Medical term:
NovoLog
insulin aspart (rDNA origin)
insulin aspart and insulin aspart protamine
Pharmacologic class: Pancreatic hormone
Therapeutic class: Hypoglycemic
Pregnancy risk category C
Action
Short-acting insulin form. Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it's converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.
Availability
Injection (NovoLog): 100 units/ml in 10-ml vials and 3-ml PenFill cartridges
Injection (NovoLog Mix 70/30): 100 units/ml in 10-ml vials, 3-ml PenFill cartridges, and 3-ml FlexPen prefilled syringes
Indications and dosages
➣ Type 1 (insulin-dependent) diabetes mellitus; type 2 (non-insulin-dependent) diabetes mellitus
Adults and children ages 6 and older: Insulin aspart-Dosage tailored to patient's needs, given subcutaneously in divided doses 5 to 10 minutes before meals. Insulin aspart provides 50% to 70% of dose; intermediate or long-acting insulin provides remainder. Dosage range is 0.5 to 1 unit/kg/day in divided doses based on meals. Insulin aspart and insulin aspart protamine- Give subcutaneously b.i.d., 15 minutes before morning and evening meals. For monotherapy, initial dosage is 0.4 to 0.6 unit/kg/day in two divided doses. Titrate in increments of 2 to 4 units q 3 to 4 days to achieve target fasting plasma glucose level. When given with oral hypoglycemics, initial dosage is 0.2 to 0.3 unit/kg/day.
Contraindications
• Hypersensitivity to drug or its components
• Hypoglycemia
Precautions
Use cautiously in:
• hepatic or renal impairment, hypothyroidism, hyperthyroidism
• elderly patients
• pregnant or breastfeeding patients
• children.
Administration
☞ Be aware that insulin is a high-alert drug.
• Know that drug is bioavailable as regular human insulin but has a faster onset and shorter duration.
• Give by subcutaneous route only, 5 to 10 minutes (15 minutes for Novolog Mix 70/30) before a meal.
• When mixing insulin aspart with intermediate or long-acting insulin, draw up insulin aspart into syringe first.
☞ Don't mix insulin aspart protamine with any other insulin.
• When giving insulin aspart by pump, don't mix with other insulins.
• Rotate injection sites to prevent lipodystrophy.
Adverse reactions
Metabolic: hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect)
Musculoskeletal: myalgia
Skin: urticaria, rash, pruritus
Other: edema; lipodystrophy; lipohypertrophy; redness, warmth, or stinging at injection site; allergic reactions including anaphylaxis
Interactions
Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect
Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect
Beta-adrenergic blockers (nonselective): masking of some hypoglycemia signs and symptoms, delayed recovery from hypoglycemia
Lithium carbonate: decreased or increased hypoglycemic effect
Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia
Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels
Liver and thyroid function studies: test interference
Urine vanillylmandelic acid: increased level
Drug-herbs. Basil, bee pollen, burdock, glucosamine, sage: altered glycemic control
Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect
Garlic, ginseng: decreased blood glucose level
Drug-behaviors. Alcohol use: increased hypoglycemic effect
Marijuana use: increased blood glucose level
Smoking: increased blood glucose level, decreased response to insulin
Patient monitoring
• Monitor blood glucose level frequently to gauge drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
☞ Stay alert for signs and symptoms of hypoglycemia. Keep glucose source at hand.
☞ Assess for evidence of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by urine and blood ketones, metabolic acidosis, extremely elevated blood glucose level, and hypovolemia).
• Monitor for glycosuria.
• Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.
Patient teaching
• Teach patient how to administer insulin subcutaneously or by injection pen.
• If patient must mix insulin aspart with intermediate or long-acting insulin, instruct him to draw up insulin aspart into syringe first.
☞ Tell patient not to mix any other insulin with mixture of insulin aspart and insulin aspart protamine.
• Advise patient to rotate subcutaneous injection sites and keep a record of sites used, to help prevent fatty tissue breakdown.
☞ Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to always carry a glucose source.
• Inform patient that changes in diet, activity, and stress level affect blood glucose levels and insulin requirements.
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Tell patient to wear medical identification stating that he is diabetic and takes insulin.
• Instruct patient to have regular medical, vision, and dental exams.
• Tell female patient to contact prescriber if she is pregnant or plans to become pregnant.
• Advise patient to store insulin in refrigerator, not freezer.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.
insulin aspart
(in-su-lin as-spart) ,NovoLOG
(trade name),Novorapid
(trade name)insulin aspart protamine suspension/insulin aspart injection mixture
,NovoLOG Mix 70/30
(trade name),Novomix 30
(trade name)Classification
Therapeutic: antidiabeticsPharmacologic: pancreatics
Pregnancy Category: C (insulin aspart protamine suspension/insulin aspart injection mixtures)
Indications
Action
- stimulating glucose uptake in skeletal muscle and fat,
- inhibiting hepatic glucose production.
- inhibition of lipolysis and proteolysis,
- enhanced protein synthesis.
Therapeutic effects
Pharmacokinetics
Time/action profile (hypoglycemic effect)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| Subcut | within 15 min | 1–2 hr | 3–4 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Endocrinologic
- hypoglycemia (life-threatening)
Local
- lipodystrophy
- pruritis
- erythema
- swelling
Miscellaneous
- allergic reactions including anaphylaxis (life-threatening)
Interactions
Drug-Drug interaction
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 or rosiglitazone may ↑ risk of fluid retention and worsening HFGlucosamine may worsen blood glucose control.Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.Route/Dosage
Availability
Nursing implications
Nursing assessment
- 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. 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.
Potential Nursing Diagnoses
Noncompliance (Patient/Family Teaching)Implementation
- 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 physician or other health care professional.
- Do not confuse Novolog with Novolin.
- 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 physician or other 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 PenFill cartridge after the expiration date on the PenFill 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.
- Subcutaneous: Administer insulin aspart subcut in the abdominal wall, thigh, or upper arm within 5–10 min before a meal. Rotate injection sites.
- 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.
Intravenous Administration
- pH: 7.2–7.6.
- Intravenous: 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.
Patient/Family Teaching
- 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).
- 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.
- Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed.
- 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 weeks of therapy.
Evaluation/Desired Outcomes
- Control of blood glucose levels in diabetic patients without hypoglycemic or hyperglycemic episodes.
NovoLog
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