NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

High strength insulin: safety update

Several new high strength insulin products are now on the market. Both Humalog Kwikpen® (insulin lispro) and Tresiba Flextouch® (insulin degludec; non-Formulary) are available as 100units/mL and 200units/mL. There are differences in the packaging and pen colours to distinguish between the different strengths of both insulins.

 

There is also a high strength version of insulin glargine (Toujeo® 300units/mL) expected to be launched. It is not bioequivalent to Lantus® 100units/mL and so doses cannot be directly converted. The manufacturer has advice for healthcare professionals on dose adjustment. 

 

The local Diabetes Managed Clinical Network is reviewing the place in therapy for these products. Until there is an agreed local policy, standard strength insulin from the Formulary should be used in line with the current GGC guidelines.

 

These high strength insulins are produced specifically to assist in limiting injection volume for highly insulin resistant patients whose insulin doses can reach beyond the capacity of a conventional 100units/mL device or syringe. These may be people with extreme obesity, or people with rare genetic insulin resistant syndromes, and as such will rarely be seen in practice.

 

Advice for healthcare professionals using high strength insulin products

 

  • GPs and others using computerised prescribing systems should take care to ensure the correct product and strength is chosen from the drop down menus.
  • Pharmacists dispensing the medicines should ask the patient to visually check and confirm the product being supplied.
  • High strength products must never be removed from the device for administration by other means. Use in any other type of delivery device such as an insulin syringe or insulin pump may result in double dosing. The required dose is displayed in the dose counter window of the prefilled pen. This means that pens will always dispense the correct dose as long as the patient dials up their usual dose in units.

 

 

 

The European Medicines Agency is consulting on guidance to minimise the risk of medication error for these products. Drug Safety Update notes steps to take before starting treatment with a high strength insulin product and the importance of monitoring glucose levels closely after starting a new treatment and in the following weeks. Doses and timing of concurrent rapid acting or short acting insulin products and other antidiabetic treatments may need to be reviewed.