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 a mixture of regular human insulin with NPH (Neutral Protamine Hagedornis) to delay absorption and prolong the duration of action.

Action profile:

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

These action profiles are based on subcutaneous injections and are approximate. They depend on the dose injected, the type and brand of insulin, and can vary significantly from one patient to another.

See Preliminary remarks on Insulins.

Diabetes

Insulin to cover basal insulin requirements.

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, allow it to reach 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 inspect the solution (it should be 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 and screw it on tightly.
• 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 upward select one or two units on the pen, and 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 by turning 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.
• repeatedly injecting insulin in the same area can cause lumps, swelling and thickened skin, which may interfere with proper absorption of the insulin. See the picture below on “rotating” injection sites.
• Do not inject insulin into areas with 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.
• Press 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 a finger for 5-10 seconds to prevent insulin from leaking out.
• Remove the needle from the pen by replacing the outer needle cap on and unscrewing it. Leaving the needle on the pen can result in leakage or air bubbles.
• Dispose of the needle safely in a sharps container.
• After each injection, replace the cap on the pen to protect it from light.

Education of patients

Arrange multiple counselling sessions to assess whether the patient is ready to begin self-injecting and understands the risks and management of hypoglycaemia, the use of the pre-filled pen (including insulin units), the proper injection technique, insulin storage, and waste management. If possible, involve the family or caregivers and provide an information leaflet adapted to the local context. Contact your OC referent for more details.