Insulin Aspart / Insulin Aspart Protamine Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Diabetes Type 1

Insulin aspart is a short acting insulin with a rapid onset and should be given immediately before meals. 50 to 70% of the daily insulin requirement may be provided by aspart and the remainder by an intermediate or long-acting insulin.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen: The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1 to 2 injections. Twice daily injections are preferred for better glycemic control. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal.

Intensive regimen: The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. The basal requirement is approximately 30 to 50% of the total dose, given as intermediate or long-acting insulin (NPH, zinc, extended zinc, lispro-protamine, glargine), 1 to 2 times daily. Meal boluses are approximately 50 to 70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2 to 5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.

Total daily insulin requirements:
Initial dose: 0.5 to 0.8 unit/kg/day subcutaneously
Honeymoon phase: 0.2 to 0.5 unit/kg/day subcutaneously
Split dose therapy: 0.5 to 1.2 unit/kg/day subcutaneously
Insulin resistance: 0.7 to 2.5 units/kg/day subcutaneously

Usual Adult Dose for Diabetes Type 2

Insulin aspart is a short acting insulin with a rapid onset and should be given immediately before meals. 50 to 70% of the daily insulin requirement may be provided by aspart and the remainder by an intermediate or long-acting insulin.

Diet and lifestyle modifications are recommended as initial treatment for type II diabetes, followed by oral agents. Insulin may be considered if patients are very hyperglycemic or symptomatic and/or not controlled with oral agents. Insulin may exacerbate obesity, further increase insulin resistance, and increase the frequency of hypoglycemia.

Insulin dosage should be individualized to achieve/maintain a target blood glucose level and is determined by various factors including body weight, body fat, physical activity, insulin sensitivity, blood glucose levels, and target blood glucose.

Conventional regimen:
Initial dose, monotherapy: Total insulin requirement: 0.1 unit/kg/day. When insulin is used alone, twice daily injections are recommended for better glycemic control. The total daily insulin dose is administered as a mixture of rapid/short-acting and intermediate-acting insulins in 1 to 2 injections. With the 2-injection regimen, generally two-thirds of the daily dose is given before breakfast and one-third is given before the evening meal. Once daily injections are sometimes used in children with suboptimal compliance; however, this may lead to more nocturia, fasting hyperglycemia, morning glucosuria, and a risk of ketoacidosis if the doses are missed.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 1.5 to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Intensive regimen:
The necessity for and efficacy of intensive insulin therapy in type II diabetes has been controversial. The total daily dose is administered as 3 or more injections or by continuous subcutaneous infusion to cover basal and pre-meal bolus insulin requirements. This method may be appropriate for closely supervised and highly motivated older children or adolescents who are able to inject their insulin, monitor their blood glucose, and recognize hypoglycemia. The basal requirement is approximately 30 to 50% of the total dose, given as intermediate or long-acting insulin (NPH,zinc, extended zinc, lispro-protamine, glargine), 1 to 2 times daily. Meal boluses are approximately 50 to 70% of the total dose, given as rapid/short-acting insulin (regular, aspart, lispro) 2 to 5 times daily before meals. Common regimens include injections of rapid/short acting insulin before each meal along with injections of intermediate or long-acting insulin in the morning and/or evening. Dosage adjustments are made to achieve target blood glucose levels and are based on frequent blood glucose measurements, diet and exercise levels.
Initial dose, monotherapy: 0.5 to 1.5 unit/kg/day subcutaneously.
Maintenance dose, monotherapy: Total daily insulin requirements may progress to 2.5 units/kg or higher in patients with obesity and insulin resistance.

Renal Dose Adjustments

Decreased dosage may be required. Careful blood glucose monitoring and dose adjustment are recommended.

Liver Dose Adjustments

Decreased dosage may be required. Careful blood glucose monitoring and dose adjustment are recommended.

Dose Adjustments

Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery, and lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects. Total daily doses should not be adjusted by more than 10% increments.

Supplemental doses may be prescribed during illness or to correct high preprandial blood glucose.

Dosage adjustments may be required when the brand, type, or species of insulin is changed.

Precautions

May be mixed with insulin isophane (NPH), but should be injected immediately. Insulin aspart should be drawn up in to the syringe first. Do not give mixtures IV.

Do not mix with zinc insulins.

Do not mix with any other insulins or diluents when using insulin aspart in subcutaneous insulin infusion pumps.

Subcutaneous insulin infusion pumps: Recommended for use in Disetronic H-Tron(R) plus V100 with Disetronic 3.15 cartridges and Classic or Tender infusion sets; MiniMed Models 505, 506, or 507 with MiniMed 3 mL syringes and Polyfin (R) or Sof-set(R) infusion sets. Replace insulin in reservoir, infusion set, and change infusion site at least every 48 hours.

Discard insulin if exposed to temperatures higher than 98.6 degrees F (37 degrees C). Note: temperature of insulin in pump may exceed ambient temperature when exposed to sunlight or radiant heat.

Patients should be educated on how to recognize symptoms of acidosis and hypoglycemia and what to do if they occur.

Intensive insulin therapy and subcutaneous insulin pumps should be avoided in patients who are unable to comply with frequent blood glucose testing and injection requirements, and those who are prone to developing severe hypoglycemia or in whom hypoglycemia could be potentially fatal, e.g., adrenal insufficiency, pituitary insufficiency, counterregulatory insufficiency, autonomic insufficiency, concurrent use of beta adrenergic blocking agents, coronary or cerebral vascular disease, or potentially noncompliant patients (alcohol or drug abuse or psychiatric disorders).

Dialysis

Data not available

Other Comments

At least twice weekly blood glucose monitoring is recommended for type I and II diabetes on conventional insulin therapy. Blood glucose is measured 3 or more times daily before meals during intensive insulin regimens. More frequent monitoring is necessary during illness or stress.

Urine ketone testing is recommended for patients with type I diabetes if they develop symptoms of colds, influenza, nausea, vomiting, or other illnesses, polyuria, or if blood glucose levels are unexpectedly high or inconsistent.

Glycosylated hemoglobin measurements are recommended every 3 months.

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