Published Apr 27, 2014
I did a search for a question similar to mine; lots of clinical scenario questions, but none about prescribing per se.
I'm reviewing management of diabetics. Long story short, I do not understand how or why to use NPH. Long-acting insulins and oral agents provide more basal control and have little or no peak (detemir has a mild one). I also understand use of short and rapid-acting insulins; they can give you tight control of blood sugar based around meals and likely last only long enough to cover the post-prandial spike.
NPH, though, seems to offer no real advantage and actually seems more dangerous than anything. Given with meals, its onset isn't quick enough to do a great job with post-prandial sugar. And it peaks in eight hours, so giving it at night (a recommendation I'm finding repeatedly) would seem to pose a major nocturnal hypoglycemia danger.
My favorite medical reference considers it the least desirable insulin to use, preferring either long acting + oral regimens or long acting + short or rapid acting insulin regimens. Does anyone here use NPH? Why, and under what circumstances? What do you like about it?
ChristineN, BSN, RN
The pts I have seen on NPH always seem to be more non-compliant. Not sure if that factors into a providers decision, but it would be less injections and, hypothetically you could get away without a glucose check at lunch or bedtime (not saying ideal).
rachel0609, ADN, RN
I seem to see the same thing, don't know if there is a correlation.
SHGR, MSN, RN, CNS
The only reason to use NPH is for people who are uninsured or underinsured. NPH and regular are the least expensive insulin (last I priced them, they were just under $30 a vial). You are correct that these are not physiological in their onset/peak/duration. But they are better than nothing.
Because it is cheap and can get the job done.
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