Insulatard: Uses, Dosage & Side Effects
An intermediate-acting human insulin (isophane/NPH) used for basal blood glucose control in type 1 and type 2 diabetes mellitus
Insulatard is an intermediate-acting human insulin preparation containing isophane insulin (also known as NPH insulin). Manufactured by Novo Nordisk using recombinant DNA technology, Insulatard is used to treat diabetes mellitus in adults, adolescents, and children who require insulin therapy. It provides basal (background) insulin coverage, with an onset of action around 1.5 hours after subcutaneous injection, a peak effect between 4 and 12 hours, and a total duration of action of up to 24 hours. Insulin is listed on the WHO Model List of Essential Medicines and is indispensable for the survival of all people with type 1 diabetes and many with type 2 diabetes.
Quick Facts: Insulatard
Key Takeaways
- Insulatard is an intermediate-acting human insulin (isophane/NPH) that provides basal blood glucose control for approximately 12–24 hours; it is a cornerstone therapy for people with type 1 diabetes and is widely used in type 2 diabetes.
- Hypoglycaemia (low blood sugar) is the most common side effect; patients must learn to recognise early symptoms such as sweating, trembling, hunger, and confusion, and always carry fast-acting glucose.
- The suspension must be gently rolled and inverted at least 20 times before each injection to ensure a uniform, milky-white appearance; failure to resuspend properly can lead to inconsistent dosing.
- Insulatard is injected subcutaneously only (never intravenously) and injection sites should be regularly rotated within the same body region to prevent lipodystrophy.
- Insulin is on the WHO Model List of Essential Medicines; Insulatard can be safely used during pregnancy and breastfeeding and is approved for use in children of all ages with diabetes.
What Is Insulatard and What Is It Used For?
Insulatard contains human insulin produced by recombinant DNA technology in Saccharomyces cerevisiae (baker’s yeast). The insulin is complexed with protamine to form isophane insulin crystals, also known as Neutral Protamine Hagedorn (NPH) insulin. This protamine complexation is the key feature that delays insulin absorption from the subcutaneous injection site, resulting in a slower onset of action and a prolonged duration of effect compared to regular (soluble) human insulin or rapid-acting insulin analogues.
After subcutaneous injection, Insulatard typically begins to lower blood glucose within approximately 1.5 hours. Its maximum blood-glucose-lowering effect (peak) occurs between 4 and 12 hours after injection, and the total duration of action extends up to approximately 24 hours. This pharmacokinetic profile makes Insulatard suitable as a basal insulin, providing background glucose control between meals and during sleep. However, it is important to understand that the time course of insulin action may vary considerably between individuals and even within the same person from day to day, partly depending on the injection site, injection technique, blood flow, temperature, and level of physical activity.
Insulatard is indicated for the treatment of diabetes mellitus in patients who require insulin. This includes:
- Type 1 diabetes mellitus: All people with type 1 diabetes require exogenous insulin for survival because their pancreas produces little or no insulin due to autoimmune destruction of the beta cells. Insulatard can serve as the basal component of a multiple daily injection (MDI) regimen, typically combined with rapid-acting insulin at mealtimes.
- Type 2 diabetes mellitus: When lifestyle measures (diet, exercise, and weight management) and oral antidiabetic medications are no longer sufficient to achieve adequate glycaemic control, basal insulin such as Insulatard may be added to the treatment regimen. It is often started as a single daily injection at bedtime, combined with existing oral therapies.
- Gestational diabetes: Insulatard can be used during pregnancy when dietary measures alone are insufficient. Insulin does not cross the placenta and is considered safe for both the mother and the developing foetus.
- Diabetes in children and adolescents: Insulatard is approved for use in children of all ages, and NPH insulin has a long track record of safety and efficacy in paediatric diabetes care.
From a global health perspective, insulin is included on the World Health Organization (WHO) Model List of Essential Medicines, reflecting its critical importance for the survival and well-being of hundreds of millions of people worldwide. According to the International Diabetes Federation (IDF) Diabetes Atlas, approximately 537 million adults (aged 20–79 years) were living with diabetes in 2021, a number projected to rise to 783 million by 2045. NPH insulin, including Insulatard, remains one of the most widely used insulin formulations globally, particularly in low- and middle-income countries where it offers a cost-effective option for basal insulin therapy.
Many people with type 1 diabetes use Insulatard as the basal component of a “basal-bolus” regimen. This involves one or two daily injections of Insulatard to cover background insulin needs, combined with rapid-acting insulin (such as insulin aspart, insulin lispro, or insulin glulisine) injected before each meal to manage the blood glucose rise after eating. This approach mimics the normal pattern of insulin secretion by a healthy pancreas.
What Should You Know Before Taking Insulatard?
Contraindications
There are specific situations where Insulatard must not be used. Understanding these absolute contraindications is critical for safe insulin therapy.
- Hypoglycaemia: Insulatard must never be administered when the patient is hypoglycaemic (blood glucose is already too low). Administering insulin during hypoglycaemia can cause severe, life-threatening hypoglycaemia with loss of consciousness, seizures, or death.
- Hypersensitivity: Do not use Insulatard if you have a known allergy (hypersensitivity) to human insulin, protamine sulphate, or any of the other ingredients in the product (metacresol, phenol, zinc chloride, glycerol, disodium phosphate dihydrate, sodium hydroxide, hydrochloric acid, protamine sulphate, or water for injection).
- Intravenous administration: Insulatard must never be administered intravenously. Its isophane (NPH) suspension formulation is designed exclusively for subcutaneous injection. Intravenous administration of a suspension can be dangerous.
- Insulin infusion pumps: Insulatard must not be used in insulin infusion pumps. Only clear, soluble insulin preparations are suitable for pump use.
Warnings and Precautions
Hypoglycaemia is the most frequent adverse effect of insulin therapy and can be life-threatening if severe. Symptoms include sweating, palpitations, tremor, hunger, confusion, drowsiness, difficulty speaking, visual disturbances, and in severe cases, loss of consciousness or seizures. Always carry a source of fast-acting carbohydrates (glucose tablets, fruit juice). Ensure that family members, caregivers, and close contacts know how to recognise and treat hypoglycaemia, including how to administer glucagon in an emergency.
Several important warnings and precautions apply to the use of Insulatard:
- Dose accuracy: Always check the insulin label before each injection to avoid medication errors. Confusion between different insulin products (e.g., accidentally injecting rapid-acting insulin instead of Insulatard, or vice versa) is a known cause of serious hypo- or hyperglycaemic events.
- Resuspension: Before each injection, the Insulatard pen or vial must be gently rolled between the palms and inverted (turned upside down and back) at least 20 times until the liquid appears uniformly white and cloudy. Do not use the insulin if it remains clear or if clumps, particles, or frosting are visible after resuspension.
- Injection site rotation: Injection sites should be rotated within the same anatomical area (abdomen, thigh, upper arm, or buttock) from one injection to the next to reduce the risk of lipodystrophy (abnormal thickening or thinning of fat tissue under the skin) and cutaneous amyloidosis. Injecting into areas of lipodystrophy or amyloidosis can lead to delayed insulin absorption and unpredictable blood glucose levels.
- Renal or hepatic impairment: Patients with kidney disease or liver disease may have reduced insulin requirements. Close blood glucose monitoring is essential, and dose adjustments should be made under medical supervision.
- Intercurrent illness: Illness, particularly infections with fever, may increase insulin requirements. Conversely, nausea, vomiting, and reduced food intake during illness may decrease insulin needs. Patients should never stop insulin entirely during illness (especially in type 1 diabetes) as this can lead to diabetic ketoacidosis (DKA), a life-threatening emergency.
- Transfer from other insulins: Switching from another type or brand of insulin to Insulatard may require a dose adjustment. This should always be done under medical supervision with increased blood glucose monitoring.
- Thiazolidinediones (glitazones): When used in combination with thiazolidinediones, insulin may increase the risk of heart failure. Patients should report symptoms such as unusual weight gain, swelling, or shortness of breath.
Pregnancy and Breastfeeding
Insulatard can be used during pregnancy. Insulin does not cross the placenta and does not cause harm to the developing foetus. Adequate glycaemic control is essential throughout pregnancy, as both hypoglycaemia and hyperglycaemia during pregnancy carry risks for the mother and baby. Insulin requirements typically decrease during the first trimester and increase during the second and third trimesters. After delivery, insulin requirements usually return rapidly to pre-pregnancy levels.
Insulin treatment during breastfeeding does not pose a risk to the nursing infant. Insulin is broken down in the gastrointestinal tract and is not absorbed in an active form by the infant. However, the mother’s insulin dose or diet may need adjustment during breastfeeding to maintain optimal blood glucose control.
Women who are pregnant or planning to become pregnant should work closely with their diabetes care team to optimise glycaemic control before and throughout pregnancy. Uncontrolled diabetes during pregnancy significantly increases the risk of congenital malformations, macrosomia (large baby), birth complications, neonatal hypoglycaemia, and pre-eclampsia.
How Does Insulatard Interact with Other Drugs?
Insulatard interacts with a wide range of medications. These interactions can either enhance (potentiate) the blood-glucose-lowering effect of insulin, increasing the risk of hypoglycaemia, or diminish it, potentially causing hyperglycaemia. Understanding these interactions is essential for safe and effective diabetes management. Whenever a new medication is started or stopped, blood glucose monitoring should be intensified, and insulin doses may need to be adjusted.
Drugs That May Increase the Hypoglycaemic Effect
The following medications may increase the blood-glucose-lowering effect of Insulatard, thereby increasing the risk of hypoglycaemia. When starting or increasing the dose of these medications, the Insulatard dose may need to be reduced:
| Drug / Drug Class | Mechanism | Clinical Significance |
|---|---|---|
| Oral antidiabetics (metformin, sulfonylureas, SGLT2 inhibitors) | Additive blood-glucose-lowering effect | High – frequent combination; monitor closely |
| GLP-1 receptor agonists (liraglutide, semaglutide) | Enhance insulin secretion and slow gastric emptying | High – insulin dose may need reduction |
| MAO inhibitors | May increase insulin sensitivity | Moderate – monitor blood glucose |
| ACE inhibitors (enalapril, ramipril, lisinopril) | May improve insulin sensitivity | Moderate – especially at initiation |
| Salicylates (high-dose aspirin) | Reduce hepatic glucose production | Moderate – at analgesic doses (>2 g/day) |
| Non-selective beta-blockers (propranolol) | May mask hypoglycaemic symptoms and delay recovery | High – prefer cardioselective beta-blockers |
| Alcohol | Inhibits hepatic gluconeogenesis | High – can cause prolonged, severe hypoglycaemia |
Drugs That May Decrease the Hypoglycaemic Effect
The following medications may reduce the blood-glucose-lowering effect of Insulatard, potentially leading to hyperglycaemia. When starting these medications, the Insulatard dose may need to be increased:
| Drug / Drug Class | Mechanism | Clinical Significance |
|---|---|---|
| Corticosteroids (prednisolone, dexamethasone) | Increase hepatic glucose production and reduce insulin sensitivity | High – significant dose adjustment often needed |
| Thyroid hormones (levothyroxine) | Increase glucose absorption and gluconeogenesis | Moderate – monitor when initiating or adjusting |
| Thiazide diuretics (hydrochlorothiazide) | Reduce insulin secretion and sensitivity | Moderate – dose-dependent effect |
| Sympathomimetics (salbutamol, terbutaline) | Stimulate glycogenolysis and gluconeogenesis | Moderate – especially systemic use |
| Growth hormone (somatotropin) | Counterregulatory hormone increasing glucose levels | Moderate – insulin dose may need increase |
| Oral contraceptives | May reduce insulin sensitivity | Low to moderate – monitor blood glucose |
| Danazol | Androgenic effects reducing glucose tolerance | Moderate – monitor blood glucose when starting |
Non-selective beta-blockers (such as propranolol) can mask the warning signs of hypoglycaemia, particularly tachycardia (fast heartbeat) and tremor, making it harder for patients to recognise low blood sugar. Cardioselective beta-blockers (such as metoprolol or bisoprolol) are generally preferred in patients with diabetes, though they may still partially mask symptoms at high doses. All patients taking beta-blockers with insulin should be counselled to rely on alternative hypoglycaemic warning signs such as sweating, hunger, and difficulty concentrating.
What Is the Correct Dosage of Insulatard?
Insulatard dosing is always individualised. The target blood glucose levels and the dosing schedule are determined by the healthcare provider in collaboration with the patient. Factors that influence the optimal dose include the type of diabetes, the patient’s body weight, blood glucose monitoring results, HbA1c levels, concomitant medications, dietary habits, physical activity levels, and the presence of other medical conditions. Insulin doses are measured in International Units (IU).
