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Ronulin N®

Patient Details

Ronulin N®

Generic Name: Insulin Isophane (NPH Insulin)
Dosage Form: 10 ml Injectable Suspension (100 IU per ml)
Pharmacological Class: Intermediate-acting insulin

Indications:

Ronulin N® is used for the control of blood sugar levels in patients with diabetes.

Description:

Ronulin N® (Insulin Isophane or NPH insulin) is an intermediate-acting insulin with a delayed onset of action compared to regular insulin, but its effect lasts longer (up to 24 hours).

Indications for Use:

  • Type 1 Diabetes
  • Type 2 Diabetes
  • Gestational Diabetes

Dosage Form:

  • Vial containing 10 ml of injectable suspension (100 IU per ml)

Preparation of Ronulin N®

Ronulin N®is a ready-to-inject suspension and does not require preparation.

  • It is recommended to remove the vial from the refrigerator 30 minutes before injection, allowing it to reach room temperature (20–25°C) before use.
  • This insulin should only be mixed with Ronulin N®. When mixing, first draw Ronulin N®into the syringe, then mix it with Ronulin N® and inject immediately.

Dosage and Injection Method:

  • Ronulin N® is administered subcutaneously (under the skin). It should not be used intravenously or intramuscularly.
  • For subcutaneous injection, choose the following sites: around the navel (at least 5 cm away from it), the upper thigh, or the upper arm. To reduce the risk of injection site reactions, rotate the injection sites daily.
  • The dose of Ronulin N® depends on the injection site, metabolism, food intake, physical activity, and blood sugar levels of the patient.

Preparation for injection:

  1. Wash and dry your hands.
  2. Disinfect the injection site with an alcohol swab and allow it to dry.
  3. Sit on a chair or lie down on a bed for better control over the injection site.
  4. Remove the plastic cap from the vial and wipe it with an alcohol swab.
  5. Draw air into the syringe by pulling back the plunger to the required dose.
  6. Insert the needle into the vial of Ronulin N®, inject the air into the vial, then withdraw the syringe. Ensure the needle does not touch the vial contents.
  7. Gently shake the vial.
  8. Hold the vial upside down and withdraw the required dose into the syringe.
  9. Before removing the syringe from the vial, ensure there are no air bubbles. If there are bubbles, tap the syringe so the air rises to the top, then push the plunger to expel the bubbles and readjust the dose.
  10. Pinch the skin at the injection site to form a bulge, then insert the needle at a 90° angle (45° for thin patients). Ensure the entire needle is in the skin.
  11. Press the plunger to inject the insulin, and do not release the skin until the injection is complete.
  12. After injecting, remove the needle from the skin and dispose of the syringe properly.

Mixing Ronulin N® and Ronulin N®:

  1. Draw air into the syringe for the required dose of Ronulin N®.
  2. Insert the needle into the Ronulin N® vial, inject air into the vial, and remove the needle. Be careful not to contaminate the needle.
  3. As in the previous step, draw air into the syringe for the required dose of Ronulin N®.
  4. Insert the needle into the Ronulin N®vial, inject air, but do not remove the needle.
  5. Invert the Ronulin N® vial and syringe.
  6. Draw the correct dose of Ronulin N® into the syringe.
  7. Ensure no air bubbles are in the syringe before removing the needle. If necessary, expel the air and adjust the dose.
  8. Reinsert the needle into the Ronulin N® vial, invert both the vial and syringe, and draw the required dose of Ronulin N®.
  9. Remove the needle, cover it with the protective cap, and proceed with the injection as described above.

Note: Never return insulin left in the syringe back to the vial after injection.
Each syringe and needle is for single-use only. Dispose of them properly after use.

Missed Dose:

If you miss a dose of Ronulin N®, consult your doctor or pharmacist for advice.

Overdose:

If you use more than the prescribed dose, contact your doctor immediately.
Overdose can lead to hypoglycemia (low blood sugar). Mild episodes can be treated with oral glucose. For more severe hypoglycemia, it may result in coma, seizures, or neurological disturbances.

Monitoring During Treatment:

During treatment with Ronulin N®, the following parameters should be monitored:

  • Blood glucose levels and HbA1c
  • Electrolyte levels (especially potassium)
  • Liver and kidney function
  • Patient's weight

Contraindications:

  • Allergy to NPH insulin or any components of the formulation.
  • During episodes of hypoglycemia.

Warnings and Precautions:

  • Using insufficient doses or stopping treatment, especially in insulin-dependent diabetic patients, may lead to life-threatening conditions like hyperglycemia (high blood sugar) or diabetic ketoacidosis.
  • Adjustments in insulin doses are necessary if there are changes in body weight or if weight loss surgery is performed.
  • If allergic reactions occur (e.g., redness, swelling, rashes, blisters, hives, itching, wheezing, tightness in the chest or throat, difficulty breathing, or swelling of the mouth, face, lips, tongue, or throat), seek medical attention immediately.
  • If symptoms of low potassium occur (e.g., muscle pain, weakness, cramps, or abnormal heart rhythm), contact your doctor.
  • Ronulin N® should be used with caution in patients with liver or kidney failure.

Use in Pregnancy and Breastfeeding:

  • Insulin should be used during pregnancy and breastfeeding under medical supervision. Due to physiological changes in pregnancy, insulin doses may need to be adjusted throughout the term.
  • Insulin is excreted in breast milk. During breastfeeding, insulin doses or diet may need to be adjusted.
  • The decision to breastfeed during treatment should consider the potential risk to the baby, the benefits of breastfeeding, and the advantages of treatment for the mother.

Side Effects:

While Ronulin N® is effective for controlling blood sugar, it may cause some side effects in some individuals. These include:

  • Weight gain
  • Injection site reactions
  • Peripheral edema (swelling)

Drug Interactions:

Consult your doctor or pharmacist about possible interactions with other medications or supplements.

Packaging:

Each package contains 1 vial of Ronolin N®.

Storage Conditions:

  • Store Ronolin N® in the refrigerator (2 to 8°C), away from light and moisture, and protect it from freezing.
  • Do not use the product after the expiration date.
  • Keep out of reach of children.
  • Keep the medication in its original packaging until use.

References:

  1. Insulin NPH: Drug information, UpToDate 2025
  2. Medicines.org.uk
Ronulin N®
Prescribing Information