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1 2 3 4 5 6 7 8Why a toolkit?The right time The right insulin Mythsand barriersInsulin management:key factsCommissioning forpeople with Type 2diabetesMedicinesoptimisationteamsCommunitypharmacy9AcknowledgementsWhat insulin preparationsare currently available?There are a number of different insulinpreparations on the UK market. Link to DiabetesUK website for latest information.Although the majority of insulin we prescribeis human insulin, other forms of insulin suchas porcine and bovine are still available. Somepatients may be prescribed animal insulin if it isthought that the human insulin has caused the lossof hypoglycaemia warning symptoms 35 or wherethey feel it works better for them than human 74 .For further information on these preparations,see www.evidence.nhs.uk/formulary/bnf/currentor www.medicines.org.ukAs the management of diabetes is an everchanging landscape, it is likely over the next fewyears that new insulin preparations will come to themarket. These will be reviewed by national bodiesand local formulary committees and decisionsmade on their likely place in therapy. Contact yourlocal medicines optimisation team or pharmacyteam for local formulary information.Who can initiate insulin?Initiating insulin is not straightforward andshould be undertaken by an appropriately trainedand competent healthcare professional 55,75 .The NICE Quality Standard for Diabetes inAdults 54 recommends:“Trained healthcare professionals initiate andmanage therapy with insulin within a structuredprogramme that includes dose titration by theperson with diabetes.”In most areas, initiation of insulin is undertakenby specialist teams either in the communityor hospital setting. In some local areas, basalinsulin initiation is undertaken by healthcareprofessionals in primary care who have completedan appropriate level of training.There are a number of national trainingprogrammes for insulin initiation and titration,for example:Optimising Glycaemic Control,University of Warwick – go to websiteandPITstop (Programme for Injectable Therapies)– go to websiteModule 1: Supporting People on GLP-1 & StartingGLP-1 anonistsModule 2: Starting & Supporting Patients duringthe first 6 months of insulin therapyModule 3: Reflect on progress & CarbohydrateAwareness/InsulinSimilar training programmes may be available inyour local community.If you are not trained in insulin initiation, pleaserefer all patients to your locally commissionedspecialist team. Please contact your local CCGfor further information on the pathway for insulininitiation in your area.If you currently initiate basal insulin and yourpatient requires a more complex insulin regimethen they should be referred to the local specialistservice either in community or acute settings forreview.Back to contentsReferencesRight Insulin, Right Time, Right Dose 43