A biphasic isophane insulin preparation containing 70% intermediate-acting insulin isophane (NPH) and 30% short-acting human insulin (regular soluble insulin). It is a premixed insulin analogue designed to provide both prandial (meal-time) and basal (background) glycemic control in a single injection. It is a suspension for injection and must be resuspended by gentle rolling before administration.
Adult: Highly individualized. Typically started at 0.2-0.4 units/kg/day or 10 units once or twice daily (usually before breakfast and/or dinner). Titrate based on self-monitored blood glucose (SMBG) patterns, typically by 2-4 units every 3-4 days.
Note: For SUBCUTANEOUS use only. Inject into abdominal wall, thigh, buttock, or upper arm. Rotate sites within the same region. Administer 30-45 minutes before a meal. Before use, gently roll the pen/vial between palms 10 times and invert 10 times until it appears uniformly cloudy. Do not shake vigorously. Do not use if clear, discolored, or contains particles.
Insulin is an endogenous hormone produced by pancreatic beta cells. This combination preparation mimics both prandial and basal insulin secretion. The soluble insulin (30%) component acts rapidly to control postprandial glucose rise, while the isophane/NPH insulin (70%) component provides a prolonged intermediate action to control basal glucose levels between meals and overnight.
Pregnancy: Pregnancy Category B (US FDA). Insulin is the drug of choice for glycemic control in pregnancy (both pre-existing and gestational diabetes). Requirements may decrease in first trimester and increase significantly in second/third trimesters. Close monitoring (HbA1c, SMBG) is mandatory.
Driving: Patients must check blood glucose before driving. Caution advised as hypoglycemia can impair cognitive and motor functions. Always carry a fast-acting carbohydrate source.
| Oral Hypoglycemic Agents (e.g., Sulfonylureas, Meglitinides) | Additive hypoglycemic effect. High risk of hypoglycemia. | Major |
| Corticosteroids (e.g., Prednisolone, Dexamethasone) | Antagonize insulin effect, causing hyperglycemia. Dose increase often needed. | Major |
| Beta-blockers (e.g., Propranolol) | May mask tachycardia of hypoglycemia, impair counter-regulatory response, and potentially prolong hypoglycemia. | Moderate |
| Thiazide Diuretics (e.g., Hydrochlorothiazide) | May cause hyperglycemia, reducing insulin efficacy. | Moderate |
| ACE Inhibitors (e.g., Ramipril), MAOIs, Pentamidine | May increase hypoglycemic risk. | Moderate |
| Alcohol | Acute intake can cause hypoglycemia (especially fasting). Chronic intake can cause hyperglycemia. | Major |
Same composition (Insulin Isophane/NPH (70%) + Human Insulin/Soluble Insulin (30%)), different brands: