From the Guidelines
No, Lantus (insulin glargine) is not NPH insulin. Lantus is a long-acting basal insulin analog that provides steady insulin levels for approximately 24 hours with a relatively flat profile and no pronounced peak, as noted in a study comparing glargine insulin with insulin isophane suspension (neutral protamine Hagedorn) in patients with type 1 diabetes 1. In contrast, NPH (Neutral Protamine Hagedorn) insulin is an intermediate-acting insulin that typically works for 12-18 hours with a peak effect around 4-6 hours after injection. This fundamental difference affects how these insulins are used clinically. Lantus is typically dosed once daily and helps maintain baseline blood glucose levels throughout the day and night, while NPH is often administered twice daily due to its shorter duration and pronounced peak.
The peakless profile of Lantus generally results in a lower risk of hypoglycemia compared to NPH, especially overnight, with a study showing that symptomatic hypoglycemia was less common in patients who used glargine (39.9 versus 49.2 percent over one month, P = .02) 1. Furthermore, long-acting insulin analogs like glargine have a modestly lower absolute risk for hypoglycemia compared with NPH insulin, as reported in a consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) 1. Patients switching between these insulins should do so under medical supervision as dosing requirements and timing may differ significantly. Key considerations include:
- Duration of action: Lantus lasts approximately 24 hours, while NPH lasts 12-18 hours.
- Peak effect: Lantus has no pronounced peak, while NPH has a peak effect around 4-6 hours after injection.
- Hypoglycemia risk: Lantus generally has a lower risk of hypoglycemia, especially overnight, compared to NPH.
- Dosing frequency: Lantus is typically dosed once daily, while NPH is often administered twice daily.
From the FDA Drug Label
The duration of action after abdominal, deltoid, or thigh subcutaneous administration of insulin glargine was similar The time course of action of insulins, including insulin glargine products, may vary between patients and within the same patient. In clinical studies, the glucose-lowering effect on a molar basis (i.e., when given at the same doses) of intravenous insulin glargine is approximately the same as that for human insulin. Figure 1 shows results from a study in patients with type 1 diabetes conducted for a maximum of 24 hours after subcutaneous injection of insulin glargine or NPH insulin.
No, Lantus (insulin glargine) is not a Neutral Protamine Hagedorn (NPH) insulin, it is an insulin analog with a different duration of action and pharmacokinetic profile compared to NPH insulin 2.
From the Research
Characteristics of Lantus (Insulin Glargine)
- Lantus (insulin glargine) is a long-acting, human insulin analogue designed to provide basal insulin supplementation 3, 4, 5.
- It is produced by recombinant DNA technology and has a stable molecule that is soluble in slightly acidic conditions (pH 4.0) and precipitates in the neutral pH of subcutaneous tissue 4, 5.
- Insulin glargine provides a relatively constant basal level of circulating insulin with no pronounced peak, unlike NPH insulin 3, 4, 5.
Comparison with NPH Insulin
- Insulin glargine achieves equivalent glycaemic control to NPH insulin given once or twice daily in patients with type 1 and type 2 diabetes 3, 6, 7, 5.
- It is associated with significantly lower fasting blood glucose (FBG) levels, especially in patients with type 1 diabetes previously on twice-daily NPH insulin 3, 7, 5.
- Insulin glargine elicits less hypoglycaemia, especially nocturnal episodes, than NPH insulin, with similar levels of glycaemic control 3, 4, 6, 7, 5.
Is Lantus (Insulin Glargine) a Neutral Protamine Hagedorn (NPH) Insulin?
- No, Lantus (insulin glargine) is not a Neutral Protamine Hagedorn (NPH) insulin, but rather a long-acting insulin analogue designed to provide basal insulin supplementation 3, 4, 5.
- It has different properties and characteristics compared to NPH insulin, including a more constant basal level of circulating insulin and reduced risk of hypoglycaemia 3, 4, 6, 7, 5.