Nph insulin: functions, dosage, side effects, how to use it

Uses

What is NPH insulin for?

NPH insulin is an artificial hormone that functions to reduce blood sugar levels. NPH (Neutral Protamine Hagedorn) insulin is also known as isophane insulin. Some people refer to this as insulin intermediate acting insulin because of how it works. In general, NPH insulin which is injected into the body will replace the role of the body's natural insulin which is not able to be produced in sufficient quantities.

This drug is used to help control blood sugar in patients with diabetes mellitus, both adults and children. Its use in conjunction with a proper diet and exercise program in diabetic patients helps prevent kidney damage, blindness, neurological problems, risk of amputation, and problems with sexual function. Proper blood sugar control can also help lower your risk of having a heart attack and stroke.

NPH insulin is a intermediate acting insulin. This insulin starts to work within 2 - 4 hours after the injection is done. The peak working period of this insulin occurs within 4-12 hours after injection and continues to work for up to 12-18 hours after the injection is made.

The use of NPH insulin is often combined with short acting insulin. After doing this injection, the patient should be careful about the possibility of hypoglycemia, especially at night. Apart from being combined with the use of insulin with a shorter working period, this drug can also be used as a single treatment or in combination with other oral diabetes medications, such as metformin.

How do you use NPH insulin?

Use NPH insulin as recommended by your doctor. Follow all directions listed on the packaging label. Do not use this medication in doses greater or less than recommended.

NPH insulin is a drug that is injected into the subcutaneous tissue (the lower layer of the skin), usually once or twice a day. The injection can be done in the area of the abdomen, thighs, buttocks, or upper arm that has fatty tissue. You can tell the presence of fatty tissue by its softer nature on the surface of your skin. Do not inject this drug directly into a vein or muscle to prevent the risk of hypoglycemia.

NPH insulin is available as a suspension. Before using it, carefully turn or roll the bottle of insulin so that the suspension is evenly mixed. You can scroll it or flip it slowly about 10 times.

Check the appearance of NPH insulin suspension. NPH insulin should appear to have a milky color after mixing because it is a suspension. Do not use this medication if there are solid particles or discoloration. If there are white particles or lumps, look frozen, or have stuck to the wall of the bottle, do not use this insulin. Ask your pharmacist or doctor for new insulin.

Before giving the injection, clean the area to be injected first and do the injection when the cleaned area has dried. You should change your injection point at each injection. Do not inject at the same place twice in succession to prevent side effects at the injection point, such as lipodystrophy. Do not inject NPH insulin when it is cold because it will be painful.

The use of NPH insulin can be mixed with certain insulin, such as regular insulin. If you are using an insulin syringe to give this insulin mixture, always switch regular insulin first followed by insulin which has a longer service life. Do not use an insulin pump to mix NPH insulin.

Do not share syringes with other people, even if you have changed needles. Sharing syringes can increase the risk of disease transmission from one person to another.

NPH insulin is a generic brand. This insulin has several trademarks that are sold, including Humulin N and Novolin N. If you are using one brand, do not change your medication to another brand without a direction from your doctor.

The dosage given takes into account your health condition and your body's response to treatment. Measure carefully the dosage you should take, because changing the dose even if it's just a little can have a big impact on blood sugar levels in the body. Do not change your dose or stop medication without consulting your doctor.

Use this remedy regularly to get the expected results. To make it easier for you to remember, do the injection at the same time every day. Contact your doctor immediately if the condition does not improve or even gets worse. You may need to adjust your dose or change your medication.

NPH insulin store rules

Read the storage instructions that come with your medicine pack. NPH insulin can have several trademarks that differ in the way it is stored.

Store NPH insulin in a container protected from heat and direct light. Don't keep it in the bathroom. You can store this medication in the refrigerator but do not freeze it. Throw out the insulin that has frozen even though it has returned to liquidation. Keep this medicine out of reach of children.

Stores unopened NPH insulin

You can store it in the refrigerator at a temperature of 2 - 8 degrees Celsius. But don't keep it on freezer. Use it before it expires
You can also store it at room temperature below 30 degrees Celsius. Use within 31 days

Store NPH insulin that has been opened

Store small bottles (vials) of NPH insulin in the refrigerator or room temperature and use within 31 days
Store the injection pen at room temperature (do not refrigerate it) and use it within 14 days. If it has been more than 14 days, you should throw this insulin out even if it is still in the injection pen.

Do not throw this product in the toilet or other drain unless instructed to do so. Dispose of this product safely when it has expired or is no longer in use. Consult your pharmacist or local waste disposal company about how to safely dispose of this product.

Dose

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before starting treatment.

What is the dose of NPH insulin for adults?

Patients with type 1 diabetes

The maintenance dose is usually in the range 0.5 - 1 unit / kg / day in divided doses.
People who are not obese may need 0.4 - 0.6 units / kg / day.
Those with obesity may need 0.8 - 1.2 units / kg / day.

Talk to your doctor about the dosage that is right for you.

Patients with type 2 diabetes

Initial dose: 0.2 unit / kg / day

What is the dose of NPH insulin for children?

Children with type 1 diabetes

Children younger than 12 years: dose has not been established. Consult your doctor.

