A medication exchange takes two minutes to do and one minute to write down. That one minute is what determines what the next caregiver understands.

On September 16, the Norwegian Directorate of Medical Products announced that rationing of the NPH insulin Humulin will be introduced. The reason is that Novo Nordisk is withdrawing Insulatard from the market. November 30th. Up to 30,000 people with diabetes May need to switch treatment, and Humulin — the only other NPH insulin on the Norwegian market — can only cover around 10 percent of today's consumption.

The rationing applies from September 16, 2026 until January 31, 2027. During this period, pharmacies may only dispense one pack of Humulin at a time. The alternatives for switching to long-acting insulin are insulin glargine or insulin degludec., According to DMP.

For those of you working clinically, this means something simple and quite significant: tens of thousands of drug exchanges will be carried out in a short time, in patients who in many cases have been using the same insulin for many years.

The exchange is going too slowly — and that creates a hump

DMP has been informing about the deregistration since 2025. However, the sales figures show that few have changed. «Now it is urgent. The doctor must find an alternative that suits you. We are concerned that there may not be enough time for both the change and follow-up,» says chief physician Ingrid Aas at DMP.

This is the last part that is interesting from a documentation perspective. A change in insulin is not complete when the prescription is written. It requires titration, monitoring of blood sugar levels, and usually at least one adjustment. When many people change at the same time, the follow-up is distributed: the GP writes the prescription, the diabetes nurse monitors the values, the pharmacy notices that the package is different, the home care service sets the dose. None of them has been involved in the conversation that determined the change.

Some patients may have a particular need for NPH insulin — DMP mentions, among others, people with gestational diabetes, people treated with glucocorticoids, and certain hospitalized patients with type 2 diabetes. This makes the assessment individual, and an individual assessment is precisely the kind of information that disappears if it is not written down.

Documentation of medication changes: four things that should be included

Patient record regulation § 6 clearly states what may be relevant and necessary in drug treatment: name of the drug, active substance, strength, amount, dosage, indication and time — as well as Effect and side effects of the treatment. In a switching period, there are four points that carry the most weight:

  1. What the patient switched from, and to. Not just the new ordination. Without the «from» clause, history becomes impossible to read backwards.
  2. Why the switch happened. Here it is worth noting a difference: the switch happens because the product is deregistered, not because the treatment failed. If the reason is not stated there, it is easy for the next prescriber to believe that the previous insulin did not work.
  3. What you agreed upon for follow-up. When should blood sugar be re-evaluated, by whom, and what triggers a dose adjustment.
  4. If the patient were allowed to keep NPH insulin: why?. When a medication is rationed, the rationale for assigning it to this particular patient is an information that both the pharmacist and colleagues benefit from. The regulation explicitly mentions that considerations behind measures that deviate from current practice should be made clear.

They National professional advisory bodies for drug approval and drug review says that healthcare professionals who conduct reconciliation should ensure a complete overview of the patient's actual medication use. In a period where many lists are changing simultaneously, «actual use» is a moving target. We have written more about this practice in the post about Clinical pharmaceutical and drug compliance and about the drug review at the nursing home.

The conversation is where the information is

What actually happens in the consultation is a conversation: the patient tells how she uses the insulin in practice, when she puts it on, what she does when she is ill, what she fears about switching. Much of this is useful later on. Little of it makes it into the note when it is to be written between two patients.

Medivox is a dictation tool. You dictate the summary while the conversation is fresh, and get a draft of the journal note in a template you have created yourself. For this autumn, it might be worth creating a custom template for medication switching with fixed fields: from, to, baseline, dosing plan, follow-up, who is following up. Then the question of whether you remember the fourth point is not a question—the template asks for it.

Transcription and generation are done by an AI service from OpenAI, and the processing takes place in the EU. Patient data is stored on our own servers in Norway, and the information is pseudonymized before the data is further processed. Medivox does not provide medical advice and has no decision support — the insulin the patient should have is and will be your decision. You own the journal and make the final decision.

What is now written will be read in January

The rationing will last until January 31, 2027. Insulatard will be out of stock from November 30. Somewhere in between, there will be a resident physician, a nurse on night duty, or a colleague who covers the general practitioner’s office, and they will read a note written in October to find out why the patient is on what they are on.

That note is already written when that day comes. The question is only whether the «why» came along.

Frequently Asked Questions

Why does Insulatard disappear?
Novo Nordisk states that commercial reasons have led to the discontinuation of production and sales, and the withdrawal applies throughout Europe. The product will be off the market from November 30, 2026.

What are the alternatives for switching from Insulatard?
DMP points to insulin glargine or insulin degludec as good alternatives when switching to long-acting insulin. Which option is suitable is an individual assessment made by the doctor together with the patient.

How long does the rationing of Humulin last?
From September 16, 2026 at 12:00 until January 31, 2027. During this period, pharmacies may only dispense one package at a time.

What should be included in the medical record when a patient changes their medication?
What was exchanged from one to the other, why, the agreed dose schedule and follow-up, and who is responsible for follow-up. The Patient Record Regulations § 6 requires, among other things, the name, active substance, strength, dosage and indication, as well as the effect and side effects.

Can dictation be used during a busy exchange period?
Dictation is the core function of Medivox, and you build your own templates. A short template for medication exchange allows the same fields to be filled every time, even when the day is over.

Use Medivox for free – Get started completely free

If you’re going to undergo many insulin changes this autumn, we’re happy to help you set up a template that suits your workflow. Contact us – then we show you how to build it yourself.

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