Skip to Content

Insulin Aspart Dosage

Medically reviewed on March 20, 2017.

Applies to the following strengths: 100 units/mL

Usual Adult Dose for Diabetes Type 1

Individualize dose based on metabolic needs, blood glucose monitoring results, and glycemic goal
-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):
-Insulin aspart (Novolog[R]): Administer subcutaneously within 5 to 10 minutes before a meal OR
-Insulin aspart with nicotinamide (Fiasp[R]): Administer at the start of a meal or within 20 minutes after starting 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

Intravenous Administration:
-Insulin aspart (Novolog[R]): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags
-Insulin aspart with nicotinamide (Fiasp[R]): Dilute to a concentration of 0.5 to 1 unit/mL in infusion system using polypropylene infusion bags
-Closely monitor blood glucose and serum potassium during administration

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

Comments:
-Always check insulin labels before administration.
-Insulin aspart with nicotinamide is an insulin aspart formulation that has been shown to lower blood glucose earlier; the total extent of blood glucose lowering is similar; therefore, dosing is the same but timing is different.
-Insulin aspart with nicotinamide has not been approved for use in insulin pumps.

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

Usual Adult Dose for Diabetes Type 2

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

Prandial Insulin:
-Insulin aspart (Novolog[R]): Administer subcutaneously within 5 to 10 minutes before a meal OR
-Insulin aspart with nicotinamide (Fiasp[R]): Administer at the start of a meal or within 20 minutes after starting a meal
-Use in combination with an intermediate-acting or long-acting basal insulin and/or with other anti-diabetic agents.

Intravenous Administration:
-Insulin aspart (Novolog[R]): Dilute to a concentration of 0.05 to 1 unit/mL in an infusion system using polypropylene infusion bags
-Insulin aspart with nicotinamide (Fiasp[R]): Dilute to a concentration of 0.5 to 1 unit/mL in infusion system using polypropylene infusion bags
-Closely monitor blood glucose and serum potassium during administration

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

Comments:
-Always check insulin labels before administration.
-Insulin aspart with nicotinamide is an insulin aspart formulation that has been shown to lower blood glucose earlier; the total extent of blood glucose lowering is similar; therefore, dosing is the same but timing is different.
-Insulin aspart with nicotinamide has not been approved for use in insulin pumps.

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.

Renal Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose adjustments may be required

Liver Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose adjustments may be required

Dose Adjustments

Additional monitoring is recommended when brand, type, or species of insulin is changed; insulin doses and/or oral antidiabetic treatment may need to be adjusted

-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
-Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Precautions

Safety and efficacy of insulin aspart (Novolog[R]) have not been established in patients younger than 2 years.
Safety and efficacy of insulin aspart (Fiasp[R]) have not been established in patients younger than 18 years.

Safety and efficacy in patients with type 2 diabetes have not been established in patients younger than 18 years.

Safety and efficacy of insulin aspart (Fiasp[R]) for Continuous Subcutaneous Infusion (Insulin Pump) use has not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available.

Other Comments

Administration advice:
-May be administered IV or subcutaneously
-Never share an insulin pen between patients (even if the needle is changed) and do not reuse or share needles or syringes between patients when using vials as this presents a risk for transmission of blood-borne pathogens.

Multiple-daily injections:
-Administer subcutaneously into the abdomen, buttocks, thigh, or upper arm
-Novolog(R) should be administered within 5 to 10 minutes before a meal
-Fiasp(R) should be administered at the start of a meal or within 20 minutes after starting a meal
-Rotate injection sites within same region to reduce the risk of lipodystrophy
-Ensure patients have been educated as to proper injection technique
-If needed, Novolog(R) may be diluted with Insulin Diluting Medium for NovoLog(R) to provide concentrations of U-10 or U-50: a dilution of 1 part Novolog(R) to 9 parts diluent results in a U-10 concentration, a dilution of 1 part NovoLog(R) to 1 part diluent results in a U-50 concentration.
--NovoLog(R) may be mixed with NPH insulin; draw NovoLog(R) into syringe first and administer immediately after mixing.

