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Insulin Interchange – Adult – Ambulatory [83]

Insulin Interchange – Adult – Ambulatory [83] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 83
Delegation Protocol Title:
Insulin Interchange - Adult - Ambulatory
Delegation Protocol Applies To:
UWHC Endocrine Diabetes Clinic and Health and Nutrition Education Department
Target Patient Population:
Adult patients with diabetes
Delegation Protocol Champion:
Vanessa Rein, MD - Department of Medicine, Division of Endocrinology
Delegation Protocol Reviewer:
Cheryl Franz, RN, BSN, CDE - Diabetes Care Coordinator
Responsible Department:
Health and Nutrition Education and UWHC Diabetes Clinic
Purpose Statement:
To delegate authority from the patient’s primary care or endocrinology provider managing the patient’s
diabetes to Registered Nurses (RN) and/or clinic-based pharmacists (RPh) in the UWHC Endocrine
Diabetes Clinic or UWMF Health and Nutrition Education Department to perform therapeutic and product
interchanges for insulin products.
Training will consist of didactic classroom training.
Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) in the Health and Education Department, RNs in the UW Endocrine Diabetes
Clinic and clinic-based pharmacists (RPhs) who have successfully completed training in the use of this
protocol.
Guidelines for Implementation:
1. This protocol is activated when a patient has a provider’s order for an insulin product which needs to
be changed to an alternative insulin or delivery system due to insurance issues, cost or patient
request.
2. Only insulin medications listed in Table 1 of this protocol are authorized for therapeutic interchange.
3. Table 2 lists the insulins eligible for product interchange. Product interchange implies an original
medication delivery system is being replaced by a different delivery system, but the medication
remains the same. For example, the original order is for an insulin lispro vial and the new order is for
an insulin lispro pen. Any insulin available as a pen or in a vial is eligible for product interchange.
4. When performing the interchange the RN/RPh will discontinue the previous insulin order and
associated supplies and enter new orders in the electronic medical record and send new prescription
to patient’s pharmacy.
4.1. Directions for insulin use and number of refills will remain the same
4.2. Quantity ordered may be adjusted. For example, insulin vials should be ordered in increments of
10 mL while certain insulin pens should be ordered in increments of 15 mL. Syringes or pen
needle should be ordered in increments of 100.
4.3. The orders do not need to be routed for provider co-signature.
5. The RN/RPh will notify the patient of the medication change, and provide any education necessary for
proper technique of insulin administration.
Table 1 – Insulin products eligible for Therapeutic Interchange
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Category Interchangeable Products
Rapid acting
Insulin aspart (Novolog)
Insulin lispro (Humalog)
Insulin glulisine (Apidra)
Short acting Regular insulin (Novolin R, Humulin R)
Intermediate acting Insulin isophane NPH (Novolin N, Humulin N)
Long acting
Lantus (glargine U-100)
Levemir (deter U-100)

Table 2 – Insulin products eligible for Product Interchange
Insulin Type Insulin Vial Insulin Pen
lispro Humalog Humalog Kwikpen
Aspart Novolog Novolog Flexpen
glulisine Apidra Apidra Solostar
NPH Humulin N Humulin N Pen
Glargine Lantus Lantus Solostar
Detemir Levemir Levemir Flexpen
NPH + Regular Humulin 70/30 Humulin 70-30 Pen
Aspart protamine + aspart Novlog 70/30 Novolog Mix 70-30 Flexpen
Lispro protamine + lispro Humalog 50/50 Humalog Mix 50-50 Kwikpen
Lispro protamine + lispro Humalog 75/25 Humalog Mix 72-25 Kwikpen

Order Mode: Protocol/Policy Without Cosign

References:
UW Health. Diabetes – Pediatric/Adult – Inpatient/Ambulatory Clinical Practice Guideline. 2015.
https://uconnect.wisc.edu/servlet/Satellite?cid=1126675405975&pagename=B_EXTRANET_UWH_HOM
E%2FFlexMemberFile%2FLoad_File&c=FlexMemberFile
https://uconnect.wisc.edu/servlet/Satellite?cid=1126675405975&pagename=B_EXTRANET_UWH_HOM
E%2FFlexMemberFile%2FLoad_File&c=FlexMemberFile.
Collateral Documents/Tools:
N/A

Approved By:
UW Health Ambulatory Protocol Committee: March 2013, October 2015 (expedited)
UWHC Pharmacy and Therapeutics Committee: August 2013, November 2015 (expedited)
UWHC Medical Board: September 2013, November 2015 (expedited)
UW Health Chief Medical Officer: September 2013, November 2015 (expedited)

Effective Date: November 2015

Schedule for Review: November 2017
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org