NPH Insulin

insulin /in·su·lin/ (in´sdbobr-lin)

1. a protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans. The major fuel-regulating hormone, it is secreted into the blood in response to a rise in concentration of blood glucose or amino acids. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis.

Insulin. The precursor proinsulin is cleaved internally at two sides (arrows) to yield insulin and C peptide.

2. a preparation of insulin, either of porcine or bovine origin or a recombinant form with sequence the same as or similar to that in humans, used in the treatment of diabetes mellitus; classified as rapid-acting, intermediate-acting, or long-acting on the basis of speed of onset and duration of activity.

3. regular insulin; a rapid-acting, unmodified form of insulin prepared from crystalline bovine or porcine insulin.

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insulin aspart  a rapid-acting analogue of human insulin created by recombinant DNA technology.

buffered insulin human  insulin human buffered with phosphate; used particularly in continuous infusion pumps.

extended insulin zinc suspension  a long-acting insulin consisting of porcine or human insulin in the form of large zinc-insulin crystals.

insulin glargine  an analogue of human insulin produced by recombinant DNA technology, having a slow, steady release over 24 hours.

insulin human  a protein corresponding to insulin elaborated in the human pancreas, derived from pork insulin by enzymatic action or produced synthetically by recombinant DNA techniques; sometimes used specifically to denote a rapid-acting regular insulin preparation of this protein.

isophane insulin suspension  an intermediate-acting insulin consisting of porcine or human insulin reacted with zinc chloride and protamine sulfate.

Lente insulin  insulin zinc suspension.

insulin lispro  a rapid-acting analogue of human insulin synthesized by means of recombinant DNA technology.

NPH insulin  isophane i. suspension.

prompt insulin zinc suspension  a rapid-acting insulin consisting of porcine insulin with zinc chloride added to produce a suspension of amorphous insulin.

regular insulin  insulin (3).

Semilente insulin  prompt insulin zinc suspension.

Ultralente insulin  extended insulin zinc suspension.

insulin zinc suspension  an intermediate-acting insulin consisting of porcine or human insulin with a zinc salt added such that the solid phase of the suspension contains a 7:3 ratio of crystalline to amorphous insulin.

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NPH Insulin,

trademark for an insulin suspension (isophane).

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insulin (obtained from beef or pork, or human recombinant technology),

n brand names: Velosulin, Humulin R, Novolin R, Lente Insulin;
drug class: exogenous insulin, antidiabetic;
action: decreases blood glucose; important in regulation of fat and protein metabolism;
uses: ketoacidosis; type 1 and type 2 diabetes mellitus; hyperkalemia; hyperalimentation.

insulin, exogenous

n a type that comes from a source external to a diabetic patient's body, taken to offset the patient's natural deficiency of insulin.

insulin, intermediate-acting,

n a type that is a medium between rapid-acting and long-acting insulins; the onset is not as fast as rapid-acting insulin, but it reaches its peak action over a 4- to 12-hour period.

insulin, Lente

n.pr an intermediate-acting type that reaches its peak action over a 4- to 12-hour period.

insulin, Lispro,

n.pr a rapid-acting type that reaches its peak action in 30 to 90 minutes.

insulin, long-acting,

n a type that has a slow onset but reaches its peak action from 12 to 16 hours after administration.

insulin, NPH,

n a synthetic type used to treat diabetes. Classified as intermediate acting; peak action occurs 4 to 10 hours after administering.

insulin, rapid-acting,

n a synthetic type of insulin used to treat diabetes. Reaches peak action 30 to 90 minutes after administering.

insulin, regular,

n a synthetic type used to treat diabetes. Classified as short acting; peak action occurs 2 to 3 hours after administering.

insulin resistance,

n a complication of diabetes mellitus characterized by a need for more than 200 units of insulin per day to control hyperglycemia and ketosis. The cause is associated with insulin binding by high levels of antibody.

insulin shock,

n See shock, insulin.

insulin, short-acting,

n a synthetic type used to treat diabetes. Reaches peak action 2 to 3 hours after administering. Also called
regular insulin.

insulin, ultralente

n a synthetic type used to treat diabetes. Classified as long acting, with peak action occurring 12 to 16 hours after administering.

