NPH insulin

HUMULIN N

What it isIntermediate-acting insulin-receptor agonist suspension; basal treatment of diabetes.

Why this oneBy far the cheapest basal insulin, and its peak can be used deliberately to cover a midday meal or steroid-induced hyperglycemia.

What limits itThe 4 to 8 hour peak causes nocturnal hypoglycemia, and the suspension must be resuspended before every dose or the dose is wrong.

FDA-approved for

NO BOXED WARNINGS

Principal riskHypoglycemia, with a 4-8 hour peak

Cost, est. cash$35–$650/month

Generic entryLong generic

Therapeutic safety burden3 / 4

Overdose danger4 / 4

Weight-gain liability3 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent

Defining liabilityHypoglycemia can rapidly cause seizures, coma or death; dosing and meal mismatches are the principal hazard.