Adults
Type 2 Diabetes – Initiation of Basal Insulin
When adding Insulatard to oral antidiabetic therapy, a typical starting dose is 10 IU once daily at bedtime, or alternatively 0.1–0.2 IU/kg/day. The dose is then titrated (gradually increased) based on fasting blood glucose (FBG) measurements, typically by 2–4 IU every 3–7 days until the target FBG is achieved (usually 4.0–7.0 mmol/L or 70–130 mg/dL, depending on guidelines and individual targets).
Type 1 Diabetes – Basal-Bolus Regimen
Total daily insulin requirements in type 1 diabetes are typically 0.5–1.0 IU/kg/day (may be higher during puberty or illness). In a basal-bolus regimen, approximately 40–60% of the total daily dose is given as Insulatard (usually split into two injections: morning and bedtime), with the remaining 40–60% given as rapid-acting insulin before meals. The exact split depends on the individual’s glucose patterns and lifestyle.
Type 2 Diabetes – Twice-Daily Regimen
Some patients with type 2 diabetes may require twice-daily Insulatard (morning and bedtime) when once-daily dosing does not provide adequate 24-hour glucose control. The total daily dose is typically divided with approximately two-thirds in the morning and one-third at bedtime, though this ratio is adjusted based on individual blood glucose patterns.
Children and Adolescents
Paediatric Dosing
Insulatard is approved for use in children of all ages. Dosing in children follows the same principles as in adults, with weight-based dosing. Prepubertal children typically require 0.7–1.0 IU/kg/day total insulin, while adolescents during puberty may require higher doses of 1.0–2.0 IU/kg/day due to increased insulin resistance driven by growth hormones. Basal insulin (Insulatard) generally accounts for 40–60% of total daily insulin. Paediatric insulin dosing must be supervised by a specialist paediatric diabetes team.
Elderly Patients
Insulin therapy in elderly patients requires careful individualisation. Older adults may be at increased risk of hypoglycaemia, which can be particularly dangerous due to the risk of falls, cardiovascular events, and cognitive impairment. Glycaemic targets are typically less stringent in elderly patients (for example, an HbA1c target of 7.5–8.0% or 58–64 mmol/mol may be appropriate, rather than the standard target of less than 7.0%). Blood glucose monitoring should be performed frequently, and dose adjustments should be gradual.
Missed Dose
If you forget to inject your Insulatard dose, monitor your blood glucose as soon as you remember. Depending on the timing and your blood glucose reading, you may take a reduced dose or wait until the next scheduled injection. Never take a double dose to compensate for a missed injection. Prolonged omission of insulin, especially in type 1 diabetes, can rapidly lead to hyperglycaemia and diabetic ketoacidosis (DKA), a medical emergency. Contact your diabetes care team for advice if you are unsure how to manage a missed dose.
Overdose
An overdose of Insulatard causes hypoglycaemia, which can range from mild (treated with oral glucose or sugary food) to severe (requiring glucagon injection or intravenous glucose). Mild hypoglycaemia: Consume 15–20 grams of fast-acting carbohydrates (glucose tablets, fruit juice, regular fizzy drink) and recheck blood glucose after 15 minutes. Severe hypoglycaemia (unconsciousness, seizure, inability to swallow): Do not attempt to give food or drink by mouth. Administer glucagon (1 mg intramuscularly or subcutaneously) if available, and call emergency services immediately. Intravenous glucose may be required in a hospital setting. After recovery from severe hypoglycaemia, the patient should eat a carbohydrate-rich snack or meal to prevent recurrence.
What Are the Side Effects of Insulatard?
Like all medicines, Insulatard can cause side effects, although not everyone experiences them. The frequency and severity of side effects depend on the insulin dose, blood glucose control, injection technique, and individual patient factors. Hypoglycaemia is by far the most common adverse reaction and can occur if the insulin dose is too high relative to the patient’s insulin requirement, if meals are missed or delayed, or if physical activity is greater than usual.
