From the Guidelines
NPH insulin is an intermediate-acting insulin.
Key Characteristics of NPH Insulin
- It is a type of human insulin, also known as Neutral Protamine Hagedorn insulin 1
- Intermediate-acting, meaning it has a slower onset and longer duration of action compared to short-acting insulins, but shorter than long-acting insulins 1
- Typically used as basal insulin to control blood glucose levels between meals and during sleep 1
- Can be used alone or in combination with other insulins, such as short-acting or rapid-acting insulins 1
- Not recommended to be mixed with certain insulins, such as lente insulins, due to potential physicochemical changes that may affect the insulin's action 1
Clinical Use of NPH Insulin
- Often used in the treatment of type 1 and type 2 diabetes to help control blood glucose levels 1
- Can be administered via subcutaneous injection, typically once or twice daily 1
- Dosing and administration should be individualized based on the patient's specific needs and glucose monitoring results 1
- May be used in combination with other glucose-lowering medications or insulin therapies to achieve optimal glycemic control 1
From the FDA Drug Label
The clinical significance of this difference has not been established. Pharmacokinetics Absorption After subcutaneous injection of insulin detemir in healthy subjects and in patients with diabetes, insulin detemir serum concentrations indicated a slower, more prolonged absorption over 24 hours in comparison to NPH human insulin In a glucose clamp study, the overall glucodynamic effect (AUCGIR 0-24h) [mean mg/kg ± SD (CV)] of four separate subcutaneous injections in the thigh was 1702.6 ± 489 mg/kg (29%) in the LEVEMIR group and 1922. 8 ± 765 mg/kg (40%) for NPH.
NPH (Neutral Protamine Hagedorn) insulin is a type of human insulin. 2
From the Research
Definition and Characteristics of NPH Insulin
- NPH (Neutral Protamine Hagedorn) insulin is an intermediate-acting insulin that has been used in the management of diabetes mellitus since 1946 3.
- It is characterized by a variable absorption rate due to the need for resuspension and a time-action profile that peaks 4-6 hours after subcutaneous administration, which can lead to an increased risk of between-meal and nocturnal hypoglycemia 3.
Comparison with Other Insulin Types
- NPH insulin has been compared to long-acting insulin analogues, such as glargine and detemir, in several studies 3, 4, 5.
- These studies have shown that long-acting insulin analogues may have a lower risk of hypoglycemia and improved glucose control compared to NPH insulin 3, 4, 5.
- However, one study found that NPH insulin may be superior to insulin glargine in cases of severe insulin resistance 6.
Administration and Efficacy
- The administration of NPH insulin at bedtime versus with dinner has been shown to reduce the risk of nocturnal hypoglycemia and improve glucose control in patients with type 1 diabetes mellitus 7.
- A meta-analysis of randomized controlled trials found that long-acting insulin analogues had a small but significant effect on HbA1c levels and reduced the risk of nocturnal and severe hypoglycemia compared to NPH insulin in patients with type 1 diabetes 5.
- Another study found that patients who switched from NPH insulin to insulin glargine had slightly greater reductions in weight, fasting blood glucose, and HbA1c levels, with a lower risk of hypoglycemia 4.