Drug reference
Diabetes mellitus ▶BY SUBCUTANEOUS INJECTION ▶Child: Administer immediately before meals or when necessary shortly after meals, according to requirements ▶Adult: Administer immediately before meals or when necessary shortly after meals, according to requirements ▶BY SUBCUTANEOUS INFUSION, OR BY INTRAVENOUS INFUSION ▶Child: According to requirements ▶Adult: According to requirements l UNLICENSED USE ▶In children Not licensed for children under 6 years.
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NICE decisions ▶Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (type 1) (July 2008) NICE TA151 Continuous subcutaneous insulin infusion is recommended as an option in adults and children 12 years and over with type 1 diabetes: . who suffer repeated and unpredictable hypoglycaemia, whilst attempting to achieve optimal glycaemic control with multiple-injection regimens, or . whose glycaemic control remains inadequate (HbA1c over 8.5% [69 mmol/mol]) despite optimised multiple- injection regimens (including the use of long-acting insulin analogues where appropriate). Continuous subcutaneous insulin infusion is also recommended as an option for children under 12 years with type 1 diabetes for whom multiple-injection regimens are considered impractical or inappropriate. Children on insulin pumps should undergo a trial of multiple-injection therapy between the ages of 12 and 18 years. www.nice.org.uk/guidance/ta151 Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (November 2008) that Apidra ® is accepted for restricted use within NHS Scotland for the treatment of adults and children over 6 years with diabetes mellitus in whom the use of a short- acting insulin analogue is appropriate.
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→Appendix 1: insulins
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Short-acting injectable insulins can be given by continuous subcutaneous infusion using a portable infusion pump. This device delivers a Endocrine system continuous basal insulin infusion and patient-activated bolus doses at meal times. This technique can be useful for patients who suffer recurrent hypoglycaemia or marked morning rise in blood-glucose concentration despite optimised multiple-injection regimens. Patients on subcutaneous insulin infusion must be highly motivated, able to monitor their blood-glucose concentration, and have expert training, advice and supervision from an experienced healthcare team. ▶With intravenous use in adults For intravenous infusion (Apidra ®), give continuously in Sodium chloride 0.9%; dilute to 1 unit/mL with infusion fluid; use a co-extruded polyolefin/polyamide plastic infusion bag with a dedicated infusion line.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Apidra (Sanofi) Insulin glulisine 100 unit per 1 ml Apidra 100units/ml solution for injection 3ml cartridges | 5 cartridge P £28.30 DT = £28.30 Apidra 100units/ml solution for injection 10ml vials | 1 vial P £16.00 DT = £16.00 ▶Apidra SoloStar (Sanofi) Insulin glulisine 100 unit per 1 ml Apidra 100units/ml solution for injection 3ml pre-filled SoloStar pens | 5 pre-filled disposable injection P £28.30 DT = £28.30 eiiii F 751
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Administer immediately before meals or when
First-line fragment. Read the complete Indications and Dose section above.
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According to requirements
First-line fragment. Read the complete Indications and Dose section above.
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