|INSULIN, ISOPHANE (NPH)
Humulin N, Novolin 70/30, Novolin N
Classifications: hormone; antidiabetic agent; intermediate acting insulin; Therapeutic: antidiabetic; intermediate acting insulin
Pregnancy Category: B
Intermediate-acting, cloudy suspension of zinc insulin crystals modified by protamine in a neutral buffer. NPH Iletin II
(pork), and Insulatard NPH are "purified" or "single component" insulins that have been purified and are
less likely to cause allergic reactions than nonpurified preparations. Lowers blood glucose levels by increasing peripheral
glucose uptake, especially by skeletal muscle and fat tissue, and by inhibiting the liver from changing glycogen to glucose.
Controls postprandial hyperglycemia, usually without supplemental doses of insulin injection.
Used to control hyperglycemia in the diabetic patient. Mixtard and Novolin 70/30 are fixed combinations of purified regular
insulin 30% and NPH 70%.
During episodes of hypoglycemia or in patients sensitive to any ingredient in the formulation; intravenous route; diabetic
ketoacidosis; hyperosmolar hyperglycemic state.
In insulin-resistant patients, hyperthyroidism or hypothyroidism; fever; older adults, pregnancy (category B), renal or
hepatic impairment; children.
Route & Dosage
Adult: SC Individualized doses (see INSULIN, REGULAR)
- Give isophane insulin 30 min before first meal of the day. If necessary, a second smaller dose may be prescribed 30 min
before supper or at bedtime.
- Ensure complete dispersion by mixing thoroughly by gently rotating vial between palms and inverting it end to end several
times. Do not shake.
- Do NOT mix insulins unless prescribed by physician. In general, when insulin injection (regular insulin) is to be combined,
it is drawn first.
- Note: Isophane insulin may be mixed with insulin injection without altering either solution. Do NOT mix with Lente forms.
- Store unopened vial at 2°8° C (36°46° F). Avoid freezing and exposure to extremes in temperature
or to direct sunlight.
Adverse Effects (≥1%)
(see INSULIN, REGULAR
(see insulin, regular
12 h. Peak:
412 h NPH. Duration:
1824 h NPH. Metabolism:
In liver and kidney. Elimination:
<2% excreted unchanged in urine. Half-Life:
up to 13 h.
(see INSULIN, REGULAR)
Assessment & Drug Effects
Patient & Family Education
- If insulin was given before breakfast, a hypoglycemic episode is most likely to occur between mid-afternoon and dinnertime,
when insulin effect is peaking. Advise to eat a snack in mid-afternoon and to carry sugar or candy to treat a reaction.
A snack at bedtime will prevent insulin reaction during the night.
- Learn the S&S of hypoglycemia and hyperglycemia (see Appendix F).