Insulin-Humulin NPH

For the management of insulin requiring diabetes.
For the latest PBS indications for Humulin NPH please see
https://www.pbs.gov.au/pbs/search?term=humulin%20nph&analyse=false&search-type=medicines

• HUMULIN NPH Cartridges should be used only for subcutaneous administration. HUMULIN NPH should be rotated in the palms of hands before use to resuspend.
• The dosage should be determined by the physician, according to the requirements of the person with diabetes. During dose changes increase the frequency of glucose monitoring.
• Subcutaneous administration should be in the upper arms, thighs, buttocks, or abdomen. Use of injection sites should be rotated so that the same site is not used more frequently than once a month, to reduce the risk of lipodystrophy and localised cutaneous amyloidosis.
• Renal impairment – Adjustment of dose may need to occur.
• Hepatic impairment – Adjustment of dose may need to occur.

• No information is available in this population.

• Hypersensitivity to insulin aspart or any active ingredient
• Hypoglycaemia

• Individuals who are travelling overseas (or to destinations with substantially different time zones) should contact their doctor/ credentialled diabetes educator for information.
  Note: Diabetes MedsCheck- how to use insulin effectively when traveling or referral to healthcare team.
• Individuals who receive insulin, which contains protamine, have an increased risk of severe reactions simulating anaphylaxis when protamine is used to reverse systemic heparinisation after cardiac catheterisation.
• Mixing of Insulins – Shorter acting insulin should be drawn into the syringe first to prevent contamination of the vial by the longer-acting (HUMULIN NPH) preparation. It is advisable to inject immediately after mixing.
  Note: Diabetes MedsCheck on how to inject insulin with referral to credentialled diabetes educator for education on correct injection technique.
• Individuals who experienced hypoglycaemic reactions after being transferred to HUMULIN have reported that these early warning symptoms were less pronounced than they were with animal-source insulin.
  Note: Diabetes MedsCheck with counselling on hypoglycaemia, what is a hypo, signs and symptoms to watch for.

• Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes. These include (but are not restricted to) change in the injection area improved insulin sensitivity (e.g., by removal of stress factors, weight loss); unaccustomed, increased, or prolonged physical activity. intercurrent illness (e.g., vomiting, diarrhoea); inadequate food intake; missed meals; and alcohol consumption. Note: Diabetes MedsCheck with counselling regarding hypoglycaemia including what to look out for, what is a hypo and what to do.
• Visual disturbances:A marked change in glycaemic management can cause temporary visual impairment, due to temporary alteration in the turgidity and refractive index of the lens. As with all insulin regimens, intensification of insulin therapy with abrupt improvement in glycaemic management maybe associated with temporary visual impairment or worsening of retinopathy. However, long-term improved glycaemic management decreases the risk of progression of diabetic retinopathy. Note: Diabetes MedsCheck with education and referral to healthcare team.
• Injection site and allergic reactions:As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Other injection site reactions with insulin therapy include redness, pain, itching, hives, swelling and inflammation. Note: Diabetes MedsCheck with education on side effects and referral to healthcare team to establish correct injection technique.
• Insulin antibodies: Immediate type allergic reactions to insulin are rare. Such reactions to insulin (including insulin HUMULIN NPH) or the excipients may, for example, be associated with generalised skin reactions, angioedema, bronchospasm, hypotension, and shock, and maybe life threatening. Note: Diabetes MedsCheck with counselling on side effect profile, what to look and referral to hospital if allergic reaction occurs.