The following side effects have been reported with Insulatard and other human insulin preparations, categorised by frequency according to international pharmacovigilance standards:
Very Common
- Hypoglycaemia (low blood sugar) – symptoms include sweating, trembling, hunger, palpitations, blurred vision, confusion, drowsiness, and in severe cases, loss of consciousness or seizures
Common
- Injection site reactions – redness, swelling, itching, pain, or bruising at the injection site
- Weight gain – a known effect of insulin therapy due to the anabolic effect of insulin and reduced glycosuria (loss of glucose in urine)
Uncommon
- Lipodystrophy – localised thickening (lipohypertrophy) or thinning (lipoatrophy) of fat tissue at injection sites, caused by repeated injection in the same area
- Oedema – fluid retention, particularly at the start of insulin therapy or after a significant improvement in blood glucose control (“insulin oedema”)
- Visual disturbances – temporary changes in vision, usually at the start of treatment, caused by changes in lens refraction as blood glucose levels normalise; this is usually transient and resolves without treatment
Rare
- Peripheral neuropathy – painful neuropathy may occasionally occur with rapid improvement of blood glucose control (“treatment-induced neuropathy of diabetes”); this is usually temporary
- Generalised allergic reactions – urticaria (hives), rash, or anaphylactic reactions (very rare; symptoms may include widespread skin rash, itching, swelling of face/lips/tongue, difficulty breathing, rapid heartbeat, and drop in blood pressure)
Very Rare / Unknown Frequency
- Cutaneous amyloidosis – a skin condition caused by repeated insulin injection at the same site, leading to lumps under the skin that can affect insulin absorption
- Insulin antibody formation – development of antibodies to human insulin, which rarely has clinical significance with modern human insulin preparations
If you experience any troublesome or persistent side effects, or any symptoms that concern you, contact your healthcare provider. Serious side effects such as severe hypoglycaemia or signs of an allergic reaction require immediate medical attention.
Lipodystrophy is preventable. Always rotate your injection sites within the same body region, using a different spot for each injection. Avoid injecting into lumps, hardened areas, or areas with visible skin changes. Using a new needle for each injection also helps reduce the risk. If you notice any lumps or indentations at injection sites, inform your diabetes care team, as injecting into affected areas can lead to erratic insulin absorption and unstable blood glucose control.
How Should You Store Insulatard?
Correct storage of insulin is essential to maintain its effectiveness and safety. Improperly stored insulin may lose potency, leading to poor blood glucose control. The following storage guidelines apply to Insulatard:
- Before opening (not in use): Store in the refrigerator at 2–8°C (36–46°F). Keep away from the freezer compartment. Do not freeze insulin, and do not use Insulatard if it has been frozen, as freezing destroys the insulin crystals and alters the product.
- After opening (in use): Insulatard that is currently being used can be kept at room temperature (below 25°C / 77°F) or in the refrigerator for up to 6 weeks (42 days). Do not refrigerate and then bring back to room temperature repeatedly.
- Protect from light and heat: Keep insulin away from direct sunlight, radiators, and other heat sources. Never leave insulin in a car (especially during hot weather) or in checked luggage during air travel (cargo holds can reach freezing temperatures).
- Storage of pens and cartridges: When using the Insulatard FlexPen or Penfill cartridge, do not store the pen or cartridge with the needle attached. Removing the needle after each injection prevents air entry into the cartridge, leakage, and contamination.
- Appearance check: Before each injection, inspect the Insulatard suspension after resuspension. It should appear uniformly white and cloudy. Do not use if it appears clear, contains visible clumps, flakes, or particles that remain after gentle mixing, or if it appears frosted or discoloured.
- Expiry date: Do not use Insulatard after the expiry date printed on the label and carton. The expiry date refers to the last day of the stated month.
- Disposal: Do not dispose of insulin in household waste. Ask your pharmacist about safe disposal of used needles (in a sharps container) and unused medicines in accordance with local regulations.
When travelling, carry your insulin in your hand luggage (not in checked bags) in an insulated case or cool bag. Do not place insulin directly against ice packs, as direct contact with ice can freeze and damage the product. If travelling to hot climates, use a specialised insulin cooling wallet or pouch. Always carry a letter from your healthcare provider confirming your need for insulin and injection supplies, especially when flying.
What Does Insulatard Contain?
Each millilitre of Insulatard 100 IU/ml contains 100 International Units (equivalent to 3.5 mg) of human insulin. The insulin is produced using recombinant DNA technology, with Saccharomyces cerevisiae (baker’s yeast) as the host organism. This means no animal-derived insulin is used, making it suitable for patients who prefer biosynthetic human insulin for religious, ethical, or medical reasons.
The complete list of excipients (inactive ingredients) in Insulatard includes:
- Protamine sulphate: Forms the crystalline complex with insulin that produces the intermediate-acting absorption profile. Protamine is derived from fish sperm. Patients with fish allergy should discuss this with their healthcare provider, although clinically significant allergic reactions to protamine in insulin preparations are very rare.
