Rapid & Ultra-Rapid Insulin Choice with Hybrid Closed Loop Systems

Following the publication of NICE TA943 in December 2023 & the start in 2024 of the 5-year rollout of Hybrid Closed Loop (HCL) technology in England & Wales, a choice of various HCL systems is now being offered. Initially to 'children, young people, women, trans men and non-binary people who are pregnant or planning to become pregnant and adults who already use pumps who want to transition to an HCL system'.

To help with this choice the 'Diabetes Specialist Nurse Forum UK' has issued a Hybrid Closed Loop (HCL) Systems Comparison Chart.' Showing insulin pumps with their associated manufacturer or distributor, with their algorithms & types of rapid or ultra-rapid insulin that each pump can use.

See the link for Version 6.0 December 2024 below: 

It occurs to me that this same offer of choice should be extended to these rapid & ultra-rapid insulins - obviously in consultation with your diabetes consultant. Considering user choice, onset action times, peak action, duration times, side effects & safety, etc.

However, the supply of insulin brands & types available on the NHS here in England depends entirely on where you live despite them all being approved nationally & listed in the NICE British National Formulary (BNF).

For instance, in my local area under the South West London Integrated Care Board (IOB), the Novo Nordisk's brand Fiasp (aspart) & Eli Lilly's brand Humalog (lispro) are available on the local formulary but not the Eli Lily brand Lyumjev (lispro). In other IOB areas in England this situation is reversed.

Why so? One reason given a year or so ago was that the insulin pumps the ICB supplied weren't  compatible with Lyumjev. That doesn't stand true now as most pumps are available with the HCL rollout. Including, the Dana i which I am using with CamAPS FX. It can use any fast or ultra-fast insulin.

Is it the cost? I doubt it. Taking my area using NHS indicative & drug tariff price costs from BNF. Fiasp insulin 100u/10ml vial costing £14.08 is available in my area. As is Humalog insulin 100u/10ml vial which costs £16.61. The same price as Lyumjev insulin 100u/10ml vial which is not included!

The quicker onset times of Lyumjev may give better outcomes than Fiasp in stopping postprandial blood sugar rises. Which fast or ultra-fast insulin may benefit those on HCLs, without being able to try how would we know?

If the brand & type of insulin isn't available to locally you would have to get an 'individual funding request (IFR) made by a consultant to try it. The other way to get an insulin added is an application made by a consultant to the ICB for 'inclusion in the local formulary.' This is time-consuming for any already busy consultant. A better way is needed to give a choice of which insulins we use.

Thank you to 'the powers that be' for giving us this great choice for CGMs, insulin pumps & HCL. This choice needs to be extended to insulin.