Insulin is a time critical medicine. Every effort should be made to ensure a patient’s insulin is administered without delay.

As a registered nurse, it is part of your responsibility to ensure that doses of critical medications are not missed. To proactively prevent missed doses, try and order patients’ medications 3-4 days before it is due to run out.

In the event of stock not being available on your ward, the following steps should be followed:

• Check if the patient has brought in their own insulin

Confirm this is appropriate to use. If deemed suitable, administer according to prescription.

If only a small quantity is left, please order this from pharmacy using the “Send a message to pharmacy” function on the MAR.

• If not available, request via the MAR and flag to your ward pharmacist or dispensary to enable urgent supply. If there is going to be a delay, consider adjustments to mealtimes.

• Outside of working hours, confirm where the insulin is stocked, using this document as well as the emergency drug cupboard stock lists on the intranet.

• If still in doubt, contact the on-call pharmacist.

Please also consider whether this can be brought in from home.

If the insulin is not available, a prescriber should be contacted so an alternative can be prescribed (see more information below).

Figure 1 explains how an insulin can be obtained, both within and outside of working hours.

Please ensure the correct insulin formulation is prescribed (as to what is available and being administered). A prescriber should be contacted to correct this if needed.

To reduce waste, majority of the insulin stored on wards and in the emergency drug cupboard are vials. These are 10ml vials which have a 28-day expiry date once opened. They can be used for multiple patients.

ONLY a U-100 insulin syringe should be used to withdraw insulin from a vial.

Fiasp and Tresiba are only currently available as cartridges. These require a compatible reusable pen device for administration, in this case a Novopen. Novopens are available from the dispensary (during working hours) and from the diabetes and paediatric wards (out-of-hours).

Insulin should NOT, under any circumstances, be withdrawn from a cartridge or a pre-filled pen.

If a patients insulin form has had to be changed to facilitate emergency administration (when their usual form is unavailable), the prescription should indicate that this is a temporary switch and a plan documented for review and switch to their usual insulin.

Outside of working hours, when a patient’s usual insulin is unavailable, an alternative can be prescribed.

The prescription should indicate that this switch has been made on a temporary basis to ensure no missed doses.

Unless instructed by the Diabetes Team please switch to usual insulin regimen as soon as the patient’s insulin becomes available.

As with all other medications, patients should be discharged with a minimum of 14 days-worth of their insulin. The quantity supplied will depend on two things. Firstly, the patient’s dose, and secondly the strength of the insulin.

To calculate this, the following equation can be used:

[Total daily dose x 14] / strength of insulin (per mL) = number of pens required. Round UP to the nearest whole pen.

NB: this should be done for each type of insulin the patient is prescribed.

The following can be used as a general guide:

Dose refers to total daily dose

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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