CHANGE FROM NOVORAPID TO TRURAPI

[Wotisname]

As title I have been on Novorapid for a good few years, I received a text from G P surgery ,We are changing your Novorapid to Trurapi . My question is I changed from Levemir a few years ago to Lantus and found I was using roughly 50% less each time I injected to achieve the same control of BS's, verses Levemir , I notice Sanofi manufacture both Trurapi & Lantus , can I assume that when I receive my first prescription containing Trurapi , I will need to start with a greatly reduced dose as I found with the change to Lantus , asking the question on here as I have not been seen by Diabetic Specialist nurse for around ten years, if I mention DSN to the practice nurse she seems to take it personally. She did not have any info on Trurapi other than " the instructions for use notes contained in your first prescription of pens , Will have all the information you need " .!!

 

[Robin]

As title I have been on Novorapid for a good few years, I received a text from G P surgery ,We are changing your Novorapid to Trurapi . My question is I changed from Levemir a few years ago to Lantus and found I was using roughly 50% less each time I injected to achieve the same control of BS's, verses Levemir , I notice Sanofi manufacture both Trurapi & Lantus , can I assume that when I receive my first prescription containing Trurapi , I will need to start with a greatly reduced dose as I found with the change to Lantus , asking the question on here as I have not been seen by Diabetic Specialist nurse for around ten years, if I mention DSN to the practice nurse she seems to take it personally. She did not have any info on Trurapi other than " the instructions for use notes contained in your first prescription of pens , Will have all the information you need " .!!

I didn’t think People were meant to be swapped to biosimilar from their normal insulin, or at least not without consultation or discussion. This is DUK's position statement. Also, do you use reusable pens with cartridges, or disposable? Trurapi uses Sanofi pens, which don’t have the ablilty to remember the dose timing and amount, like my Novopen Echo does, so I’d resist any change on that basis.

Biosimilar insulins (our position)

Biosimilar insulin is a biological copy of an original insulin and there is increasing interest in developing and using them. Biosimilar insulins are cheaper than original products so they present the NHS with opportunities around availability and cost of care. However, there is lack of...

www.diabetes.org.uk

 

[rebrascora]

It is interesting to hear that you needed less Lantus than Levemir, but they are quite different insulins with different action profiles. One is insulin Glargine and the other is insulin Determir. Novorapid and Trurapi are both insulin Aspart I believe and therefore it should be a like for like swap.
Like @Robin I use the reusable NovoPenEcho pens which do half unit doses and have a memory feature which remembers your last dose in terms of units and how long ago you injected it, for those "did I or didn't I?" moments, which I find REALLY useful, so I would refuse to be changed to a different brand as the pens do not accept cartridges from other makers of insulin and NovoEcho pens are pretty much the best on the market.

If you use disposable pens, then obviously you don't have that issue and you may well find that the Trurapi works just the same as NR but it really should be a decision that you have some say in, just like they should not swap you from Libre to Dexcom One without discussion and if you have valid reasons not to change they should be accepted and a change should not be forced. It is ultimately a cost cutting exercise on behalf of the doctor's surgery as Trurapi will be cheaper, but the important thing is what works best for you. If Trurapi works just as well, great, but if it doesn't or there are reasons why a change would disrupt your diabetes management, then that should be considered.

 

[Wotisname]

I didn’t think People were meant to be swapped to biosimilar from their normal insulin, or at least not without consultation or discussion. This is DUK's position statement. Also, do you use reusable pens with cartridges, or disposable? Trurapi uses Sanofi pens, which don’t have the ablilty to remember the dose timing and amount, like my Novopen Echo does, so I’d resist any change on that basis.

Biosimilar insulins (our position)

Biosimilar insulin is a biological copy of an original insulin and there is increasing interest in developing and using them. Biosimilar insulins are cheaper than original products so they present the NHS with opportunities around availability and cost of care. However, there is lack of...

www.diabetes.org.uk

Thanks Robin for your reply, I use disposable pens .

 

[Wotisname]

It is interesting to hear that you needed less Lantus than Levemir, but they are quite different insulins with different action profiles. One is insulin Glargine and the other is insulin Determir. Novorapid and Trurapi are both insulin Aspart I believe and therefore it should be a like for like swap.
Like @Robin I use the reusable NovoPenEcho pens which do half unit doses and have a memory feature which remembers your last dose in terms of units and how long ago you injected it, for those "did I or didn't I?" moments, which I find REALLY useful, so I would refuse to be changed to a different brand as the pens do not accept cartridges from other makers of insulin and NovoEcho pens are pretty much the best on the market.

If you use disposable pens, then obviously you don't have that issue and you may well find that the Trurapi works just the same as NR but it really should be a decision that you have some say in, just like they should not swap you from Libre to Dexcom One without discussion and if you have valid reasons not to change they should be accepted and a change should not be forced. It is ultimately a cost cutting exercise on behalf of the doctor's surgery as Trurapi will be cheaper, but the important thing is what works best for you. If Trurapi works just as well, great, but if it doesn't or there are reasons why a change would disrupt your diabetes management, then that should be considered.

Thanks Rebrascora for your reply I imagined the change may be a cost cutting exercise on behalf of the surgery, there have been a lot of changes of late at the practice, the two original practice nurses one of which was Type 1 ID herself have retired, replaced by some one who has a very, very, limited knowledge of Diabetes, face to face with one of the two G P's is hard to come by. I use disposable pens so the change should be uncomplicated. 😉

 

[mashedupmatt]

It might be that there is a shortage of the disposable pens that Novo use due to increase in prescriptions for Wegovy and the like or a cost cutting exercise - but I am definitely an advocate for the Novopen Echo, which does half units and is compatible with Novorapid so I would definitely question the change (particularly if Novorapid is working for you just fine)

 

[Bruce Stephens]

I would definitely question the change (particularly if Novorapid is working for you just fine)

For someone who's using disposable pens, the substitution makes sense for a GP to suggest. Trurapi is a bio similar and is apparently cheaper.

