Humulin NPH 100 IU/mL suspension in cartridge – intermediate-acting human insulin for diabetes

Humulin NPH contains human insulin, produced by recombinant DNA technology and with the same structure as the insulin made by the pancreas. Its action is prolonged by the addition of protamine sulphate, so it is an intermediate-acting insulin and is usually used as a basal insulin.

In Serbia it is authorised as Humulin® NPH, 100 IU/mL, suspension for injection in cartridge (Eli Lilly), in a pack of 5 cartridges of 3 mL. Your doctor may also prescribe a fast-acting insulin to be used with it.

What is Humulin NPH used for and how is it used correctly?

Key facts about the medicine

What is Humulin NPH used for?

According to the Summary of Product Characteristics, Humulin NPH is intended for the treatment of patients with diabetes mellitus who require insulin to maintain normal blood glucose. Diabetes develops when the pancreas does not make enough insulin to control blood sugar. Humulin NPH is used for long-term glucose control and is usually given as a basal insulin.

How is it used and dosed?

The dose, timing and frequency are decided only by your doctor, according to your needs – follow these instructions strictly and attend regular check-ups at your diabetes clinic.

• Mixing before use: roll the cartridge 10 times between your palms and turn it upside down 10 times until the suspension is evenly cloudy or milky white; do not shake vigorously (froth affects the dose). A small glass bead inside the cartridge helps mixing.
• Do not use the cartridge if it contains clumps or if solid white particles stick to the bottom or wall (a “frosted” look).
• The 3 mL cartridge is used only in a Lilly 3 mL pen (not in a 1.5 mL pen). Before each injection dial 1–2 units and, holding the needle upwards, prime until a drop of insulin appears at the needle tip.
• Insulin is injected under the skin (upper arm, thigh, buttock or abdomen); keep the needle in the skin for 5 seconds and do not rub the site.
• Rotate injection sites – each new one at least 1 cm from the last – to prevent lumps under the skin (lipodystrophy, cutaneous amyloidosis) and poor insulin action.
• Remove the needle after the injection; never add another insulin to the cartridge and do not reuse an empty cartridge.
• When switching from another insulin (e.g. of animal origin) the dose may be higher or lower and may change over several weeks or months.

Special patient groups

• Children and adolescents: according to the SmPC there are no specific data for this product, but published data indicate that human insulin can be used in children and adolescents; the dose is set by the doctor.
• Kidney or liver disease: tell your doctor – insulin needs may change, and worsening kidney or liver function increases the risk of hypoglycaemia.
• Illness, extra exercise, alcohol, travel across time zones: can change the dose and injection schedule you need – ask your doctor.

Contraindications – when the medicine must not be used

Do not use Humulin NPH:

• if you think hypoglycaemia (low blood sugar) is starting;
• if you are allergic to human insulin or to any of the excipients (except when used as part of a desensitisation programme, according to the SmPC).

According to the SmPC, apart from the soluble form (Humulin R), no other Humulin formulation, including Humulin NPH, may be given into a vein.

Warnings and precautions

• With well-controlled blood sugar, long-standing diabetes, neuropathy or beta-blockers, the early warning signs of a hypo may be weaker or different – frequent blood sugar testing is therefore important.
• Too little insulin or stopping treatment can lead to hyperglycaemia and diabetic ketoacidosis, which can be life-threatening.
• Heart failure has occurred in patients with long-standing type 2 diabetes and heart disease or previous stroke who used pioglitazone with insulin – contact your doctor if you notice unusual shortness of breath, rapid weight gain or swelling.
• Injecting into thickened or lumpy skin may weaken the effect of insulin; ask your doctor before changing injection areas.
• The medicine is essentially sodium-free (less than 1 mmol per dose).

Interactions with other medicines and alcohol

Your insulin needs may change if you take:

• steroid hormones (corticosteroids), thyroid hormone replacement, growth hormone, danazol;
• oral medicines for diabetes, acetylsalicylic acid (aspirin), MAO inhibitors (some antidepressants);
• beta2-sympathomimetics (e.g. salbutamol, terbutaline, ritodrine), beta-blockers, thiazide diuretics;
• some ACE inhibitors (e.g. captopril, enalapril) or angiotensin II receptor blockers;
• octreotide or lanreotide (may either increase or decrease insulin needs).

Alcohol affects blood sugar and may change the insulin dose you need.

