Insulin Aspart

Insulin Aspart is a prescription medication used to treat Type 1 and Type 2 Diabetes Mellitus.

• Insulin Aspart is available under the following different brand names: NovoLog, NovoLog FlexPen, NovoPen Echo, NovoLog FlexTouch, Fiasp.

Adult and pediatric dosage

Injectable solution

• 100 units/mL (NovoLog, Fiasp)

Prefilled syringe

• 100units/mL (3mL NovoLog FlexPen, NovoLog FlexTouch, Fiasp FlexTouch)

Type 1 Diabetes Mellitus

Adult dosage

• 0.2-0.6 unit/kg/day in divided doses; conservative doses of 0.2-0.4 unit/kg/day often recommended to reduce risk of hypoglycemia 
• Total maintenance daily insulin requirement may vary; it is usually between 0.5 and 1 unit/kg/day; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.6-1.2 units/kg/day. 

Pediatric dosage

• May require 0.8-1.2 units/kg/day SC during growth spurts; adolescents may require less than 1.2 units/kg/day; otherwise, may use 0.5-1 unit/kg/day. 

Type 2 Diabetes Mellitus

Adult dosage

• 10 units/day SC (or 0.1-0.2 units/kg/day) in the evening or divided every 12 hours of an intermediate (eg, NPH) or long-acting insulin at bedtime is recommended; conversely, regular insulin or rapid-acting insulin (aspart insulin) before meals also recommended

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Insulin Aspart include:

• low blood sugar, 
• weight gain, 
• low potassium, 
• swelling in hands and feet, 
• skin rash, 
• itching, 
• redness, 
• swelling, and 
• thickening or hollowing of the skin where the medicine was injected

Serious side effects of Insulin Aspart include:

• redness or swelling where the injection was given, 
• itchy skin rash over the entire body, 
• trouble breathing, 
• fast heartbeats, 
• lightheadedness, 
• swelling of the tongue or throat, 
• swelling, 
• rapid weight gain, 
• shortness of breath, 
• leg cramps, 
• constipation, 
• irregular heartbeats, 
• fluttering in the chest, 
• increased thirst or urination, 
• numbness or tingling, 
• muscle weakness, and
• limp feeling

Rare side effects of Insulin Aspart include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Insulin Aspart has severe interactions with the following drugs:
  • pramlintide 
• Insulin Aspart has serious interactions with the following drugs:
  • ethanol
  • macimorelin
• Insulin Aspart has moderate interactions with at least 127 other drugs.
• Insulin Aspart has minor interactions with at least 79 drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• During episodes of hypoglycemia
• Documented hypersensitivity

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Insulin Aspart?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Insulin Aspart?”

Cautions

• Decreased insulin requirements: Diarrhea, nausea/vomiting, malabsorption, hypothyroidism, renal impairment, and hepatic impairment; monitor therapy closely
• Increased insulin requirements: Fever, hyperthyroidism, trauma, infection, and surgery
• Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia; these changes should be made cautiously and only under close medical supervision, and the frequency of blood glucose monitoring should be increased.
• All insulin products can cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia; untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death; monitor potassium levels in patients at risk for hypokalemia if indicated (eg, patients using potassium-lowering medications, patients taking medications sensitive to potassium concentrations)
• Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat accordingly, and consider discontinuing thiazolidinediones
• Never share pen between patients even if the needle is changed; patients using vials must never share needles or syringes with another person
• To avoid accidental mix-ups between insulin products, instruct patients to always check the insulin label before each injection
• If hypersensitivity reactions occur, discontinue therapy; treat per standard of care and monitor until symptoms and signs resolve
• Malfunction of insulin pump or insulin infusion set or insulin degradation can rapidly lead to hyperglycemia and ketoacidosis; patients using continuous subcutaneous insulin infusion pump therapy must be trained to administer insulin by injection and have alternate insulin therapy available in case of pump failure
• Insulin products may cause sodium retention and edema, particularly if previously poor metabolic control is improved by intensified insulin therapy

Hyperglycemia or hypoglycemia with changes in insulin regimen

• Changes in insulin, insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia
• Changes should be made cautiously and only under close medical supervision and the frequency of blood glucose monitoring should be increased
• Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis reported to result in hyperglycemia; a sudden change in the injection site (to the unaffected area) has been reported to result in hypoglycemia
• Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring
• Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change injection site to unaffected areas and closely monitor for hypoglycemia
• For patients with type 2 diabetes, dosage adjustments in concomitant oral antidiabetic treatment may be needed
• Accidental mix-ups between insulin products reported; to avoid medication errors between this drug and other insulins; instruct patients to always check the insulin label before each injection

Hypoglycemia

• Severe hypoglycemia can cause seizures, may lead to unconsciousness, maybe life-threatening or cause death; hypoglycemia can impair concentration ability and reaction time
• The risk of hypoglycemia after injection is related to the duration of action of insulin and, in general, is highest when glucose-lowering effect of insulin is maximal; as with all insulin preparations, glucose-lowering effect time course of insulins may vary in different individuals or at different times in the same individual and depends on many conditions, including the area of injection as well as injection site blood supply and temperature; other factors which may increase risk of hypoglycemia include changes in meal pattern (eg, macronutrient content or timing of meals), changes in the level of physical activity, or changes to co-administered medication; patients with renal or hepatic impairment may be at higher risk of hypoglycemia
• In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, an increased frequency of blood glucose monitoring is recommended
• Pediatric patients with type 1 diabetes treated with mealtime and postmeal FIASP reported a higher rate of blood glucose confirmed hypoglycemic episodes compared to patients treated with NovoLog; the imbalance was greater during the nocturnal period; monitor blood glucose levels closely in pediatric patients

Drug Interactions Overview

• Drugs may increase the risk of hypoglycemia
  • Antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analogs (eg, octreotide), and sulfonamide antibiotics
  • Reduce dose and monitor glucose levels when Insulin Aspart is coadministered with these drugs
• Drugs may decrease the blood glucose-lowering effect of the Insulin Aspart
  • Atypical antipsychotics (eg, olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (eg, in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (eg, albuterol, epinephrine, terbutaline), and thyroid hormones
  • Increase dose and monitor glucose levels when Insulin Aspart is coadministered with these drugs
• Drugs may increase or decrease the blood glucose-lowering effect of the Insulin Aspart
  • Alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
  • Adjust dose and monitor glucose levels when Insulin Aspart is coadministered with these drugs
• Drugs may blunt signs and symptoms of hypoglycemia
  • Beta-blockers, clonidine, guanethidine, and reserpine
  • Monitor glucose levels when Insulin Aspart is coadministered with these drugs

Pregnancy and Lactation

• Available information from published randomized controlled trials during the second trimester of pregnancy has not reported association with insulin aspart and major birth defects or adverse maternal or fetal outcomes
• Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, stillbirth, and delivery complications
• Poorly controlled diabetes also increases the fetal risk for major birth defects, and macrosomia related morbidity
• There are no data on the presence of insulin in human milk, effects on the breastfed infant, or milk production; one small published study reported that exogenous insulin, including Insulin Aspart, was present in human milk; however, there is insufficient information to determine effects of Insulin Aspart on the breastfed infant; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy, and any potential adverse effects on the breastfed infant from the drug, or from the underlying maternal condition