2 Anti diabetic drugs

Refer to NICE guidance for prescribing advice

IW CCG Diabetes Treatment Options

6.1.2.1 Sulphonylureas (2nd line)

1st      GLICLAZIDE     
2nd     GLIPIZIDE    
3rd     GLIMEPIRIDE    
      TOLBUTAMIDE   (for selected patients with renal insufficiency and some elderly patients)  

6.1.2.2 Biguanides (1st line in most patients)

1st        METFORMIN     Metformin is 1st line in most patients  
2nd     METFORMIN MR    Metformin MR is reserved for patients intolerant of standard release formulations

6.1.2.3 Other antidiabetic drugs

Thiazolidinediones

1st        PIOGLITAZONE     
1st     PIOGLITAZONE/METFORMIN (Competact)    Competact should be used when both metformin and pioglitazone are required and where compliance is an issue. This can be a more cost effective option than the separate components 

Meglitinides

        REPAGLINIDE    (Pending new NICE guidance 2015 regarding preference) 

Alpha glucosidase inhibitors

3rd        ACARBOSE     

Dipeptidylpeptidase-4 inhibitors

    MHRA Drug Safety Update     Dipeptidylpeptidase-4 inhibitors ('gliptin'): risk of acute pancreatitis    Sep 12

 

        ALOGLIPTIN     
      SITAGLIPTIN (Januvia)    
      JANUMET (metformin, sitagliptin, phosphate monohydrate)    
2nd      LINAGLIPTIN   (useful for renal patients)  
      VILDAGLIPTIN    
      JENTADUETO (linagliptin, metformin)    
      EUCREAS (vildagliptin, metformin)    
      SAXAGLIPTIN    

GLP-1 analogues

1st        EXENATIDE (Byetta (BD), Bydureon (Weekly)     Exenatide should be used within NICE guidance for Type 2 diabetes. Caution pancreatitis and renal failure risk.
    NICE TA248   Diabetes (type 2) - exenatide (prolonged release)   Feb 12 
2nd     LIRAGLUTIDE (Victoza)    
    NICE TA203    Diabetes (type 2) - liraglutide   Oct 10
    lyxumia SPC   LIXISENATIDE (Lyxumia)    
             

SGLT2 inhibitors

1st line     EMPAGLIFLOZIN    
    NICE TA336   Empagliflozin in combination therapy for treating type 2 diabetes   Mar 15
      DAPAGLIFLOZIN      
    NICE TA418   Dapagliflozin in triple therapy for treating type 2 diabetes   Nov 16
    NICE TA288   Type 2 diabetes - Dapagliflozin   Jun 13 
      CANAGLIFLOZIN    
    NICE TA315   Canagliflozin in combination therapy for treating type 2 diabetes   May 14

6.1.3 Diabetic ketoacidosis

Soluble insulins as 6.1 above

6.1.4 Treatment of hypoglycaemia - see Hypoglycaemia management flowchart

1st        LUCOZADE    (non prescribable)      
1st       GLUCOSE TABLETS        
1st       GLUCOSE ORAL GEL (Glucogel)        
2nd     GLUCAGON Injection (Glucagen)        
2nd       GLUCOSE 20% Injection        
        Lucozade, glucose tablets and Glucogel should only be used if the patient can swallow

6.1.6 Diagnostic and monitoring agents

Seek specialist advice, contact the diabetes centre ex 4248

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