Pregnancy and breast-feeding

Insulin needs usually fall during the first three months of pregnancy and rise during the remaining six. A pregnant woman using insulin must be well controlled throughout pregnancy. While breast-feeding, your insulin dose or diet may need adjusting. If you are pregnant, planning a pregnancy or breast-feeding, ask your doctor for advice.

Driving and using machines

During hypoglycaemia your ability to concentrate and react may be reduced. Talk to your doctor about driving if you have frequent hypos or if the warning signs are weak or absent.

Possible side effects

The most common side effect of insulin is hypoglycaemia (low blood sugar). The first signs usually come on quickly: tiredness, nervousness or shakiness, headache, fast heartbeat, nausea, cold sweat.

• common (up to 1 in 10): local allergy – redness, swelling or itching at the injection site, usually settling within a few days to a few weeks;
• uncommon (up to 1 in 100): lipodystrophy or lipohypertrophy – thinning or thickening of fatty tissue at the injection site;
• very rare (up to 1 in 10,000): generalised allergy – fall in blood pressure, rash all over the body, difficulty breathing, wheezing, fast heartbeat, sweating;
• frequency not known: cutaneous amyloidosis (lumps under the skin); oedema (swelling of the hands or ankles), especially at the start of treatment or when treatment is changed.

Overdose, missed dose and stopping treatment

• Too much insulin: your blood sugar may fall – check it. For a mild hypo take glucose tablets, sugar or a sweet drink, then fruit, biscuits or a sandwich, and rest. A more severe hypo is treated with glucagon (followed by glucose or sugar); if there is no response to glucagon, hospital treatment is needed.
• Missed or smaller dose: your blood sugar may rise – check it. Do not use a double dose.
• Stopping treatment: may lead to very high blood sugar; do not change or stop insulin without your doctor’s advice.
• Illness: you still need insulin even when you are not eating normally – check your blood sugar, follow your “sick day” rules and tell your doctor.

Related information

For home blood sugar self-monitoring, see also the category Blood glucose meters – products in this category do not replace the medicine prescribed to you.

Composition, pack and manufacturer

• Active substance: human insulin (rDNA) – 100 IU/mL; one 3 mL cartridge contains 300 IU of human isophane insulin (in suspension with protamine sulphate).
• Excipients: protamine sulphate; m-cresol; phenol; glycerol; disodium phosphate heptahydrate; zinc oxide; water for injections; sodium hydroxide or hydrochloric acid to adjust acidity.
• Appearance: white suspension that settles on standing (white sediment with colourless liquid above) and is quickly resuspended by gentle mixing.
• Pack: carton of 5 cartridges of 3 mL.
• Marketing authorisation holder: Predstavništvo Eli Lilly (Suisse) SA, Belgrade (Novi Beograd), Vladimira Popovića 38–40. Manufacturers: Lilly France, Fegersheim (France) and Eli Lilly Italia S.p.A., Sesto Fiorentino (Italy).

Storage

• Before first use: in a refrigerator at 2–8 °C; do not freeze.
• After first use: below 30 °C for up to 28 days; do not keep the pen with the cartridge in use in the fridge and do not expose it to heat or direct sunlight.
• Keep out of the sight and reach of children. The shelf life of the unopened medicine is printed on the pack (3 years according to the SmPC).
• Return unused medicine to a pharmacy that collects unwanted medicines.

Frequently asked questions

Does Humulin NPH need to be mixed before injection?

Yes. Roll the cartridge 10 times between your palms and turn it upside down 10 times until the suspension is evenly milky white. Vigorous shaking causes froth and can change the dose.

What is the difference between Humulin NPH and Humulin R?

Humulin NPH is an intermediate-acting insulin (a suspension with protamine sulphate) usually used as a basal insulin, whereas Humulin R is a fast-acting clear solution. Your doctor decides which insulin you need and in what combination.

Where should I keep the cartridge in use?

Below 30 °C for up to 28 days, out of the fridge and protected from heat and direct sunlight. Unopened cartridges are kept in the fridge at 2–8 °C.

What should I do if my blood sugar drops?

Take glucose tablets, sugar or a sweet drink, then fruit, biscuits or a sandwich, and rest. If you get worse, breathe quickly and shallowly and your skin turns pale, contact a doctor immediately.

Sources

• ALIMS – Summary of Product Characteristics, Humulin® NPH 100 IU/mL suspension for injection in cartridge (SmPC, Serbian)
• ALIMS – Package leaflet, Humulin® NPH 100 IU/mL suspension for injection in cartridge (PIL, Serbian)

Sources checked on: 25 October 2026.