insulin aspart

IN-soo-lin AS-spart

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

BEERS REMS, High Alert

Type 1 or type 2 diabetes mellitus.

Lowers blood glucose by:
- stimulating glucose uptake in skeletal muscle and fat,
- inhibiting hepatic glucose production.
Other actions of insulin:
- inhibition of lipolysis and proteolysis,
- enhanced protein synthesis.
A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin.

Therapeutic effects:

Control of hyperglycemia in patients with diabetes.

Absorption: Rapid acting.

Distribution: Identical to endogenous insulin.

Metabolism/Excretion: Metabolized by liver, spleen, kidney, and muscle.

Half-Life: Approximately 60–90 min.

(hypoglycemic effect)

ROUTE	ONSET	PEAK	DURATION
SUBQ	within 15 min	1–2 hr	3–4 hr

Contraindicated in:

Hypoglycemia;
Allergy or hypersensitivity to insulin aspart.

Use Cautiously in:

Stress and infection, which may temporarily ↑ insulin requirements;
Renal impairment (may ↓ insulin requirements);
Hepatic impairment (may ↓ insulin requirements);
Must be used with a longer-acting insulin in patients with type 1 diabetes;
OB: Pregnancy may temporarily ↑ insulin requirements;
Geri: Appears on Beers list. ↑ risk of hypoglycemia in older adults. Avoid use of regimens containing only short- or rapid-acting insulin without concurrent use of basal or long-acting insulin.

Endo: HYPOGLYCEMIA

F and E: hypokalemia

Local: cutaneous amyloidosis, lipodystrophy, pruritus, erythema, swelling

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Drug-drug:

Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.
Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin,phenothiazines, and rifampin may ↑ insulin requirements.
Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates, may ↓ insulin requirements.
Concurrent use with pioglitazone may ↑ risk of fluid retention and worsening HF

Drug-Natural Products:

Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

SC (Adults and Children ): Determined by needs of the patients; generally 0.5–1 units/kg/day total. 50–70% may be given as insulin aspart, and the remainder as intermediate- or long-acting insulin. May also be given via SUBQ infusion pump; initial programming based on total daily dose of insulin given in previous regimen with 50% of total daily dose given as premeal boluses and 50% of total daily dose given as basal infusion; dose can then be adjusted based on response.

Insulin aspart (vials and prefilled cartridges/pens): 100 units/mL
Insulin aspart protamine suspension/insulin aspart injection mixture (vials and prefilled pens): 70% insulin aspart protamine suspension and 30% insulin aspart injection—NovoLog Mix 70/30 100 units/mL

Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait)and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; nausea; vomiting; unusual thirst) during therapy.
Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

Lab Test Considerations:

Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitored every 3–6 mo to determine effectiveness.
- Monitor serum potassium in patients at risk for hypokalemia (those using potassium-lowering agents, those receiving IV insulin) periodically during therapy.

Toxicity and Overdose:

Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.

High Alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation “u” for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting health care professional.
Do not confuse Novolog with Humalog or Novolin. Do not confuse Novolog FlexPen with Novolog Mix 70/30 FlexPen. Do not confuse Novolog Mix 70/30 with Novolin 70/30.
Due to the short duration of action, insulin aspart must be used with a longer-acting insulin or insulin infusion pump therapy.
Check type, species source, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting health care professional.
- Use only insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/mL.
- When mixing insulins, draw insulin aspart into syringe first to avoid contamination of regular insulin vial. Administer immediately after mixing. Do not mix with crystalline zinc insulin preparations.
- Insulin aspart should be refrigerated, but do not freeze or administer solution if it has been frozen. Cartridges or vials may be kept at room temperature for up to 28 days if kept from excessive heat and sunlight. Do not use if cloudy, discolored, or unusually viscous. Never use the cartridge after the expiration date on the cartridge or on the box.
- Because of the short duration of insulin aspart, supplementation with longer-acting insulin is usually necessary to control blood glucose levels.
SC: Administer insulin aspart SUBQ in the abdominal wall, thigh, or upper arm within 5–10 min before a meal. Rotate injection sites to prevent lipodystrophy and cutaneous amyloidosis. Repeated insulin injections into areas of localized cutaneous amyloidosis may cause hyperglycemia; a sudden change to an unaffected injection site may cause hypoglycemia.
- When used in pumps: Change the solution in the reservoir at least every 6 days, change the infusion set, and the infusion set insertion site at least every 3 days. Do not mix with other insulins or with a diluent when used in the pump.

IV Administration:

IV: May be given IV in selected clinical situations under appropriate medical supervision. Diluent: Dilute with 0.9% NaCl or D5W in infusion systems using polypropylene infusion bags. Concentration: 0.05–1 unit/mL.
May be administered via disposable external insulin pump. Do not administer solution that appears thickened, cloudy, discolored, or contains particles. Store cartridges for pump in refrigerator. Do not mix with other insulins or solutions when used with pump. Choose a new infusion site every 48 hr. Discard cartridges after 7 days, even if solution remains.
Y-Site Compatibility:
- imipenem/cilastatin/relebactam
Y-Site Incompatibility:
- posaconazole

Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, external pumps, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient that insulin pens should not be shared with others, even if clean needles are used.
Demonstrate technique for mixing insulins by drawing up insulin aspart first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
Caution patient not to share pen device with another person, even if needle is changed; may risk transmission of blood-borne pathogens.
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood sugar levels are not controlled.
Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
Emphasize the importance of regular follow-up, especially during first few wk of therapy.

Control of blood glucose levels in patients with diabetes without hypoglycemic or hyperglycemic episodes.

insulin aspart: Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLOG, NovoLOG FlexPen, NovoLOG PenFill,

insulin aspart protamine suspension/insulin aspart injection mixture: NovoLOG Mix 70/30, NovoLOG Mix FlexPen

insulin aspart: NovoRapid,

insulin aspart protamine suspension/insulin aspart injection mixture: NovoMix 30

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