A biphasic isophane insulin injection, also known as biphasic human insulin or 75/25 premixed insulin. It is a sterile suspension containing 75% Insulin Isophane (NPH, an intermediate-acting insulin) and 25% Human Insulin (regular, soluble, short-acting insulin) in a single vial or cartridge. This combination provides both a rapid onset to cover postprandial glucose rise and a prolonged duration to provide basal insulin coverage, simplifying the regimen for patients requiring both meal-time and basal insulin.
Adult: Highly individualized. Typically initiated at 0.2-0.5 units/kg/day, divided into 2 doses (pre-breakfast and pre-dinner). The total daily dose is often split as 2/3 in the morning and 1/3 in the evening, but must be titrated based on blood glucose monitoring. Usual maintenance range: 0.5-1.0 units/kg/day.
Note: For SUBCUTANEOUS injection only. Administer 30-45 minutes before a meal. Rotate injection sites (abdomen, thigh, buttocks, upper arm) to prevent lipodystrophy. Gently roll the vial/pen to resuspend; do not shake. Inspect visually; it should be uniformly cloudy/milky. Do not use if clear, discolored, or contains particles. Use appropriate insulin syringe (U-100) or delivery device.
Insulin is the principal hormone required for proper glucose utilization. It regulates carbohydrate, lipid, and protein metabolism by promoting cellular uptake of glucose (especially in muscle and adipose tissue), inhibiting hepatic glucose production (glycogenolysis and gluconeogenesis), and promoting glycogen, lipid, and protein synthesis.
Pregnancy: Pregnancy Category B (US FDA). Insulin is the drug of choice for glycemic control in pregnant women with pre-existing or gestational diabetes. Requirements may decrease in first trimester and increase significantly in second/third trimesters. Close monitoring and dose adjustments are mandatory.
Driving: Caution required. Patients must check blood glucose before driving and regularly on long journeys. Must be aware that hypoglycemia can impair cognitive and motor functions. Should always carry a fast-acting carbohydrate source (glucose tablets) in the vehicle.
| Oral Hypoglycemic Agents (Sulfonylureas, Meglitinides) | Additive hypoglycemic effect, increased risk of hypoglycemia. | Major |
| Corticosteroids (e.g., Prednisolone, Dexamethasone) | Antagonize insulin effect, cause hyperglycemia, requiring dose increase. | Major |
| Beta-blockers (e.g., Propranolol) | May mask tachycardia symptoms of hypoglycemia, potentiate hypoglycemia, and impair recovery. | Moderate |
| Thiazide Diuretics (e.g., Hydrochlorothiazide) | May cause hyperglycemia, increasing insulin requirements. | Moderate |
| ACE Inhibitors (e.g., Ramipril) | May enhance insulin sensitivity, increasing hypoglycemia risk. | Moderate |
| Alcohol | Potentiates hypoglycemic effect and can cause delayed hypoglycemia, especially in fasting state. | Major |
| MAO Inhibitors, Anabolic Steroids | Increase hypoglycemic effect. | Moderate |
| Thyroid Hormones, Somatropin, Danazol | Increase blood glucose, requiring higher insulin doses. | Moderate |
Same composition (Insulin Isophane/NPH (75%) + Human Insulin/Soluble Insulin (25%)), different brands: