INSULIN HUMAN, ISOPHANE (NPH) 100 UI/ml, 3ml, pref. pen N

Insulatard InnoL^® or Insulatard FlexPen^®

• In the WHO list of Essential Medicines 2023

Pancreatic hormone, antidiabetic

Intermediate-acting isophane human insulin.

Isophane insulin is made up of regular human insulin combined with NPH (Neutral Protamine Hagedornis) to delay absorption and prolong the duration of action.

Action profile:

• onset of action: 1 - 2 hrs
• peak action: 4 - 12 hrs
• duration of action: 14-18 hrs

These action profiles are based on subcutaneous injections and are only approximations. They depend on the dose injected, the type and brand of insulin and are highly variable from one patient to another.

See Preliminary remarks on Insulins.

Diabetes

Insulin to cover basal insulin needs.

Insulin pre-filled pens are the preferred option for the patient self-administration (and OPD use).

A portable, hand-held device, typically in the form of a large pen, prefilled with a pharmaceutical agent and intended to be used by a patient to subcutaneously inject a dose of the pharmaceutical via a replaceable needle. The device typically includes a dial for dosing and is discarded when the pharmaceutical is exhausted and is therefore used over a short period (single-use).

Must be given as deep SC injection only.

Before using insulin for the first time, store it at room temperature for 1 or 2 hours (cold insulin is more painful).

Preparation for administration:

• Wash hands.
• Check the pen label (type and strength of insulin, expiry date) and the solution (opaque, white and aqueous).
• Stir the insulin by gently rolling the pen between the palms of the hands. Do not shake the pen.
• Remove the cap from the pen.
• Wipe the pen tip (rubber seal) with a disinfectant.
• Attach a pen needle to the pen after removing the protective seal of the needle. Push the needle straight onto the pen. Screw the needle on the pen.
• Remove the outer cap of the needle and save it (you will need it to remove the needle after the injection).
• Remove the inner cap of the needle.
• Remove air from the pen. Pointing the needle up in the air, select one or two units on the pen. Gently tap the pen to move air bubbles to the top of the pen.
• Press the injection button. A drop of insulin should appear on the tip of the needle. If no drop appears, change the needle and repeat this step.
• Select the correct dose on the pen. Turn the dose selector to the required number of units.

How to administer SC insulin:

• Insulin can be injected into the abdomen (two fingers away from the belly button), upper arm, buttocks, hips, buttocks, or the front or side of the thigh.
• Injecting insulin in the same area repeatedly can cause lumps, swelling and thickened skin, and it may keep insulin from absorbing properly. See the picture below on “rotating” injection sites.
• Do not inject insulin into areas that have wounds or bruising.
• Clean the chosen injection site with soap and water. Allow to dry.
• Pinch the skin.
• Keep the pen straight at a 90-degree angle to the skin and insert the needle with one quick motion.
• Push the injection button with the thumb to inject the dose of insulin. Wait for 10 seconds before releasing the button and removing the needle from the skin.
• Apply gentle pressure on the injection site with the finger for 5-10 seconds to keep insulin from leaking out.
• Remove the needle from the pen by replacing the outer needle cap on and unscrewing. Leaving the needle on the pen can result in leakage or air bubbles.
• Safety discard the needle into a sharps container.
• Replace the cap on the pen after each injection to protect it from light.

Education of patients

Set up several counselling sessions to determine whether the patient is ready to start self-injecting and understands the risks and management of hypoglycaemia, the use of the pre-filled pen (including the units of insulin), the injection technique, the insulin storage, the waste management. Involve the family/carers if possible and provide an information leaflet adapted to the local context. Contact your OC referent for more details.