I'd also suggest asking about reusable pens because they have useful features, but it seems that many GP surgeries don't really think about them for some reason. Bit of a shame, there have been a few stories over the years about the benefits of smart insulin pens (by which they often just mean those like Novopen Echo Plus which allow recording of doses).

But for someone who prefers disposable pens for some reason, surely it's harder to reject absolutely such a switch? (At least to try Trurapi and see how it works for them.)

 

[mashedupmatt]

Was trying to find out how much cheaper Trurapi is but it's not on the list yet (for anyone who is interested, you can look it up here: https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff )- it's a shame that GP Surgeries don't consider reusable pens more (I'm lucky, mine is fine) as there is obviously an environmental benefit - using less plastic etc.

 

[Bruce Stephens]

it's a shame that GP Surgeries don't consider reusable pens more (I'm lucky, mine is fine) as there is obviously an environmental benefit - using less plastic etc.

It is. I'm not sure how much environmental difference there is (the reusable pens are presumably costly to produce) but the reusable ones are convenient (rather, the much smaller cartridges are). I guess GPs just have so many different conditions to deal with that it's not practical to keep up with all of them.

 

[DianeD]

Trurapi can be prescribed as a cartridge for a reusable pen. But it only fits one pen and that is not a 'smart one' that records doses but can have a 1/2 unit option.

 

[SWWChris]

Sorry to revive this thread, it is directly linked to my problem. I was forced onto Truapi as a cost saving exercise by my GP surgery in September last year. The first problem was that they changed the insulin prescription but did not prescribe a pen, on phoning the surgery they argued that my Novopen would work but a Google search told me different. Then later the same day I was contacted and told a prescription was raised for an AllStar Pro pen. I was ok with this but then on collecting the new insulin was told that the pens were not available. I then got back to the surgery and asked for the Novo Rapid to be reinstated but they refused and gave me a one off prescription to keep me going! This went on for a couple of months until finally the pharmacy got a pen, in the meantime I was regularly searching online to buy a pen because I like to have a backup, but none in stock.

I then discovered that the Allstar pens dont have a memory function and questioned this with the surgery but NEVER received a reply!!

The switch to Truapi itself went fine, but I have since been constantly trying to find a spare pen to purchase without luck

My question/reason for posting is -

1. My doctor surgery treated my appallingly, changed my insulin and did not offer any support, not even a phone call
2. Doctor surgery point blank refused to accept the pens were different
3. Wont give me a spare pen and even if they did they are not available

Frustrating because I get the reason for the change but am pretty upset about the cold hearted way it was done and lack of ongoing support (I suffer hugely from anxiety).

Rant over but if anyone has a suggestion regarding where I might purchase a spare Allstar Pro pen it would be fantastic

 

[everydayupsanddowns]

How do you feel about the swap @Wotisname ?

Are you happy with how NR is working for you? Are you happy enough to give the switch a try and see whether trurapi works OK for you. As has been suggested, it may be connected with NovoNordisk’s ongoing flap about supply issues because of Ozempic etc. But there are more ways to deliver NR if you’d prefer to stay on the insulin you know.

 

[Wotisname]

How do you feel about the swap @Wotisname ?

Are you happy with how NR is working for you? Are you happy enough to give the switch a try and see whether trurapi works OK for you. As has been suggested, it may be connected with NovoNordisk’s ongoing flap about supply issues because of Ozempic etc. But there are more ways to deliver NR if you’d prefer to stay on the insulin you know.

There was zero consultation from G P surgery about change from NR to Trurapi , I was informed via a text message that the change was supported by local diabetes experts, local practices in Cheshire & Merseyside Medicines Management Team. Also my first prescription of Trurapi was for one box of 5 ml pens, someone at the surgery decided I wouldn't need the usual two boxes I had been receiving of NR., also local pharmacy I have been using for twenty plus years were unaware of the change, and had been inundated with requests from other surgeries to change patient prescriptions without prior warnings . Regarding how the change has gone, 3/4 days finger prick results indicated I needed to increase insulin doses until my body adjusted to the change .Not wanting to rock the boat at the surgery about the lack of consultation about the change, suspect they are fully on board with changes new government are applying to NHS.
.

 

[everydayupsanddowns]

Cynically I think the lack of consultation is possibly mostly a time pressure thing (make the change, and those who are going to complain, will complain). Wasn’t it Banksy who allegedly said “it is easier to ask for forgiveness than permission”?

I can’t help but think it’s counterproductive though. People are more likely to be worried and feel negatively about a switch that hasn’t been explained to them.

Surgeries do it with BG meters too, where a local authority seems to strike a deal with one manufacturer.

Never seems the best course of action. Snd hardly representative of individualised healthcare.

“Nothing about us, without us” as Aussie diabetes advocate Renza S often says!

 

[Merluza]

My surgery has switched my meters a couple of times and as I can't get the one I would like, cost savings of course, and the one they will give me works well enough I can let it go. If they want to switch insulin that would be a different matter and I would argue against it strongly unless it was recommended by my hospital consultant who I would also expect to speak to me first.

My surgery is presently considering what to do about the Libre2+. As it costs them the same I would have expected it to just be updated but from what I heard from the GP pharmacist I think it will be curtains for anybody not type 1, cost savings again. Shortly after they switched my statin to a cheaper one I started getting nasty reactions so I'm leery about this kind of thing.