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Insulin Aspart / Insulin Degludec Dosage

Usual Adult Dose for Diabetes Type 1

Doses should be individualized based on clinical response

Administer subcutaneously 1 to 2 times a day with any main meal
-Individuals with type 1 diabetes will generally require a rapid or short acting insulin at meals in which this combination insulin is NOT administered.

Insulin-naive patients:
Initial dose: One-third to one-half the total daily insulin requirement subcutaneously once or in divided doses twice a day with a main meal
-The remaining total daily insulin requirement should be provided as a short or rapid-acting insulin divided and administered subcutaneously at meals in which this combination insulin is NOT administered
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.

Switching from Once or Twice Daily Premix Insulin:
-Initiate at the same dose units and injection schedule as the current premix
-Short or rapid-acting insulin should be used for meals NOT covered by this insulin mix

Switching from Once or Twice Daily Basal Insulin:
-Initiate at the same dose units as the basal insulin once or in divided doses twice a day with a main meal of the day
-Short or rapid-acting insulin should be used for meals NOT covered by this insulin mix

Comments:
-Adjust dosage according to metabolic needs, blood glucose measurements, and glycemic goals.
-Dose increases should occur no sooner than every 3 to 4 days; dose adjustment should be made based on morning fasting blood glucose measurement (before breakfast).
-When changing treatment regimens, the dose and frequency of short or rapid-acting insulin may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.

Use: To improve glycemic control in individuals with type 1 diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Initial dose: 10 units subcutaneously once a day with the main meal of the day
Maintenance dose: Adjust dose according to blood glucose measurements before breakfast (fasting); dose increases should occur no more frequently than every 3 to 4 days

Switching from Once or Twice Daily Premix Insulin:
-Initiate subcutaneously at the same dose units and injection schedule as the current premix insulin

Switching from Once or Twice Daily Basal Insulin:
-Initiate at the same dose units as the basal insulin once or in divided doses twice a day with a main meal
-For patients switching from once-daily basal insulin to this insulin mix, monitor blood glucose closely due to the rapid-acting insulin component

Comments:
-With changing treatment regimens, the dose and frequency of short or rapid-acting insulin or other anti-diabetic medications may need to be adjusted to minimize hypoglycemia; closely monitor blood glucose.
-Short or rapid-acting insulin may be used for meals NOT covered by this insulin mix.

Use: To improve glycemic control in individuals with type 2 diabetes mellitus.

Usual Pediatric Dose for Diabetes Type 1

Doses should be individualized based on clinical response
-Not recommended for pediatric patients requiring less than 5 units/day of this insulin

1 year or older:

Administer subcutaneously once a day with any main meal
-Individuals with type 1 diabetes will generally require a rapid or short-acting insulin at meals in which this combination insulin is NOT administered

Insulin-naive patients:
Initial dose: One-third to one-half the total daily insulin requirement subcutaneously once a day with a main meal
-The remaining total daily insulin dose should be provided as a short or rapid-acting insulin divided and administered subcutaneously at meals NOT covered by this insulin mix.
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.

Switching from Once or Twice Daily Premix Insulin:
-Initiate at 80% of the previous total daily mixed insulin dose subcutaneously once a day with a main meal
-In patients also using short or rapid-acting insulin at mealtimes, continue at the same dose for meals NOT covered by this insulin mix

Switching from Once or Twice Daily Basal Insulin:
-Initiate at 80% of the previous long or intermediate-acting insulin component of the daily regimen subcutaneously once a day with a main meal
-In patients also using short or rapid-acting insulin at mealtimes, continue at the same dose for meals NOT covered by this insulin mix

Comments:
-Doses should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals.
-Dose increases should occur no sooner than every 3 to 4 days; dose adjustments should be made based on morning fasting blood glucose measurement (before breakfast).
-When changing treatment regimens, the dose and frequency of short or rapid-acting insulin may need to be adjusted.
-With changing regimens, closely monitor blood glucose to minimize hypoglycemia.

