GP leaders and experts are warning of an ‘increasingly urgent’ need to switch patients with diabetes from Levemir insulin before it is discontinued at the end of this year.

Local medical committees in London are among those writing to the integrated care board with patient safety concerns after pharmacies in the area are already reporting intermittent supply problems.

Manufacturer Novo Nordisk informed the Department of Health and Social Care in September 2024 that it would be withdrawing several older insulins including Levemir (insulin determir) in both its Penfill and Flexpen options.

A medicines supply notifications warning of the move was issued last year, but an update in April reiterated that a high number of patients remain on Levemir and should be switched to an alternative as soon as possible.

Joint guidance has been issued from professional diabetes associations on alternatives to mitigate against knock-on shortages of other insulins.

It is thought thousands of patients could still be using Levemir and experts warned that switching was complex.

Dr Stephen Lawrence, a GP and associate clinical professor in primary care at Warwick University, said the discontinuation of Levemir was a ‘genuine patient safety concern’.

‘Insulin detemir cannot simply be replaced through an automatic prescription substitution.

‘There is no direct like-for-like alternative: the choice of basal insulin, dose, injection timing and delivery device must be tailored to the individual, with education and closer glucose monitoring during the early weeks after the change.’

He added it would be ‘unsafe’ to expect already pressured practices to absorb a large programme of reviews without safeguards.

‘General practice may be well placed to deliver many switches, particularly where practices have established diabetes expertise.

‘But it must be accompanied by protected capacity, training, a funded and clearly commissioned pathway, robust clinical governance and timely access to specialist diabetes advice for more complex patients.’

Data from the NHS Business Services Authority show that prescribing of insulin determir has roughly halved over the past year.

But in June 2026, there were still 18,990 prescription items dispensed.

In an update to members, North East London LMCs said around 1,600 patients across the ICB remained on Levemir in July and pharmacies were already hitting supply problems.

‘The LMCs are extremely concerned about the risk of gaps in insulin provision, which could lead to significant patient harm.

‘While some PCNs have accepted the third-party Levemir switching support offer, this does not cover all affected patients. At the current rate of switching, completion would not be expected until around October 2027,’ the update warned.

General practice may be well placed to undertake much of the work, it said, but stressed ‘practices cannot safely absorb this additional clinical workload without resources, particularly when the ICB is considering funding additional capacity in secondary and community services’.

Affected patients need to be clearly signposted to a commissioned pathway ‘rather than routinely back to general practice’, it added.

In its newsletter, Redbridge LMC said switching patients from Levemir was ‘not a simple medicine swap’.

‘Members noted that secondary care and community services may not have sufficient capacity to absorb this work, creating a risk that it falls to general practice by default.’

Dr Rob Barnett, secretary of Liverpool LMC said their local medicines management team had been supporting practices as well as work being done in secondary care and community diabetes services.

He has not had an update but ‘in July there were approximately 1300 patients in Cheshire and Merseyside who needed switching’.

The RCGP has also issued a reminder that stocks of Levemir are expected to be depleted by December 2026.

No new patients should be started on it and existing patients should be switched ‘if possible as part of a planned review’.

It is thought that two-thirds of Levemir prescriptions are for individuals with type 1 diabetes, while the remaining third are for those with type 2 diabetes or other forms of the condition.

The RCGP also reiterated warnings that supplies of Humulin I and Abasaglar cannot support a significant increase in demand and should not be routinely used unless there is a clear clinical need.

Professor Azeem Majeed, a GP in south London and professor of primary care and public health at Imperial College London, said switching patients from Levemir was a ‘major task’.

He said while people with type 1 diabetes and those with frailty may be best supported by specialist diabetes teams, with services stretched it was likely that a substantial share of the work may fall on GPs.

‘However, local NHS commissioners need to fund the additional workload, provide practical training and ensure rapid access to specialist diabetes advice

‘Sending out guidance is useful, but it does not create the capacity to implement it.’

Pulse has asked the Department of Health and Social Care and NHS England for comment.

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GP leaders issue ‘urgent’ patient safety concerns over Levemir discontinuation