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Clinician’s Corner: NPH “Neutral Protamine Hagedorn”

NPH “Neutral Protamine Hagedorn”  as we mentioned in the history of insulin is regular insulin that is matched molecule for molecule with the protein Protamine, which makes the regular insulin longer acting. The first commercially available NPH was available in 1950.  The human insulin formulations became available in the early 1980’s

Humulin-N® or Novolin -N® U-100 (isophane insulin) has an onset of action= 1.5-4 hours, with a peak between 4-12 hours. NPH insulin has a duration of action of 24 hours.

COMPARING LONG ACTING (BASAL) insulins to NPH

  • The type of insulin does not appear to affect cardiovascular outcomes, according to the HEART2D trial
  • A large health care delivery system studied and found there was no benefit of insulin analogs (Lantus and others) compared with NPH in reducing emergency department or hospital admissions for hypoglycemia. NPH group had slightly better control (HbA1c=7.9) versus basal insulin (HbA1c 8.2) suggesting both groups were managed aggressively.

IS NPH a reasonable choice to replace basal insulins due to cost?

  • Standard long-acting insulin analogs like glargine (Basaglar/Lantus) and detemir (Levemir) are not superior to NPH insulin in efficacy terms as determined by the number of participants reaching HbA1c targets.
  • The use of the glargine and detemir which have flatter curves, showed 50% less nighttime hypoglycemia, when compared to NPH.
  • All insulin analogs, both short- and long-acting insulin analogs (Lantus, Novolog and others), cause less hypoglycemia and less weight gain compared with therapies based on regular human insulin and NPH insulin.

COST:

It depends… the wholesale acquisition prices are as follows:

  • Lantus 10cc vial ($300.00 per vial)
  • Humulin NPH ($160.00)
  • Novolin-N ($150.00)

Keep in mind that human insulin whether NPH, Regular or mixed 70/30 is over the counter.  However, a prescription needs to be issued for a pharmacist to bill insurance.  Even the older insulin formulations are out of reach for most customers.  Your Thompson Pharmacist can help guide your health care provider through the maze of available insulins.  Our goal is to give you a fuller and more active life.

Put your Thompson Pharmacist on your diabetes management team.  Go Ahead and ASK… at Thompson Pharmacy… its ALL FOR YOU!