II. Mechanism
- See Insulin
- Traditional Basal insulin (NPH) is largely replaced by Analog Basal Insulins (e.g. Insulin Glargine) and Insulin Pumps
- However, NPH is the least expensive Basal insulin
- Consider NPH Insulin as an alternative for those who cannot afford Analog Basal Insulin (e.g. Insulin Glargine)
- NPH Insulin is an intermediate duration typically dosed twice daily (contrast with once daily for Insulin Glargine)
- NPH Insulin is synthesized by crystallizing zinc insulin Protamines at a neutral pH 7
- NPH is named for its synthesis and its inventor (Neutral Protamine Hagedorn)
III. Medications
- NPH Insulin, Novolin N, Humulin N, Humulin L (Lente)
- Onset: 1 to 2 hours
- Peak: 6 to 8 hours
- Peak time is higher risk of hypoglcemia
- Consider snack at 6 hours after dose
- Duration: 10 to 16 hours (Lente slightly longer)
- Humulin L (Lente) was discontinued in the U.S. in 2006 (leaving only NPH Insulin in this class)
- Increased risk of Hypoglycemia (esp nocturnal) compared with newer analogues
- NPH is much less expensive than analogues ($25/vial as of 2016 at Walmart)
- Combination Agents - Basal and Bolus Insulin (for Type II Diabetes if poor compliance)
- NPH 50/Regular 50
- NPH 70/Regular 30 (Humulin 70/30 or Novolin 70/30)
- NPL 75/Lispro 25 (Humalog Mix 75/25)
- NPH 70/Aspart 30 (Novolog Mix 70/30)
IV. Dosing
- See Insulin Dosing
- See Insulin Dosing in Type I Diabetes
- See Insulin Dosing in Type II Diabetes
- NPH Insulin may be mixed in same syringe with bolus/rapid Insulins (draw up Bolus Insulin first)
- Do NOT mix other basal/Long-Acting Insulins (e.g. Insulin Glargine) with Bolus Insulins
- Typical daily dosing
- NPH Insulin is injected subcutaneously (SQ)
- Total daily Insulin
- Type 1 Diabetes: 0.3 to 0.5 units/kg (up to 0.5 to 1.0 units/kg in children)
- Type 2 Diabetes: 1 to 1.5 units/kg
- Basal insulin dose (NPH)
- Give 50% of total daily dose as NPH Insulin SQ divided twice daily
- As an alternative, newer Insulins such as Insulin Glargine (Lantus) may be used daily
- Give remaining 50% of total Insulin daily units as Bolus Insulin divided over 3 meals
- In type 2 diabetes, Basal insulin is often started without Bolus Insulin
- Give 50% of total daily dose as NPH Insulin SQ divided twice daily
V. Adverse Effects
- See Insulin
VI. Safety
- Considered safe in pregnancy and Lactation
VIII. References
- (2014) Presc Lett 21(12): 69
- Lepore (2000) Diabetes 49:2142-8 [PubMed]
- Mayfield (2004) Am Fam Physician 70(3):489-512 [PubMed]
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Related Studies
| novolin n (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| NOVOLIN N 100 UNIT/ML FLEXPEN | OTC | $16.76 per ml |
| NOVOLIN N 100 UNIT/ML VIAL | OTC | $13.21 per ml |
| humulin n (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| HUMULIN N 100 UNIT/ML KWIKPEN | OTC | $30.15 per ml |
| HUMULIN N 100 UNIT/ML VIAL | OTC | $14.30 per ml |