BNF for Children 2011-2012

BNFC 2011–2012 6.1.1 Insulins 353INSULIN ASPART(Recombinant human insulin analogue)Cautions section 6.1.1; interactions: Appendix 1(antidiabetics)Hepatic impairment section 6.1.1Renal impairment section 6.1.1Pregnancy section 6.1.1Breast-feeding section 6.1.1Side-effects see under InsulinLicensed use not licensed for use in children under 2yearsIndication and doseDiabetes mellitus. By subcutaneous injectionImmediately before meals or when necessaryshortly after meals, according to requirements. By subcutaneous infusion, or intravenousinjection, or intravenous infusionAccording to requirementsAdministration for intravenous infusion, dilute to aconcentration of 0.05–1 unit/mL with Glucose 5% orSodium Chloride 0.9% and mix thoroughly; insulinmay be adsorbed by plastics, flush giving set with5 mL of infusion fluid containing insulin.NovoRapid c (Novo Nordisk) AInjection, insulin aspart (recombinant human insulinanalogue) 100 units/mL, net price 10-mL vial =£16.28; Penfill c cartridge (for Innovo c andNovoPen c devices) 5 3-mL = £28.84; 5 3-mLFlexPen c prefilled disposable injection devices (range1–60 units, allowing 1-unit dosage adjustment) =£32.00Counselling Show container to child or carer and confirmthe expected version is dispensedINSULIN GLULISINE(Recombinant human insulin analogue)Cautions section 6.1.1; interactions: Appendix 1(antidiabetics)Hepatic impairment section 6.1.1Renal impairment section 6.1.1Pregnancy section 6.1.1Breast-feeding section 6.1.1Side-effects see under InsulinLicensed use not licensed for children under 6 yearsIndication and doseDiabetes mellitus. By subcutaneous injectionImmediately before meals or when necessaryshortly after meals, according to requirements. By subcutaneous infusion or intravenous infusionAccording to requirementsApidra c (Sanofi-Aventis) AInjection, insulin glulisine (recombinant human insulinanalogue) 100 units/mL, net price 10-mL vial =£16.60; 5 3-mL cartridge (for ClikSTAR c , OptiPen cPro 1, and Autopen c 24) = £28.30; 5 3-mLOptiClik c cartridge (for OptiClik c Pen) = £30.27; 5 3-mL Apidra c Optiset c prefilled disposable injectiondevices (range 2–40 units, allowing 2-unit dosageadjustment) = £28.30; 5 3-mL Apidra c SoloStar cprefilled disposable injection devices (range 1–80 units, allowing 1-unit dosage adjustment) = £25.00Counselling Show container to patient and confirm thatpatient is expecting the version dispensedNote The Scottish Medicines Consortium (p. 3) has advised(October 2008) that Apidra c is accepted for restricted usewithin NHS Scotland for the treatment of children over 6 yearswith diabetes mellitus in whom the use of a short-acting insulinanalogue is appropriateINSULIN LISPRO(Recombinant human insulin analogue)Cautions section 6.1.1; children under 12 years (useonly if benefit likely compared to soluble insulin);interactions: Appendix 1 (antidiabetics)Hepatic impairment section 6.1.1Renal impairment section 6.1.1Pregnancy section 6.1.1Breast-feeding section 6.1.1Side-effects see under InsulinIndication and doseDiabetes mellitus. By subcutaneous injectionShortly before meals or when necessary shortlyafter meals, according to requirements. By subcutaneous infusion, or intravenousinjection, or intravenous infusionAccording to requirementsAdministration For intravenous infusion, dilute to aconcentration of 0.1–1 unit/mL with Glucose 5% orSodium Chloride 0.9% and mix thoroughly; insulinmay be adsorbed by plastics, flush giving set with5 mL of infusion fluid containing insulin.Humalog c (Lilly) AInjection, insulin lispro (recombinant human insulinanalogue) 100 units/mL, net price 10-mL vial =£16.61; 5 3-mL cartridge (for Autopen c Classic orHumaPen c ) = £28.31; 5 3-mL Humalog cKwikPen prefilled disposable injection devices (range1–60 units, allowing 1-unit dosage adjustment) =£29.46Counselling Show container to child or carer and confirmthe expected version is dispensed6.1.1.2 Intermediate- and long-actinginsulinsWhen given by subcutaneous injection, intermediateandlong-acting insulins have an onset of action ofapproximately 1–2 hours, a maximal effect at 4–12hours, and a duration of 16–35 hours. Some are giventwice daily in conjunction with short-acting (soluble)insulin, and others are given once daily. Soluble insulincan be mixed with intermediate and long-acting insulins(except insulin detemir and insulin glargine), essentiallyretaining the properties of the two components,although there may be some blunting of the initial effectof the soluble insulin component (especially on mixingwith protamine zinc insulin, see below).Close monitoring of blood glucose is essential whenintroducing a change to the insulin regimen; the totaldaily dose as well as any concomitant treatment mayneed to be adjusted.6 Endocrine system