As a medicine insulin must be prescribed and dispensed (and therefore coded) as a brand name. For further information (see https://bnf.nice.org.uk/guidance/guidance-on-prescribing.html).

NHS dictionary of medicines and devices (dm+d) is the recognised NHS standard for recording and sharing of medicines information (see https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/dictionary-medicines-and-devices-dmd). Contact nhsbsa.dmdenquiries@nhs.net for further information. Dm+d concepts for recording insulin must be of the actual medicinal product (AMP) type. These contain brand/ trade family name (e.g., Humulin I KwikPen), concentration (e.g., U100 [100units/ml] suspension or solution for injection), presentation type and size (e.g., 3ml cartridge or 10ml vials) and supplier name (e.g., Eli Lilly & Co Ltd). If an appropriate dm+d concept is not available, the free text entry must contain these components. For example, the following terminology aligned to the AMP would be acceptable: ‘Humulin I 100units/ml suspension for injection 10ml vials (Mawdsley-Brooks & Company Ltd); whereas the following wording representing the generic virtual medicinal product (VMP) would not be acceptable: ‘Insulin isophane human 100units/ml suspension for injection 10ml vials’.

Common examples of basal insulin types include:

Trade family group │ Generic │ Concentration │Example dm+d mapped SNOMED Concept (FSN)

~Humulin I │ Human isophane insulin/ NPH. │ U100 │ Humulin I 100units/ml suspension for injection 3ml cartridges (Sigma Pharmaceuticals Plc) (product)

~Insulatard │ Human isophane insulin/ NPH. │ U100 │ Insulatard Penfill 100units/ml suspension for injection 3ml cartridges (Novo Nordisk Pharmaceuticals Ltd) (product)

~Lantus │ Insulin glargine. │ U100 │ Lantus 100units/ml solution for injection 10ml vials (PI) (Waymade Ltd) (product)

~Toujeo │ Insulin glargine. │ U300 │ Toujeo 300units/ml solution for injection 1.5ml pre-filled SoloStar pens (Sanofi) (product)

~Levemir │ Insulin detemir. │ U100 │ Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens (Mawdsley-Brooks & Company Ltd) (product)

~Tresiba │ Insulin degludec.│ U100 & U200 │ Tresiba FlexTouch 200units/ml solution for injection 3ml pre-filled pens (Pharmaram Ltd) (product)

Basal insulin preparations are also available as fixed-dose combinations with other (non-insulin) medications. e.g Xultophy (Insulin degludec and Liraglutide) and Suliqua (Insulin glargine and Lixisenatide)*

Common examples of bolus insulin types include:

Trade family group │ Generic │ Concentration │ Example dm+d mapped SNOMED Concept (FSN)

~Humulin S │ Human soluble insulin. │ U100 │ Humulin S 100units/ml solution for injection 3ml cartridges (CST Pharma Ltd) (product)

~Novorapid │ Insulin aspart. │ U100 │ NovoRapid FlexPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)

~Humalog │ Insulin lispro. │ U100 & U200 │ Humalog KwikPen 100units/ml solution for injection 3ml pre-filled pens (Ethigen Ltd) (product)

Premixed (biphasic) insulin injections include a combination of two insulins mixed together (rapid or medium acting insulin), given once, twice or three times a day e.g., Insuman Comb 25 (isophane insulin suspension of 25% dissolved insulin and 75% crystalline protamine insulin).**

For further examples (see https://www.gloshospitals.nhs.uk/media/documents/InsulinFormulary.pdf).

* An example of acceptable terminology aligned to the AMP for the fixed dose combination medication Suliqua would be: ‘Suliqua 100units/ml / 33micrograms/ml solution for injection 3ml pre-filled SoloStar pens (Sanofi)’; whereas the VMP ‘Insulin glargine 100units/ml / Lixisenatide 33micrograms/ml solution for injection 3ml pre-filled disposable devices’ would not be acceptable.

** An example of acceptable terminology aligned to the AMP for the premixed (biphasic) insulin Insuman Comb 25 would be: ‘Insuman Comb 25 100units/ml suspension for injection 5ml vials (Aventis Pharma)’; whereas the VMP ‘Insulin isophane biphasic human 25/75 100units/ml suspension for injection 5ml vials’ would not be acceptable.

demo/WRIST-Demo/diabetes-record version 0.1.0

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