- Zinc chloride: Stabilises the insulin-protamine crystals and supports the hexameric structure of insulin in solution.
- Glycerol: Used as a tonicity agent to make the solution isotonic (compatible with body tissues).
- Metacresol and phenol: Act as preservatives to prevent microbial growth in the multi-dose vials, cartridges, and pre-filled pens.
- Disodium phosphate dihydrate: A buffering agent that helps maintain the pH of the suspension.
- Sodium hydroxide and hydrochloric acid: Used for pH adjustment during manufacture.
- Water for injection: The solvent in which all other components are suspended.
Insulatard is available in several presentation forms:
- Insulatard Penfill: 3 ml cartridges containing 100 IU/ml, for use in Novo Nordisk insulin delivery devices.
- Insulatard FlexPen: Pre-filled, disposable injection pens containing 3 ml of Insulatard 100 IU/ml (300 IU total per pen). The FlexPen delivers doses from 1 to 60 IU in increments of 1 IU.
- Insulatard InnoLet: Pre-filled pen designed for ease of use, with large dose display and audible clicks.
- Insulatard vials: 10 ml vials containing 100 IU/ml (1,000 IU total), for use with insulin syringes. A 40 IU/ml concentration is also available in some markets.
The marketing authorisation holder for Insulatard is Novo Nordisk A/S, Bagsværd, Denmark. Novo Nordisk has been manufacturing insulin since 1923 and is one of the world’s largest producers of insulin products.
How Should You Inject Insulatard?
Proper injection technique is essential for consistent insulin delivery and optimal blood glucose control. Insulatard is a suspension and requires gentle mixing before each use, unlike clear insulin solutions. Follow these steps for correct injection:
- Wash your hands thoroughly with soap and water before handling your insulin pen, vial, or syringe.
- Resuspend the insulin: Gently roll the pen or vial between your palms 20 times, then invert it (turn upside down and back) at least 20 times. The insulin should appear uniformly milky-white and cloudy. Do not shake vigorously, as this can cause frothing and inaccurate dosing.
- Check the insulin: After resuspension, inspect the liquid. Do not use it if it remains clear, contains visible clumps, or appears discoloured. If using a new pen, perform an air shot (prime) by dialling 2 units and pressing the injection button with the needle pointing upward until a drop of insulin appears at the needle tip.
- Attach a new needle: Use a new needle for each injection. Remove the outer and inner needle caps.
- Select your dose: Dial the prescribed number of units on the pen’s dose selector.
- Choose an injection site: Insulatard can be injected into the thigh, the abdominal wall (at least 5 cm from the navel), the upper outer arm (deltoid region), or the buttock (gluteal region). The rate of absorption may vary by site: generally fastest from the abdomen and slowest from the thigh or buttock. For consistency, many clinicians recommend using the same body region at the same time of day (e.g., always thigh at bedtime).
- Inject: Pinch a fold of skin (unless using a very short needle, typically 4–5 mm) and insert the needle at a 90-degree angle. Press the injection button fully and hold the pen in place for at least 6 seconds (10 seconds if using a syringe or high dose) before withdrawing the needle to ensure the full dose is delivered.
- Dispose of the needle: Remove and safely dispose of the needle in a sharps container after each injection. Never re-use needles.
Rotate your injection site within the same body region with each injection to reduce the risk of lipodystrophy and cutaneous amyloidosis. For example, if you inject into your left thigh at bedtime, move to a different spot on your left thigh (at least 1–2 cm apart) with the next injection. Regularly check your injection sites for lumps, indentations, or skin changes, and report any abnormalities to your diabetes team.
Frequently Asked Questions About Insulatard
Insulatard (NPH insulin) is an intermediate-acting human insulin with a pronounced peak effect between 4 and 12 hours after injection and a duration of up to 24 hours. Long-acting insulin analogues such as insulin glargine (Lantus, Toujeo) and insulin detemir (Levemir) have a flatter, more prolonged action profile with less peak effect, resulting in a lower risk of nocturnal hypoglycaemia in some patients. However, Insulatard remains widely used worldwide, is less expensive, and is effective for many patients. The choice between NPH insulin and long-acting analogues depends on individual patient factors, glycaemic targets, hypoglycaemia risk, cost, and availability.
