Expert Insights: Managing upcoming Insulin Discontinuations

Author: Sanofi

Editorial Team

Toujeo (insulin glargine 300U/mL) Prescribing Information

Lantus (insulin glargine 100U/mL) Prescribing Information

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Levemir is being discontinued with stock expected to run out by end of 2026. As the only basal insulin licensed for twice-daily use, there's no direct alternative — a planned, proactive approach to switching is essential.¹

Sanofi have been supporting the switch efforts by running webinars and talks at Diabetes UK 2026. We were joined by three leading speakers, each with hands-on experience in managing insulin switches:

Phil Newland-Jones

Consultant Pharmacist
Diabetes & Endocrinology and Clinical Director Diabetes & Endocrinology UHS

Tamsin Fletcher-Salt

Lead Diabetes and Endocrinology Nurse for the University Hospital of North Midlands. Clinical Inpatient Diabetes Lead NHS Midlands Network.

Anne Goodchild

Diabetes Specialist Nurse, director of DIME square Ltd and Founder of PITstop and Pre-PITstop.

You can find the key takeaways and speaker insights from these events below:

What do I need to consider before the switch is made?

The Association of British Clinical Diabetologists (ABCD) and Primary Care Diabetes & Obesity (PCDO) Society have published the below guidance¹:

Do not initiate new patients on Levemir¹
A planned and proactive approach is essential¹
Alternative insulins need to be chosen after individual clinical review with clinical blood glucose (CBG)/CGM data and an aim to optimise the individual’s treatment regimen¹
Local plans should aim to diversify prescribing across available options¹
People living with diabetes should be reviewed at 2-3 weeks to support with dose titration, as necessary.¹
For those at higher risk of dysglycaemia aim for close clinical review within 1-2 weeks of change where possible, including those with the below attributes:
◦ Impaired hypoglycaemia awareness
◦ History of severe hypoglycaemia or recurrent diabetic ketoacidosis (DKA)
◦ Evidence of lipohypertrophy at injection sites
◦ Frailty and/or older age
◦ Children and Adolescents
◦ Renal or severe hepatic impairment
◦ High glucose variability on CGM
◦ Cognitive or functional impairment
◦ Learning difficulties or low health literacy
◦ Those with visual impairment and manual dexterity problems
◦ High alcohol intake or binge drinking
◦ High level of physical activity

When considering options to change insulins, consider:

Type of diabetes
Local formularies and guidance
Product availability, via the SPS tool
Product cost
Device availability and suitability for the patient

When optimising the treatment regimen, you may want to consider:

physical and mental ability to manage current regimen
injection technique, injection sites, insulin storage
renal and ASCVD protection within treatment regimen
how is the individual currently living their life (e.g. shift work, flexible eating pattern, activity, sleep)
hypoglycaemia and current glucose profile, including variability
retinopathy screening results
concordance with all medication
HbA1c trajectory
time in range and percentages either side

What clinical considerations need to be made when making the switch?

The ABCD PCDOS guidance states that “when switching between insulins, there can be differences between absorption, potency, and action profile, therefore consider reducing doses by 10-20% to avoid the initial risk of hypoglycaemia.” ¹

Close monitoring is required:²,³ where possible, people with diabetes should be encouraged to self-adjust insulin doses according to their blood glucose concentrations after switching to alternative insulins whilst awaiting a further review.¹

Read the guidance below to see specific guidance and case studies for patients with Type 1 and Type 2 Diabetes

Switching patients with type 1 diabetes requires careful consideration — it's an opportunity to review the full treatment regimen, not just change the insulin to optimise and agree time in range targets, based on the patients’ co-mobordities.

Want more support? Download fictional case studies for managing the switch:

Managing the switch with Toujeo (insulin glargine 300U/mL)

Switching patients with type 2 diabetes requires careful consideration — it's an opportunity to review the full treatment regimen, not just change the insulin to optimise and agree time in range targets, based on the patients’ co-mobordities.

Want more support? Download fictional case studies for managing the switch:

Managing the switch with Toujeo (insulin glargine 300U/mL) or Lantus (insulin glargine 100U/mL)