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NPH Insulin

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NPH Insulin, Intermediate-Acting Insulin, Isophane Insulin, Neutral Protamine Hagedorn Insulin, Novolin N, Humulin N, Humulin L, Lente Insulin

  • See Also
  1. Basal insulin
  2. Insulin Glargine
  3. Insulin
  4. Bolus Insulin
  5. Insulin Dosing
  6. Glucose Metabolism
  7. Type II Diabetes Medications
  8. Type 1 Diabetes Mellitus
  • Mechanism
  1. See Insulin
  2. Traditional Basal insulin (NPH) is largely replaced by Analog Basal Insulins (e.g. Insulin Glargine) and Insulin Pumps
    1. However, NPH is the least expensive Basal insulin
    2. Consider NPH Insulin as an alternative for those who cannot afford Analog Basal Insulin (e.g. Insulin Glargine)
  3. NPH Insulin is an intermediate duration typically dosed twice daily (contrast with once daily for Insulin Glargine)
  4. NPH Insulin is synthesized by crystallizing zinc insulin Protamines at a neutral pH 7
    1. NPH is named for its synthesis and its inventor (Neutral Protamine Hagedorn)
  • Medications
  1. NPH Insulin, Novolin N, Humulin N, Humulin L (Lente)
    1. Onset: 1 to 2 hours
    2. Peak: 6 to 8 hours
      1. Peak time is higher risk of hypoglcemia
      2. Consider snack at 6 hours after dose
    3. Duration: 10 to 16 hours (Lente slightly longer)
    4. Humulin L (Lente) was discontinued in the U.S. in 2006 (leaving only NPH Insulin in this class)
    5. Increased risk of Hypoglycemia (esp nocturnal) compared with newer analogues
    6. NPH is much less expensive than analogues ($25/vial as of 2016 at Walmart)
  2. Combination Agents - Basal and Bolus Insulin (for Type II Diabetes if poor compliance)
    1. NPH 50/Regular 50
    2. NPH 70/Regular 30 (Humulin 70/30 or Novolin 70/30)
    3. NPL 75/Lispro 25 (Humalog Mix 75/25)
    4. NPH 70/Aspart 30 (Novolog Mix 70/30)
  • Dosing
  1. See Insulin Dosing
  2. See Insulin Dosing in Type I Diabetes
  3. See Insulin Dosing in Type II Diabetes
  4. NPH Insulin may be mixed in same syringe with bolus/rapid Insulins (draw up Bolus Insulin first)
    1. Do NOT mix other basal/Long-Acting Insulins (e.g. Insulin Glargine) with Bolus Insulins
  5. Typical daily dosing
    1. NPH Insulin is injected subcutaneously (SQ)
    2. Total daily Insulin
      1. Type 1 Diabetes: 0.3 to 0.5 units/kg (up to 0.5 to 1.0 units/kg in children)
      2. Type 2 Diabetes: 1 to 1.5 units/kg
    3. Basal insulin dose (NPH)
      1. Give 50% of total daily dose as NPH Insulin SQ divided twice daily
        1. As an alternative, newer Insulins such as Insulin Glargine (Lantus) may be used daily
      2. Give remaining 50% of total Insulin daily units as Bolus Insulin divided over 3 meals
        1. In type 2 diabetes, Basal insulin is often started without Bolus Insulin
  • Adverse Effects
  1. See Insulin
  • Safety
  1. Considered safe in pregnancy and Lactation
  • Reources
  1. NPH Insulin (Humulin-N, DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f6edd793-440b-40c2-96b5-c16133b7a921
  2. FDA Insulin storage and emergency switching
    1. https://www.fda.gov/Drugs/EmergencyPreparedness/ucm085213.htm
  • References
  1. (2014) Presc Lett 21(12): 69
  2. Lepore (2000) Diabetes 49:2142-8 [PubMed]
  3. Mayfield (2004) Am Fam Physician 70(3):489-512 [PubMed]