Yes, Insulatard can be mixed with rapid-acting (insulin aspart, insulin lispro) or short-acting (regular/soluble human insulin) insulin when using vials and syringes. When mixing, always draw the clear (rapid-acting or short-acting) insulin into the syringe first, then draw the cloudy (Insulatard) insulin. This prevents contamination of the rapid-acting insulin vial with protamine, which could alter its action profile. Inject the mixture immediately after mixing. Pre-filled pens and cartridges must never be used for mixing.
Weight gain is a common side effect of insulin therapy, including Insulatard. Insulin promotes glucose uptake into cells and reduces the loss of glucose through the urine, which can lead to increased calorie retention. Additionally, patients who have had poorly controlled diabetes may gain weight as their blood sugar improves because calories that were previously lost in the urine are now being stored. To minimise weight gain, your healthcare team may advise dietary adjustments, regular physical activity, and careful dose titration. In type 2 diabetes, combining insulin with metformin (which is weight-neutral) or a GLP-1 receptor agonist (which may promote weight loss) can help offset insulin-related weight gain.
After gently rolling and inverting the pen or vial at least 20 times, Insulatard should appear uniformly white and cloudy. If the suspension remains clear, or if you can see white clumps, particles, flakes, or a frosted appearance that does not disappear after gentle mixing, do not use that cartridge, pen, or vial. These changes indicate that the insulin has been damaged (possibly by freezing, excessive heat, or vigorous shaking) and may not work correctly. Dispose of the damaged product and use a new one. Always store insulin according to the recommended guidelines to prevent damage.
Yes, Insulatard is considered safe during pregnancy. Human insulin does not cross the placenta and does not cause harm to the developing baby. Maintaining good blood glucose control during pregnancy is essential, as uncontrolled diabetes increases the risk of birth defects, macrosomia (large baby), pre-eclampsia, and neonatal complications. Insulin requirements change throughout pregnancy: they typically decrease in the first trimester, increase during the second and third trimesters, and drop rapidly after delivery. Pregnant women with diabetes should have frequent blood glucose monitoring and regular contact with their diabetes care team. NPH insulin (including Insulatard) has extensive clinical experience and a long safety track record in pregnancy.
Alcohol can have unpredictable effects on blood glucose and insulin therapy. Moderate amounts of alcohol may initially raise blood sugar (particularly if the drinks contain carbohydrates), but alcohol also inhibits hepatic gluconeogenesis (the liver’s ability to produce glucose), which can cause delayed and prolonged hypoglycaemia, sometimes occurring several hours after drinking. This risk is especially high if alcohol is consumed without food or after exercise. If you choose to drink alcohol, do so in moderation, always with food, and monitor your blood glucose more frequently. Never substitute alcohol for a meal, and be aware that others may mistake symptoms of hypoglycaemia for intoxication.
References
This article is based on the following international medical guidelines and peer-reviewed sources:
- European Medicines Agency (EMA). Insulatard – Summary of Product Characteristics. Last updated 2024. Available at: www.ema.europa.eu
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Geneva: WHO; 2023.
- American Diabetes Association (ADA). Standards of Care in Diabetes – 2024. Diabetes Care. 2024;47(Suppl 1):S1–S321.
- International Diabetes Federation (IDF). IDF Diabetes Atlas, 10th Edition. Brussels: IDF; 2021. Available at: diabetesatlas.org
- National Institute for Health and Care Excellence (NICE). Type 1 diabetes in adults: diagnosis and management (NG17). Updated 2022. Available at: www.nice.org.uk/guidance/ng17
- National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management (NG28). Updated 2022. Available at: www.nice.org.uk/guidance/ng28
- Holman RR, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357(17):1716–1730. doi: 10.1056/NEJMoa075392
- Heller S, et al. Hypoglycaemia in patient with type 2 diabetes treated with insulin: it can happen. BMJ Open Diabetes Res Care. 2020;8(1):e001194.
- Blumer I, et al. Diabetes and pregnancy: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227–4249.
- Novo Nordisk. Insulatard – Prescribing Information / Patient Information Leaflet. Bagsværd, Denmark.
Editorial Team
This article has been researched, written, and medically reviewed by the iMedic Medical Editorial Team, which includes licensed specialists in endocrinology, diabetology, and clinical pharmacology.
Content researched and written by medical professionals with expertise in diabetes care and pharmacology. Based on current international guidelines (ADA, EMA, NICE, WHO) and peer-reviewed literature.
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