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isophane insulin suspension (NPH insulin)

Humulin N, Novolin N

Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it's converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.

Availability

Glulisine, recombinant: 100 units/ml in 10-ml vials

Isophane suspension, injection (regular): 70 units NPH and 30 units regular insulin/ml (100 units/ml total), 50 units NPH and 50 units regular insulin/ml (100 units/ml total)

Isophane suspension (NPH insulin): 100 units/ml

Lispro: 100 units/ml in 10-ml vials and 1.5-ml cartridges

Regular insulin injection: 100 units/ml

Regular U-500 (concentrated), insulin human injection: 500 units/ml

Zinc suspension, extended (ultralente): 100 units/ml

Zinc suspension (lente insulin): 100 units/ml

⊘Indications and dosages

➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin-dependent) diabetes mellitus unresponsive to diet and oral hypoglycemics

Adults and children: In newly diagnosed diabetes, total of 0.5 to 1 unit/kg/day subcutaneously as part of multidose regimen of short- and long-acting insulin. Dosage individualized based on patient's glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/ml) for patients requiring more than 200 units/day.

➣ Diabetic ketoacidosis

Adults and children: Loading dose of 0.15 units/kg (nonconcentrated regular insulin) I.V. bolus, followed by continuous infusion of 0.1 unit/kg/hour until glucose level drops. Then administer subcutaneously, adjusting dosage according to glucose level.

Contraindications

• Hypersensitivity to drug or its components
• Hypoglycemia

Precautions

Use cautiously in:
• hepatic or renal impairment, hypothyroidism, hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

☞ Be aware that insulin is a high-alert drug whether given subcutaneously or I.V.
☞ Don't give insulin I.V. (except nonconcentrated regular insulin), because anaphylactic reaction may occur.
• When mixing two types of insulin, draw up regular insulin into syringe first.
• For I.V. infusion, mix regular insulin only with normal or half-normal saline solution, as prescribed, to yield a concentration of 1 unit/ml. Give every 50 units I.V. over at least 1 minute.
• Rotate subcutaneous injection sites to prevent lipodystrophy.
• Administer mixtures of regular and NPH or regular and lente insulins within 5 to 15 minutes of mixing.

Route	Onset	Peak	Duration
I.V. (regular)	10-30 min	15-30 min	Unknown
Subcut. (glulisine)	Rapid	Unknown	Short
Subcut. (lente)	1-2.5 hr	7-15 hr	24 hr
Subcut. (lispro)	15 min	30-90 min	6-8 hr
Subcut. (lispro/protamine mix; regular U-500 conc.)	Unknown	Unknown	Unknown
Subcut. (NPH)	1-1.5 hr	4-12 hr	24 hr
Subcut. (regular)	30-60 min	2-4 hr	Unknown
Subcut. (ultralente)	8 hr	10-30 hr	>36 hr

Adverse reactions

Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect)

Skin: urticaria, rash, pruritus

Other: edema; lipodystrophy; lipohypertrophy; erythema, stinging, or warmth at injection site; allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect

Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect

Beta-adrenergic blockers (nonselective): masking of some hypoglycemia symptoms, delayed recovery from hypoglycemia

Lithium carbonate: decreased or increased hypoglycemic effect

Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels

Liver and thyroid function tests: interference with test results

Urine vanillylmandelic acid: increased level

Drug-herbs. Basil, burdock, glucosamine, sage: altered glycemic control

Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect

Garlic, ginseng: decreased blood glucose level

Drug-behaviors. Alcohol use: increased hypoglycemic effect

Marijuana use: increased blood glucose level

Smoking: increased blood glucose level, decreased response to insulin

Patient monitoring

• Monitor glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
☞ Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.
☞ Assess for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).
• Monitor for glycosuria.
• Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Teach patient how to administer insulin subcutaneously as appropriate.
• Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him not to change order of mixing insulins.
• Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.
☞ Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to carry a glucose source at all times.
• Instruct patient to store insulin in refrigerator (not freezer).
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.
• Instruct patient to wear medical identification stating that he is diabetic and takes insulin.
• Advise patient to have regular medical, vision, and dental exams.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.