Missed doses: For patients on basal-bolus treatment who miss a mealtime dose, monitor blood glucose levels to determine if an insulin dose is needed; resume usual dosing at next meal

Continuous Subcutaneous Infusion (Insulin pump): Novolog(R)
-Infusion sets should be inserted into the subcutaneous fat layer of the abdominal wall; rotate sites to avoid lipodystrophy
-Do not use diluted, intermediate-acting, long-acting or mixed insulins in insulin pumps
-Check pump labeling to ensure the pump has been evaluated with insulin aspart
-Insulin aspart in the reservoir should be changed at least every 6 days; infusion sets and insertion site should be changed at least every 3 days
-Remind patients on insulin pump therapy that they must have an alternative insulin delivery system available in case of pump system failure.

Intravenous: Novolog(R) or Fiasp(R)
-Novolog(R): Administer by IV infusion at a concentration of 0.05 to 1 unit/mL
-Fiasp(R): Administer by IV infusion at a concentration of 0.5 to 1 unit/mL
-To be administered under close medical supervision with close monitoring of blood glucose and serum potassium to avoid hypoglycemia and hypokalemia
-Use polypropylene infusion bags and compatible infusion fluids
-Insulin mixtures should never be administered IV

Storage requirements:
Vials/Cartridge Systems/Pens: Protect from light; do not freeze, discard if frozen
-Unopened: Store in refrigerator (36F to 46F [2C to 8C])
-Open (in-use) Vials: Use within 28 days; store below 86F (30C), may refrigerate after opening
-Open (in-use) Novolog(R) Cartridge System and Pens: Use within 28 days; store below 86F (30C), but do not refrigerate after opening
-Open (in-use) Fiasp(R) Pens: Use within 28 days; store below 86F (30C), may refrigerate after opening

Diluted Novolog(R):
-Concentrations of U-10 or U-50 when prepared with insulin diluting medium may be used for up to 28 days when stored below 30C (86F)

Infusion Fluids:
-If prepared as indicated, stable at room temperature for 24 hours.

Pump:
-Discard insulin in pump reservoir after 6 days or after exposure to temperatures that exceed 37C (98.6F)

Reconstitution/preparation techniques:
-Insulin Pens and Cartridge Systems: The manufacturer product information should be consulted.
-To avoid contamination, pens should be used by a single patient only: always remove needle from delivery device after use and store pens without a needle attached; always use a new needle for each injection.

-For IV infusion:
Novolog(R): Dilute to a concentration of 0.05 to 1 unit/mL in 0.9% normal saline (NS) in infusion systems using polypropylene infusion bags; stable at room temperature for 24 hours.
Fiasp(R): Dilute to a concentration of 0.5 to 1 unit/mL in 0.9% NS or D5W in infusion systems using polypropylene infusion bags; stable at room temperature for 24 hours.

General:
-Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs; duration of action of this insulin will vary according to dose, injection site, blood flow, temperature, and level of physical activity.
-Insulin aspart is a rapid-acting insulin analog that is equipotent to human insulin when administered IV; when administered subcutaneously, it has a more rapid onset of action and a shorter duration of action.
-Insulin aspart with nicotinamide (Fiasp[R]) is an insulin aspart formulation that lowers blood glucose earlier than insulin aspart (Novolog[R]), although the total extent of blood glucose lowering is similar; therefore, dosing is the same but timing is different.
-Rapid acting insulin analogs are superior to regular insulin when administered subcutaneously because they are more predictable.
-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.
-Closely monitor blood glucose and potassium in patients receiving IV insulin.
-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:
-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 instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
-Patients should understand the time action profile of all the insulins they are using; they should understand there are 2 formulations of insulin aspart and they should know which product they are using.
-Patients should be instructed on how to handle situations which may affect their insulin requirements, including missed doses, stress, infections, and illness.
-Remind patients to check insulin labels before injection to avoid medication errors.
-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.

Hide