Insulet N 100 IU/ml Injection

Insulet N – Isophane (NPH) Human Insulin 100 IU/ml Intermediate-Acting Injection

What is Insulet N?

Insulet N is an intermediate-acting NPH (isophane) human insulin in a 10 ml vial, manufactured by Healthcare Pharmaceuticals Ltd., Bangladesh. The "N" stands for NPH — Neutral Protamine Hagedorn — the classic intermediate-acting insulin formulation where protamine delays absorption to extend duration to 16–24 hours with a peak at 4–12 hours. Insulet N provides overnight and inter-meal basal glucose control, and is also used as the NPH component in manual premix preparation (combined in the same syringe with soluble insulin). As part of Healthcare Pharmaceuticals' comprehensive Insulet range, it provides a locally manufactured, affordable NPH insulin option for Bangladeshi patients with both Type 1 and Type 2 diabetes.

Generic Name and Composition

Each ml contains: 100 IU isophane human insulin (rDNA). NPH insulin is a crystalline suspension formed by combining human insulin with protamine and zinc in precise proportions. This complex dissolves slowly after SC injection as tissue enzymes cleave protamine — releasing human insulin steadily over 16–24 hours. Unlike long-acting analogues (glargine, detemir), NPH has a pronounced action peak at 4–12 hours, providing stronger overnight coverage but with higher nocturnal hypoglycaemia risk.

Indications

• Type 1 diabetes — intermediate basal insulin, used alongside rapid or short-acting insulin
• Type 2 diabetes — once- or twice-daily basal insulin for fasting glucose control
• Manual syringe mixing with soluble (R) insulin to create a custom premix ratio
• Pregnancy: NPH is the preferred basal insulin in pregnancy per international guidelines

How It Works — Mechanism of Action

After SC injection, protamine is cleaved by tissue enzymes, releasing human insulin from the suspension. The slow dissolution produces a broad action profile: onset 1–2 hours, peak glucose-lowering effect at 4–12 hours, and duration up to 24 hours. The peak action overnight (when injected at bedtime) reduces fasting glucose — the primary target in Type 2 diabetes initiating insulin therapy. When mixed with soluble insulin, NPH provides both immediate bolus coverage and intermediate basal coverage in one injection.

Dosage and Administration

Once daily at bedtime for fasting glucose control in Type 2 diabetes, or twice daily as part of a more intensive regimen. Starting dose (Type 2, insulin-naive): 10 IU at bedtime, titrated by 2 IU every 3 days until fasting glucose target is met. Resuspend by rolling the vial 10 times before each draw — inspect for uniform milky white suspension. Draw NPH last when mixing with soluble insulin. Inject SC into abdomen, thigh, or upper arm. Rotate sites.

Side Effects

Very common: Hypoglycaemia — particularly nocturnal at the 4–12 hr peak window. Common: Injection site reactions, lipohypertrophy, weight gain. Uncommon: Lipoatrophy, peripheral oedema. Rare: Hypersensitivity, anaphylaxis.

Drug Interactions

Enhance hypoglycaemia: OADs, GLP-1 agonists, SGLT-2 inhibitors, ACE inhibitors, MAO inhibitors, salicylates, alcohol. Reduce effect: Corticosteroids, glucagon, thyroid hormones, sympathomimetics, thiazides, oral contraceptives. Mask symptoms: Beta-blockers, clonidine.

Contraindications

• Active hypoglycaemia
• Hypersensitivity to human insulin or protamine
• Intravenous use (NPH suspension — SC injection only)

Pregnancy and Lactation

Pregnancy: Insulet N (NPH) is the preferred basal insulin during pregnancy per WHO, ADA, and NICE guidelines — preferred over glargine or detemir for basal needs. Monitor glucose closely. Lactation: No clinically significant passage into breast milk.

Precautions and Warnings

• Resuspend before each injection — roll vial 10 times; never shake. Uniformly cloudy white appearance required.
• Nocturnal hypoglycaemia risk — the 4–12 hr peak overlaps with sleep; bedtime snack may be needed at higher doses.
• Mixing order: Always draw soluble (clear) insulin first, then NPH (cloudy) — prevents protamine contamination of the soluble insulin vial.
• Do not mix NPH with insulin analogues (aspart, lispro, glargine) — stability not established.
• Do not freeze. Protect from light.

Overdose

Hypoglycaemia. Mild: oral glucose. Severe: IV dextrose 20–50% or IM glucagon 1 mg. NPH duration of 16–24 hours means prolonged monitoring and possible repeat glucose administration is necessary, especially with large overdoses.

Storage Instructions

• Unopened vial: 2–8 degrees C. Do not freeze.
• In-use vial: Below 25 degrees C. Protect from light.
• Discard 28 days after first use.

Frequently Asked Questions

Q1: What is the difference between Insulet N and Insulet GN?
Insulet N is NPH (isophane) human insulin — intermediate-acting with a peak at 4–12 hours and duration of 16–24 hours. It typically requires twice-daily dosing and carries higher nocturnal hypoglycaemia risk. Insulet GN is insulin glargine — a long-acting analogue with a flat, peakless 24-hour profile, once-daily, with lower nocturnal hypoglycaemia risk. Insulet N is preferred in pregnancy; Insulet GN is preferred for once-daily convenience and lower peak-related hypoglycaemia risk.

Q2: Can Insulet N be mixed with Insulet 30/70 or other Insulet premixes?
NPH insulin can be mixed with soluble (R) human insulin — not with premixed insulin formulations. Mixing NPH with an existing premix changes the ratio unpredictably. Insulet N is designed to be mixed with soluble human insulin (Insulet R) only, to create a custom premix ratio per physician guidance.

Q3: Who manufactures Insulet N?
Insulet N is manufactured by Healthcare Pharmaceuticals Ltd., Bangladesh. The Insulet range covers: Insulet 30/70 (premix), Insulet 50/50 (premix), Insulet N (NPH), Insulet GN (glargine), and Insulet ASP (insulin aspart) — a comprehensive locally manufactured insulin portfolio.

Q4: Why might my doctor choose Insulet N over a long-acting insulin analogue?
NPH (Insulet N) is often preferred for: patients in pregnancy (NPH is guideline-recommended), patients on a budget (NPH is less expensive than analogues), and patients already well-controlled on NPH. Long-acting analogues are preferred when nocturnal hypoglycaemia is a problem or once-daily dosing is strongly preferred. Your diabetologist will choose based on your individual glucose pattern, lifestyle, and treatment goals.

Medical Disclaimer: For educational purposes only. Insulet N is Rx-only. Consult your diabetologist before starting or changing insulin therapy. DiabetesStore.com.bd is a licensed online pharmacy in Bangladesh.