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]
Images: Related links to external sites (from Bing)
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 |
Ontology: NPH Insulin (C0021658)
Definition (MSH) | An intermediate-acting INSULIN preparation with onset time of 2 hours and duration of 24 hours. It is produced by crystallizing ZINC-insulin-PROTAMINES at neutral pH 7. Thus it is called neutral protamine Hagedorn for inventor Hans Christian Hagedorn. |
Definition (NCI) | An intermediate-acting insulin used in the treatment of diabetes mellitus. Administered once or twice daily, NPH (neutral protamine hagedorn) insulin lowers blood glucose within 1 to 2 hours after administration and exerts a peak effect at 6 to 10 hours. Endogenous insulin, a pancreatic hormone composed of two polypeptide chains, is important in the normal metabolism of carbohydrates, proteins and fats, promoting glucose utilization and protein synthesis; it has anabolic effects on many types of tissues. (NCI04) |
Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116) |
MSH | D007336 |
SnomedCT | 126217003, 66384003, 412219004, 412220005, 412221009 |
LNC | LP16324-3, MTHU019391 |
English | Hagedorn Insulin, Protamine, Insulin, Isophane, Isophane Insulin, Protamine Hagedorn Insulin, Insulin Isophane, Isophane insulin injection, Isophane protamine insulin inj, Isophane protamine insulin injection, Insulin Isophane NPH, NPH Insulin, insulin isophane, Neutral Protamine Hagedorn Insulin, insulins nph, isophane insulin, nph insulin isophane, nph isophane insulin, nph insulin, protamine hagedorn insulin, insulin nph, Insulin, NPH, Insulin, Isophane [Chemical/Ingredient], Isophane insulin preparation (substance), Isophane insulin preparation, Insulin NPH, Isophane Insulin, Regular, Regular Isophane Insulin, Isophane insulin, NPH insulin, Neutral protamine hagedorn insulin, Isophane insulin (substance), Isophane insulin (product), Isophane insulin NPH, Isophane insulin nph (product), Isophane insulin nph (substance), Isophane insulin nph |
Finnish | Isofaani-insuliini |
Russian | INSULIN, IZOFAN, INSULIN NPH, INSULIN-IZOFAN, ИНСУЛИН, ИЗОФАН, ИНСУЛИН NPH, ИНСУЛИН-ИЗОФАН |
French | Insuline neutre protamine Hagedorn, Insuline isophane ordinaire, Insuline NPH, Insuline isophane |
Italian | Insulina protamina di Hagedorn, Insulina protamina neutra di Hagedorn, Insulina NPH, Insulina isofano |
Swedish | Insuliln, NPH |
Czech | NPH insulin, insulin NPH, insulin isofan |
Spanish | insulina NPH isofánica (producto), insulina isófana (sustancia), insulina isófana, insulina isófana NPH (sustancia), insulina isófana NPH, insulina NPH (sustancia), insulina isofánica, insulina NPH isofánica, insulina NPH isofánica (sustancia), insulina isófana NPH (producto), insulina protamina neutra, Insulina Isófana, Insulina NPH, preparado de insulina isofánica (sustancia), preparado de insulina isofánica, Insulina PNH, insulina NPH, insulina NPH (producto) |
Polish | Insulina izofanowa wołowo-wieprzowa, Insulina NPH wieprzowa, Insulina NPH ludzka, Insulina izofanowa wołowa, Insulina izofanowa wieprzowa, Insulina NPH wołowa, Insulina izofanowa ludzka, Insulina NPH wołowo-wieprzowa, Insulina izofanowa |
Japanese | NPHインスリン, イソフェンインスリン, イソファンインシュリン, イソフェンインスリン水性懸濁液, イソファンインスリン, インスリン-イソフェン |
Portuguese | Insulina NPH, Insulina Isofana |
Norwegian | Insulin NPH, NPH-insulin, Insulin med middels lang virketid, Insulin, isofant |
German | Insulin, Isophan- |
Ontology: Intermediate-acting insulin (C0304869)
Concepts | Pharmacologic Substance (T121) , Hormone (T125) , Amino Acid, Peptide, or Protein (T116) |
SnomedCT | 126214005, 68475005 |
English | Intermediate-acting insulin preparation, Intermediate acting insulin product (product), Intermediate acting insulin product, Intermediate-acting insulin (substance), Intermediate-acting insulin, Intermediate-acting insulin, NOS, Intermediate-acting insulin preparation (substance), Insulin, Intermediate-acting |
Spanish | insulina de acción intermedia (producto), producto con insulina de acción intermedia (producto), producto con insulina de acción intermedia, insulina de acción intermedia (sustancia), insulina de acción intermedia, preparado insulínico de acción intermedia (producto), preparado insulínico de acción intermedia (sustancia), preparado insulínico de acción intermedia |