Prescribing Information – Diabetes Managed Clinical Network

Guidance on Humulin M3 vial and Humalog Mix 25 vial shortages

Situation/Background: There is a supply problem with Humulin M3 Vials. Resupply dates are now anticipated to be mid-June 2024. Initially a temporary switch to Humalog Mix 25 Vial was recommended as an alternative while Humulin M3 Vials were unavailable but now there is a supply problem with Humalog Mix 25 Vials. Resupply dates are currently anticipated to be

Humalog Insulin Shortages

The latest medication shortage for diabetes now involves insulin – namely Humalog 10ml vials and Humulin M3. The former is usually prescribed for people on insulin pumps and the latter is most commonly used in older people with Type 2 diabetes (especially in care homes). As you will see from the attached guidance: For Humalog

Updated Guidance on Managing GLP-1 RA Shortage

There now do seem to be sufficient supplies of Rybelsus (oral semaglutide) to permit switching of patients on injectable agents, who have not been able to source an injection for more than 2 weeks. Please remember that there is a relative contraindication with Rybelsus for patients with diabetic retinopathy, although clearly for those with mild

Guidance from the Diabetes MCN Prescribing Subgroup on managing the GLP-1 shortage (supplementary information) – Feb 2024

Please do not double up on lower dose preparation where a higher dose of the GLP1-RA is not available. There have been reports of this happening and this will exacerbate the shortages. Patients should only be prescribed one dose from one pen – do not give multiple pen devices or multiple doses to make up a dose.

GLP1-RA Update for Diabetes and Obesity – Jan 2024

Dear colleagues, We are writing to provide an update on the national GLP1-RA supply situation for the indications of both type 2 diabetes and obesity. Please see the attached national patient safety alert (NPSA) for GLP1-RAs, issued on 3 January 2024 – here. This supersedes the previous publication from 2023. Main changes: We would encourage

Glucose-Lowering Therapy

Primary Care Prescribing Guidance on Oral Anti-Diabetic Therapy for Type 2 Diabetes Mellitus

Abbreviated prescribing guidance is available here: Primary care prescribing guide August 2023

A supplementary Information for the above primary care guidance is available here: Supplementary Information for T2D Prescribing Guide for Primary Care.

Further Lothian prescribing advice for Type 2 diabetes is available on the East Region Formulary is available here: diabetes-mellitus-type-2opens a new window

Anti-Hypertensive and Lipid-Lowering Therapy

Guidance on lipid-lowering of anti-hypertensive agents and lipid-lowering therapy is available here: Lothian Hypertension Guidelines

Glucose and Ketone Monitoring

Ketone Monitoring

Guidance on capillary glucose monitoring and capillary blood ketone monitoring devices is available here: diabetes-mellitus/diabetes-mellitus-diagnostic-and-monitoring-agents/opens a new window

Glucose Monitoring

FreeStyle Libre 2

Abbott’s FreeStyle Libre 2 flash continuous glucose monitoring system should be initiated on specialist advice. Further information is available here Edinburgh Diabetes – Start Libre

FreeStyle LibreLink App latest update – August 2023: The latest update to the FreeStyle LibreLink app, now available on the Apple App Store or Google Play Store, allows people in the UK and Ireland who use Abbott’s FreeStyle Libre 2 system to receive glucose readings every minute automatically* sent to their phone**. Patients now have the choice to either view their glucose levels and trends with a quick glance at their phone or, for those who prefer a proactive approach to continue scanning for their glucose values.

*Glucose readings are automatically displayed in the FreeStyle LibreLink App only when a users smartphone and sensor are connected and in range. **The FreeStyle LibreLink App is only compatible with certain mobile devices and operating systems. Please check the website for more information about device compatibility before using the app. Use of FreeStyle LibreLink may require registration with LibreView. For more information, click and view Abbott FreeStyle Libre 2 System

Dexcom ONE

Dexcom ONE latest update – March 2023: Dexcom ONE sensor and transmitter is now routinely available in line with local/regional guidance and is included on the East Region Formulary for Specialist Initiation. Please see the ERF for more information Dexcom ONE East Region Formulary Information.

Dexcom ONE sensors and transmitters should both be prescribed and are available for electronic prescribing on Vision and EMIS.

Patients can set up and started at https://www.dexcom.com/en-gb/learn

Steroid Safety Bundle

Management of long term high dose steroid therapy, please see NHS Lothian Steroid Safety Bundle (PDF)

and Long-term steroid use-patient information leaflet (pdf)

Information Prescriptions for People with Diabetes

Information Prescriptions are a personalised single side of A4 which include easy-to-read explanations, clear images and individual goals to prevent diabetes health complications. Further information is available here Information Prescriptions for people with diabetes | Diabetes UK

Patient information leaflets for individual medications and ‘sick day’ guidance for patients is available here: Patient Information Leaflets

Please send any queries to natalie.martin@nhslothian.scot.nhs.uk