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insulin aspart

Pronunciation

Generic Name: insulin aspart (IN su lin AS part)
Brand Name: NovoLOG, NovoLOG FlexPen, NovoLOG PenFill, NovoLOG FlexTouch

What is insulin aspart?

Insulin aspart is a fast-acting form of insulin that works by lowering levels of glucose (sugar) in the blood.

Insulin aspart is used to improve blood sugar control in adults and children who are at least 2 years old.

Insulin aspart may also be used for purposes not listed in this medication guide.

What is the most important information I should know about insulin aspart?

You should not use this medicine if you are having an episode of hypoglycemia (low blood sugar).

What should I discuss with my healthcare provider before using insulin aspart?

You should not use this medicine if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar).

To make sure insulin aspart is safe for you, tell your doctor if you have:

  • liver or kidney disease; or

  • if you take any oral (taken by mouth) diabetes medicine.

Insulin aspart is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether insulin aspart passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Insulin aspart is not approved for use by anyone younger than 2 years old. This medicine is not for use in children with type 2 diabetes.

How should I use insulin aspart?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Insulin aspart is given as an injection (shot) under your skin, using a needle and syringe or an insulin pump. You will be shown how to use injections at home. Do not self inject this medicine if you do not understand how to give the injection and properly dispose of used needles and syringes.

Insulin aspart is a fast-acting medicine that begins to work very quickly. After using insulin aspart, you should eat a meal within 5 to 10 minutes.

Choose a different place in your injection skin area each time you use this medication. Do not inject into the same place two times in a row.

If you use this medicine with an insulin pump, do not mix or dilute insulin aspart with any other insulin. Infusion pump tubing, catheters, and the needle location on your skin should be changed every 3 days. Change the medicine in the reservoir every 6 days.

Never share an injection pen or cartridge with another person. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another.

Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, confusion, irritability, dizziness, or feeling shaky. Always keep a source of sugar with you in case you have low blood sugar. Sugar sources include fruit juice, hard candy, crackers, raisins, and non-diet soda. Be sure your family and close friends know how to help you in an emergency.

If you have severe hypoglycemia and cannot eat or drink, use a glucagon injection. Your doctor can prescribe a glucagon emergency injection kit and tell you how to use it.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, and weight loss.

Check your blood sugar carefully during times of stress, travel, illness, surgery or medical emergency, vigorous exercise, or if you drink alcohol or skip meals. These things can affect your glucose levels and your dose needs may also change. Do not change your medication dose or schedule without your doctor's advice.

Insulin aspart is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Do not freeze insulin or expose it to high heat or bright light. Do not use any insulin that has been frozen or has been in temperatures above 98 degrees F.

Storing unopened insulin aspart in a refrigerator: Store in the original carton and do not freeze. Throw away unopened insulin if the expiration date on the label has passed.

Storing unopened insulin aspart at room temperature: Store in the original carton. Throw away unopened insulin if not used within 28 days.

Storing "in-use" vials: After first use, store the vial in a refrigerator or at room temperature. Use within 28 days.

Storing "in-use" cartridges or injection pens: After first use, store the cartridge or pen at room temperature. Do not refrigerate. Use within 28 days.

What happens if I miss a dose?

Since insulin aspart is used before meals, you may not be on a timed dosing schedule. Whenever you use insulin aspart, be sure to eat a meal within 5 to 10 minutes. Do not use extra insulin aspart to make up a missed dose.

It is important to keep insulin aspart on hand at all times. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An insulin overdose can cause life-threatening hypoglycemia.

Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, seizure (convulsions), or coma.

What should I avoid while using insulin aspart?

Do not change the brand of insulin aspart or syringe you are using without first talking to your doctor or pharmacist.

Avoid drinking alcohol. It can lower your blood sugar while using insulin aspart.

Insulin aspart side effects

Get emergency medical help if you have signs of insulin allergy: itching skin rash over the entire body, wheezing, trouble breathing, fast heart rate, sweating, or feeling like you might pass out.

Call your doctor if you have a serious side effect such as:

  • swelling in your hands or feet; or

  • low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling.

Common side effects may include low blood sugar (headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Insulin aspart dosing information

Usual Adult Dose for Diabetes Type 1:

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day; 50% to 70% of total daily requirements are generally provided by prandial insulin with the remainder provided by intermediate-acting or long-acting basal insulin
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges

Multiple-daily injection (MDI):
-Administer subcutaneously immediately before a meal (within 5 to 10 minutes) or soon after the start of a meal
-Match prandial insulin dose to carbohydrate intake, pre-meal blood glucose, and anticipated activity
-Use in combination with an intermediate-acting or long-acting basal insulin

Continuous Subcutaneous Infusion (Insulin Pump)
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure the pump has been evaluated with this insulin
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion

Intravenous Administration
-Dilute to a concentration of 0.05 to 1 unit/mL in normal saline in an infusion system using polypropylene infusion bags; closely monitor blood glucose and serum potassium during administration

Use: To improve glycemic control in adult patients with diabetes mellitus.

Usual Adult Dose for Diabetes Type 2:

Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges.

Prandial Insulin:
-Administer subcutaneously immediately before a meal (within 5 to 10 minutes) or soon after the start of a meal
-Use in combination with an intermediate-acting or long-acting basal insulin and/or with other anti-diabetic agents.

Continuous Subcutaneous Infusion (Insulin Pump)
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure the pump has been evaluated with this insulin
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion

Intravenous Administration
-Dilute to a concentration of 0.05 to 1 unit/mL in normal saline in an infusion system using polypropylene infusion bags; closely monitor blood glucose and serum potassium during administration

Use: To improve glycemic control in patients with diabetes mellitus.

