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GPs face switching emergency as insulin shortage could affect 50,000 patients

Exclusive GP practices are facing a pre-Christmas rush to get tens of thousands of patients switched to alternative insulin injections, as supplies of some insulin products could soon run out, with the manufacturer warning that interruption of insulin treatment is ‘potentially life-threatening’.

The products – Sanofi’s Insuman Basal, Comb 25 cartridges and prefilled pens – are used by nearly 50,000 people in the UK and are likely to be in short supply for the next eight months, the drugs company said.

Sanofi said some stock will still be in the supply chain. 

But GP leaders said the situation was ‘serious’, and practices would have to err on the side of caution and switch patients to an alternative, to avoid potentially life-threatening consequences of running out of the drug.

In a letter sent out to NHS healthcare professionals earlier this month, Sanofi said there would be a ‘possible supply shortage in the United Kingdom of some Insuman presentations (recombinant human insulin) from 1 December 2015’ due to ’limited capacity at the manufacturing site’ and that ‘supply is expected to return to normal in July 2016’.

It apologised for the ‘inconvenience and difficulty that this issue may cause’ and warned: ’Interruption of insulin treatment is potentially life threatening. Therefore replacement with alternative insulin formulations is needed to avoid hyperglycaemia and serious complications.’

The four specific products affected are Insuman Basal 100 IU/mL and Insuman Comb 25 100 IU/mL cartridges, and Insuman Basal Solostar 100 IU/mL and Insuman Comb 25 Solostar pre-filled pens.

For patients on Insuman Basal preparations the alternative human insulins are Humulin I and Insulatard, while those on Comb 25 products can be switched to Humulin M3, Sanofi said. 

Sanofi told Pulse that ‘approximately 48,000 patients in the UK are prescribed Insuman Basal or Insuman Comb 25’, and that there are a ’small number of patients’ for whom the Insuman products may be the only suitable insulin preparations. It has ’reserved a supply that we can make available on a case-by-case basis’ for this group.

The company said it was ‘difficult to estimate’ how many other patients would need to switch, as ‘there is already some available stock within the supply chain’, but that it was ‘working closely with the EMA and the relevant national health authorities to minimise the impact of the shortage on patients and healthcare service providers’.

However, Dr Bill Beeby, GPC representative in the north-east, said the risks of running out of insulin were ‘serious’ so practices would need to get on and switch patients to an alternative.

Dr Beeby said: ‘When you’ve got someone on insulin, it is quite serious – people can’t do without insulin they would have to be switched and that’s going to involve considerable workload.’

The Insuman shortage is the latest in a long line of drug shortages that GPs say can take up to an hour of their time every day, and comes just as GPs were also notified this month they should call in patients with diabetes who are on pioglitazone, because of shortages of that drug due to last until February.

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said the shortage ‘could not have come at a worse time of year’.

He said: ‘This one is particularly problematic as a simple switch to an alternative is not possible, and most patients will need input to manage the change safely.’

Readers' comments (9)

  • Complete fiasco, and way beyond a joke.
    It is really time to review the PPRS, and include penalties for companies that cannot provide a consistent supply.

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  • It takes up to an hour a day of GP time - all they need do is have a list with the prescription clerk of pre-agreed changes and a standard letter to give to patients to inform them that due to shortages their medication has been changed. I wish it only took an hour a day for us to manage the dozens of shortages - not to mention the associated multitude of upset/anxious/angry patients (and, let's face it, GPs & surgery staff) who continually ask why product "x" is not available, as if it is a)our fault for the shortage and b) we can just knock up something in the dispensary as a replacement

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  • Vinci Ho

    Need to do search to see how many patients are on these insulin . The usual panic before Christmas will not help!!

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  • Funny I haven't received a CAS warning over this. Normally we get everything we don't need, even the ones that say specifically "Dispensing GPs Only" (which we are not). Created a search and non of these insulins are prescribed to our patients. Phew!!!

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  • Yes but, Steve Eggleston, that is your job. You are a pharmacist and this is what you do.
    GPs are doctors and rely on supplies of drugs for their patients and the neither have the time or the expertise to do this chasing around.

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  • 10:18 - "nemo dat quod non habet"

    Our job is not to runaround finding equivalents to hard to source items.
    Four years at university no where near qualifies us to do that, let alone diagnose...

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  • Shortages and out of stocks have been going on for years. I've retired, but I used to give local GPs a list of the unobtainable items and the nearest available. Not exactly rocket science.

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  • What is missing in this story is WHY there is a shortage. "limited capacity at the manufacturing site..." tells us nothing. For too long the NHS has docilely accepted the flim flam PR language from suppliers. Those in procurement need to get tough and stop being stooges for those they are buying from. While they are at it, they ought to be seriously questioning the rocketing prices of some of the most common generics. Thousands of hours will now be wasted by overworked GPs having to explain the change to patients.

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  • What do you expect when you rely on private companies which are only accountable to their shareholders?
    This is just one example of what we can expect for the future in healthcare generally if we continue to rely more and more on the uncommitted private sector.

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