Children over 12 years: the recommended dose is 0.5 - 1 unit / kg / day

Maintenance dose in adolescents: maximum 1.2 units / kg / day during the growth spurt

In what dosages and preparations is NPH insulin available?

Injection, Subcutaneous: 100 units / mL (3 mL); 100 units / mL (10 mL)

Side effects

What side effects may arise from using NPH insulin?

Immediately contact your doctor or to the nearest hospital if you notice serious allergy symptoms due to using NPH insulin. Allergy symptoms that generally appear are itching, reddish rash, swelling of the face / eyes / lips / tongue / throat area, dizziness, and difficulty breathing.

Reactions at the injection point are also possible (such as pain, redness, irritation). If this condition does not go away or gets worse, contact your doctor immediately.

Contact your doctor immediately if you experience:

Fluid accumulation, the symptoms are weight gain, swelling of the feet or hands, shortness of breath
Low potassium levels, characterized by cramps in the legs, constipation, irregular heartbeat, palpitations, thirst and persistent urination, numbness or tingling, muscle weakness and feeling weak.

Some of the common side effects that arise from using NPH insulin are:

Low blood sugar levels
Itchy, mild rash on the skin
Thickening or indentation at the point of injection

Consumption of this drug can also cause hypoglycemia. This happens when you don't consume enough calories or do excessive physical activity. The first aid you can do is to eat foods or drinks that contain sugar, namely table sugar, candy, honey, or non-diet soda.

Remember that your doctor prescribes certain medications because they judge their benefits to outweigh the risk of possible side effects. Almost all drugs have side effects, but in most cases, they rarely require serious attention.

The list above is not a complete list of the side effects of NPH insulin that occur. There may be other side effects not mentioned above. Talk to your doctor about any side effects you fear will occur.

Warnings and Precautions

What should I pay attention to before using NPH insulin?

Tell your doctor if you have an allergy to other types of isophane insulin / NPH insulin, or any allergies to any other medicines. Also inform other types of allergies you may have, such as allergies to certain foods or certain conditions. This medicine may contain other ingredients that have the potential to cause an allergic reaction
Inform all of your complete medical history to the doctor who treats you, both your past and current illnesses. To ensure that NPH insulin is safe for you, make sure that you inform your doctor if you have adrenal / pituitary gland disorders, kidney disease, liver disease, and thyroid gland problems. Also inform if you have a history of hypokalemia (low levels of potassium in the body)
You may experience visual disturbances, weakness, and drowsiness due to changes in blood sugar levels. For this reason, you should not immediately engage in activities that require high alertness, such as driving or operating large machinery, until you know how this treatment affects your body.
If you are going to have a surgical procedure, including dental surgery, tell your doctor or dentist about any medications you are taking, including NPH insulin.
If you will be traveling to a place with a different time zone, consult your doctor regarding the injection schedule. Carry insulin reserves with you when traveling to ensure you keep getting the insulin supply as needed
Parents and children may be more prone to side effects such as hypoglycemia when taking this drug
Tell your doctor if you are planning or are pregnant. Consult your doctor regarding the use of this drug while pregnant and breastfeeding. Your doctor may provide other diabetes treatment alternatives during pregnancy

Is NPH insulin safe for pregnant and lactating women?

Based on studies conducted on animals, the use of NPH insulin does not indicate a negative risk to the fetus. However, no studies on the risks of using insulin to the fetus have been carried out in pregnant women. The US Food and Drug Administration (FDA) classified this drug into a category B pregnancy risk, no risk in several studies. It is recommended that you consult your doctor regarding the use of this medicine during pregnancy.

NPH insulin is known to flow out of the body through breast milk but has a tendency not to have a negative impact on nursing mothers. Talk to your doctor before breastfeeding. You may need to adjust your diabetes medication during breastfeeding.

Interaction

What drugs may interact with NPH insulin?

Several drugs cannot be prescribed together because they can cause drug interactions. Drug interactions can cause the drug to not work optimally or increase the risk of side effects. However, your doctor may prescribe the two drugs at the same time if needed by adjusting the frequency of the medication schedule and the dose given.

Tell your doctor about all the products you use, including prescription / non-prescription drugs, vitamins, or herbal products to prevent drug interactions that have the potential to cause side effects.

Products known to have possible drug interactions with NPH insulin are repaglinide and rosiglitazone.

Some of the other products that may also interact with NPH insulin are as follows:

Aspirin
Albuterol (combivent)
Atorvastatin (Lipitor)
Furosemide (Lasix)
Zoloft (sertraline)

The above list is not a complete list of drugs that may interact with NPH insulin. Make sure you save any medications you are currently taking and tell your doctor about it to prevent drug interactions.

What health conditions might interact with NPH insulin?

Kidney / liver disease
Hypokalemia
Hypoglycemia

Overdose

What should I do in an emergency or NPH insulin overdose?

If someone has overdosed and finds serious symptoms such as fainting or difficulty breathing, call emergency medical help immediately (119) or immediately to the nearest hospital emergency department. Symptoms of an overdose can also include hypoglycemia which is characterized by body sweating, trembling, blurred vision, numbness or tingling in the mouth, difficulty speaking, weakness, fainting, seizures, and a fast heartbeat.