Usual Adult Dose for Diabetic Ketoacidosis:

Successful treatment of hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar state (HHS) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management.

Intravenous:
-IV insulin infusion is generally started 1 to 2 hours after initiating fluid replacement therapy
-Dose: 0.14 unit/kg/hour IV; alternatively, a bolus of 0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr has been used
-If blood glucose has not fallen by 10% in first hour, give bolus of 0.14 units/kg while continuing insulin infusion.

DKA: When blood glucose concentration reaches 200 mg/dL, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain a blood glucose between 150 and 200 mg/dL until resolution of DKA (serum bicarbonate level 15 mEq/L or greater, venous pH greater than 7.3, and a calculated anion gap in the normal range)

HHS: When blood glucose concentration reaches 300 mg/dL or less, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain blood glucose between 250 and 300 mg/dL until resolution of HHS.

Subcutaneous:
-Rapid acting insulin analogs (lispro, aspart, and glulisine) have been used in studies for the treatment of uncomplicated mild to moderate DKA. The following regimens have been used:
-Initial dose of 0.2 unit/kg followed by 0.1 unit/kg every hour subcutaneously until blood glucose decreased below 250 mg/dL, then 0.05 unit/kg every hour until DKA resolved
-Initial dose of 0.3 units/kg followed by 0.2 unit/kg every 2 hours until blood glucose decreased below 250 mg/dL, then 0.1 unit/kg every 2 hours until DKA resolved

Comments:
-An endocrinologist or critical care specialist with training and expertise in the management of DKA or HHS should direct care; frequent monitoring of clinical and laboratory parameter is necessary as well as identification and correction of precipitating event.
-Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema.
-To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning.

Use: Treatment of hyperglycemic emergencies.

Usual Adult Dose for Nonketotic Hyperosmolar Syndrome:

Successful treatment of hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar state (HHS) requires frequent monitoring of clinical and laboratory parameters while carefully correcting volume deficits, managing electrolytes, and normalizing blood glucose. Insulin therapy is used to slowly correct high glucose levels; consult current treatment protocols for specific guidance on fluid and electrolyte management.

Intravenous:
-IV insulin infusion is generally started 1 to 2 hours after initiating fluid replacement therapy
-Dose: 0.14 unit/kg/hour IV; alternatively, a bolus of 0.1 unit/kg followed by an infusion of 0.1 unit/kg/hr has been used
-If blood glucose has not fallen by 10% in first hour, give bolus of 0.14 units/kg while continuing insulin infusion.

DKA: When blood glucose concentration reaches 200 mg/dL, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain a blood glucose between 150 and 200 mg/dL until resolution of DKA (serum bicarbonate level 15 mEq/L or greater, venous pH greater than 7.3, and a calculated anion gap in the normal range)

HHS: When blood glucose concentration reaches 300 mg/dL or less, decrease the insulin infusion to 0.02 to 0.05 unit/kg/hr; dextrose should be added to the IV fluids to maintain blood glucose between 250 and 300 mg/dL until resolution of HHS.

Subcutaneous:
-Rapid acting insulin analogs (lispro, aspart, and glulisine) have been used in studies for the treatment of uncomplicated mild to moderate DKA. The following regimens have been used:
-Initial dose of 0.2 unit/kg followed by 0.1 unit/kg every hour subcutaneously until blood glucose decreased below 250 mg/dL, then 0.05 unit/kg every hour until DKA resolved
-Initial dose of 0.3 units/kg followed by 0.2 unit/kg every 2 hours until blood glucose decreased below 250 mg/dL, then 0.1 unit/kg every 2 hours until DKA resolved

Comments:
-An endocrinologist or critical care specialist with training and expertise in the management of DKA or HHS should direct care; frequent monitoring of clinical and laboratory parameter is necessary as well as identification and correction of precipitating event.
-Starting insulin therapy before IV fluid replacement may precipitate shock, and increase the risk of hypokalemia and cerebral edema.
-To prevent rebound hyperglycemia, initiate subcutaneous insulin 15 to 30 minutes (rapid-acting) or 1 to 2 hours (regular insulin) before stopping the insulin infusion; alternatively, basal insulin may be administered in the evening and the insulin infusion stopped the next morning.

Use: Treatment of hyperglycemic emergencies.

Usual Pediatric Dose for Diabetes Type 1:

2 years and older: Individualize dose based on metabolic needs and frequent monitoring of blood glucose
-Use HbA1c values to guide therapy; consult current guidelines for optimal target ranges

Multiple-daily injection (MDI):
-Administer subcutaneously immediately before a meal (within 5 to 10 minutes) or soon after the start of a meal
-Match prandial insulin dose to carbohydrate intake, pre-meal blood glucose, and anticipated activity
-Use in combination with an intermediate-acting or long-acting basal insulin

Continuous Subcutaneous Infusion (Insulin Pump)
-Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure the pump has been evaluated with this insulin
-While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion

Intravenous Administration
-Dilute to a concentration of 0.05 to 1 unit/mL in normal saline in an infusion system using polypropylene infusion bags; closely monitor blood glucose and serum potassium during administration

Use: To improve glycemic control in pediatric patients 2 years or older with type 1 diabetes mellitus.

What other drugs will affect insulin aspart?

Many other medicines can increase or decrease the effects of insulin aspart on lowering your blood sugar. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about insulin aspart.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.04. Revision Date: 2016-05-11, 3:33:10 PM.

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