Known brand names include Humulin N.
An intermediate-acting human insulin, white and cloudy after mixing, injected under the skin. It lowers blood sugar in adults and children with diabetes and starts later and lasts longer than regular insulin.
Labeled use. Labeled for diabetes mellitus; insulin is essential therapy in type 1.
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NPH is the classic intermediate-acting basal insulin, usually given once or twice daily, often with regular insulin in a split-mixed regimen. Its distinct peak makes overnight and between-meal hypoglycemia more likely than with peakless long-acting analogs such as glargine, but it costs much less and some human insulins are sold without a prescription. It is the basal insulin that can be mixed in one syringe with regular insulin or lispro; glargine must never be mixed.
Intermediate-acting human insulin (isophane: crystals of human insulin and protamine), with slower onset and longer duration than regular insulin. Lowers glucose by driving uptake into muscle and fat and suppressing hepatic glucose production; also blocks lipolysis and proteolysis and shifts potassium into cells. After 0.4 unit/kg subcutaneously, median peak effect 6.5 hours (range 2.8 to 13) and median peak serum insulin about 4 hours.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
No fixed adjustment; not studied. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.
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No fixed adjustment; not studied. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.
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Hypoglycemia: oral glucose for mild episodes; a glucagon product or concentrated IV glucose for coma, seizures, or neurologic impairment. Continue carbohydrates and observation because lows can recur after apparent recovery. Correct any hypokalemia.
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Decades of published data have not linked human insulin to major birth defects, miscarriage, or poor maternal or fetal outcomes. Poorly controlled diabetes in pregnancy raises the risk of DKA, preeclampsia, birth defects, stillbirth, and preterm delivery.
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Human insulin passes into milk, with no adverse infant reactions reported. Effects on milk production are unknown.
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Indicated in children. Dose to metabolic needs with frequent glucose monitoring to limit hypoglycemia.
Effect of age not studied. Older adults may face more hypoglycemia because of coexisting disease and multiple medicines.
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