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

Usual Pediatric Dose for Diabetes Type 2

1 year or older:
-Not recommended for patients requiring less than 5 units/day of this insulin

Initial dose: 10 units subcutaneously once a day with the main meal of the day
Maintenance dose: Adjust dose according to blood glucose measurements before breakfast (fasting); dose increases should occur no more frequently than every 3 to 4 days

Switching from Once or Twice Daily Premix Insulin:
-Initiate subcutaneously at 80% of the previous long- or intermediate-acting insulin component of the daily regimen administered subcutaneously once daily with a main meal

Switching from Once or Twice Daily Basal Insulin:
-Initiate subcutaneously at 80% of the previous long- or intermediate-acting insulin component of the daily regimen administered subcutaneously once daily with a main meal

Comments:
-In patients also using short or rapid-acting insulin at mealtimes, continue short or rapid-acting insulin at meals NOT covered by this insulin mix.
-With changing treatment regimens, the dose and frequency of short or rapid-acting insulin or other anti-diabetic medications may need to be adjusted to minimize hypoglycemia; closely monitor blood glucose.

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

Renal Dose Adjustments

Use caution; glucose-monitoring should be intensified and the insulin dose adjusted on an individual basis.

Liver Dose Adjustments

Use caution; glucose-monitoring should be intensified and the insulin dose adjusted on an individual basis.

Dose Adjustments

Elderly: Greater sensitivity is possible in older adults and hypoglycemia may be more difficult to recognize; glucose-monitoring may need to be intensified

-Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, with trauma, during concurrent use of with medications effecting glycemic control, or after surgery
-Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or with concurrent use of medications having hypoglycemic effects.

Dosage adjustments may be required with changes to insulin regimens, changes in insulin, manufacturer, type, or method of administration; oral antidiabetic treatment may need to be adjusted as well.

Precautions

Safety and efficacy have not been established in patients younger than 1 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-For subcutaneous use only; do not give IV/IM or in an insulin pump
-Always check insulin labels before administration
-Never share an insulin pen between patients, even if the needle is changed; do not reuse or share needles or syringes between patients as this presents a risk for transmission of blood-borne pathogens
-Instruct patients on proper administration
-The dose counter shows the number of units regardless of strength; no dose conversion should be done when transferring a patient to a new strength
-Do not transfer this insulin from the insulin pen into an insulin syringe for administration; the markings on the insulin syringe will not measure the dose correctly
-Patients who are blind or have vision problems should not use this pen without help from a person trained to use the pen
-Only use this insulin if the solution appears clear and colorless

DOSING INSTRUCTIONS:
-Administer subcutaneously with a main meal
-This insulin must be taken with a carbohydrate containing meal
-Inject subcutaneously in the thigh, upper arm, or abdominal wall; rotate sites in order to reduce the risk of lipodystrophy

Missed dose:
-If a patient misses a dose they should be advised to take it with the next main meal of the day and then resume with their usual dosing schedule; do not take an extra dose to make up for a missed dose

Preparation and Instructions for Use: See Manufacturer's Instructions for Use

Storage requirements:
-Prior to use: Store in the refrigerator at 36C to 46C (2C to 8C); do not freeze, if frozen do not use
-In-use: May be refrigerated or stored at room temperature below 86F (30C)
-In-use pens may be used for a maximum of 4 weeks (28 days) after opening
-Keep the cap on the pen to protect from light

Compatibility:
-Do not dilute or mix with any other insulin products or solutions

General:
-Not recommended for the treatment of diabetic ketoacidosis.
-Not recommended for pediatric patients requiring less than 5 units of this insulin mix.
-Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs.
-Hypoglycemia is the most common adverse reaction of insulin therapy; the timing generally reflects the time-action profile of the administered insulin.

Monitoring:
-Blood glucose monitoring is essential for patients receiving insulin therapy.
-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.

Patient advice:
-Read the US FDA-approved patient labeling (Patient Information and Instructions for Use).
-Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
-Patients should be reminded to always check insulin labels before injection, especially if using more than 1 type of insulin.
-Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
-Patients should be instructed on how to handle situations which may affect their insulin requirements.
-Patients should check blood sugar prior to driving a car or operating machinery.
-Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.