Novolog insulin is also called insulin aspat and is a rapid-acting insulin that is very close to human insulin, but with just small change in the insulin protein. It is this small change that helps it to get absorbed into the blood quickly after it is injected into the fat layer under the skin.
Aspart insulin was approved by the FDA in 2000 for use in adults and children with diabetes. It can be used for the treatment of both type1 diabetes mellitus and type 2 diabetes mellitus. Insulin aspart is clear and colorless liquid. It is almost like the human insulin, except for one difference in the insulin protein. It is human insulin analog.
Novolog insulin starts to work about 20 minutes after subcutaneous injection. It peaks in 1 to 3 hours. The usual duration of action is about 3 to 5 hours when given subcutaneously. The difference in time of onset, peak and duration between aspart and regular insulin results from the fact that aspart is absorbed faster
and clears faster than regular insulin when given subcutaneously. When given by IV infusion, the difference in onset, peak and duration of action disappears.
The usual concentration is of insulin aspart is 100 units per milliliter or 100U/ml. It can be diluted to produce less concentrated insulin down to 10U/ml. Aspart that is used in insulin pump or insulin pens cannot be diluted. Aspart insulin is comparable to that of regular insulin. Aspart, however works faster than regular human insulin when administered subcutaneously, that is, in the fat layer under the skin.
Novolog insulin is usually a clear, colorless solution that contains insulin aspart (rDNA origin) injection 100 units per milliliter (100U/ml). It usually is supplied as:
Only a prescribing clinician can prescribe aspart insulin or adjust its dose. Blood glucose should be monitored closely for patients on aspart, especially before each dose.
The dose may need to be lowered for people with liver and/or kidney problems.
Aspart insulin is usually given 5 to 10 minutes before a meal because it starts to work about 20 minutes after injection.
When aspart insulin concomitant with a long acting or intermediate acting insulin, the aspart insulin dose is usually about 2/3 of the total daily insulin.
Novolog can only be mixed with NPH. It cannot be mixed with any other insulin or medication preparation. If aspart is to be mixed with NPH, the insulin aspart needs to be drawn into the syringe first, and then followed by the NPH. This mixture is only for immediate injection in the fat layer under the skin, not to be stored. NPH may slightly decease the peak level of aspart
Novolog cannot be diluted, mixed with NPH or any other insulin or drug when used in an infusion pump or insulin pens.
Infusion pumps that can be used for Novolog are:
If you are using any pump not listed above, make sure that the pump lists aspart as one of the insulin that can be safely infused. In addition, read the instruction on both pump and insulin aspart. If any of the instructions differ between the pump and aspart direction, follow the direction on the aspart insulin.
Patients who are using infusion pump with aspart should infuse the aspart insulin bolus before each meal. Remember to rotate the sites for the bolus to avoid lipodystrophy.
If you are using an infusion pump, change the infusion set and infusion site every 3 days. The Novolog insulin in the reservoir of the infusion pump should be changed every 6 days.
Patients on aspart insulin, especially patients with type 1 diabetes need to use long-acting insulin or intermediate-acting insulin in addition to insulin aspart, when aspart is used for subcutaneous injection. This is because aspart is rapid-acting, so this other insulin provides small needed insulin in the blood in between meals.
Novolog can only be diluted with the insulin dilution liquid that is for aspart to reduce the number of units per ml for subcutaneous injection. Check with your healthcare professional on how to make this mixture.
Aspart can also be mixed with 0.9% sodium chloride solution or normal saline for IV infusion.
Aspart insulin is a clear colorless liquid, always check the label to make sure that you have the correct insulin.
Protect aspart from light and direct heat. Always keep the insulin vial in the carton to shield the insulin from light. Keep unopened aspart insulin in refrigerator and the aspart in use at room temperature, but below 86˚F or 30˚C. Discard opened aspart vials after 28days.
If aspart insulin is exposed to a temperature of up to 98.6˚F (37˚C), it should be discarded.
Monitor insulin pumps for malfunction or failure. In the event of insulin infusion pump failure, use subcutaneous injections of insulin to prevent hyperglycemia or diabetic ketoacidosis. If the malfunction delivers more than desired dose of aspart, monitor blood glucose levels and treat any resulting hypoglycemia or hypokalemia as needed. Always report any insulin pump malfunction to the doctor.
When using the FlexPen, remember to use only sterile needles and remove the needle after each use. Never leave the pen with an injection needle connected as this will introduce bubbles, infection or leak which may affect the potency of the aspart.
Punctured cartridge of the FlexPen can be kept at a temperature of less than 30˚C (86˚F for 26 days), while in use, the cartridge should not be refrigerated.
store FlexPen or Penfill cartridge device with the needle removed. Attached needle can introduce bubbles, cause contamination and/or leak and affect potency. Protect all aspart insulin from light and heat.
Use NovoPen 3 PenMate, NovoFine disposable needles or any compatible needles for Novlog insulin
Inject into the fat layer under the skin (subcutaneous) when the treatment with aspart insulin is used in combination with intermediate or long-acting insulin regimen. The injection should be in the fat layer under the skin in the upper arms, thighs, buttocks and abdomen.
Always check the finger-stick blood sugar before administering insulin aspart. Do not inject if blood glucose is too low. It is a good idea to get the limits or blood glucose parameters from your doctor.
Rotate the injection site to avoid lipodystrophy. Lipodystrophy is the thickening or thinning of the fat layer under the skin.
Thinning of the fat layer is called lipoatrophy and thickening is called lipohypertrophy.
Aspart can be used for intravenous (IV) infusion only in a hospital or clinic condition where a patient is closely monitored for hypoglycemia and hypokalemia by healthcare personnel.
Use sterile insulin injection needles. Dispose of the injection needles into secure containers. This protects you and others from needle-stick injury and stops the spread of diseases.
Insulin doses may need to be adjusted during illness.
Those in hypoglycemia
Those allergic to Novlog or any of its inactive ingredients.
Do not give to patients in hypoglycemia
Do not give to people who are allergic to aspart or any other material in the formulation
Do not administer aspart if you do not plan to eat within about ten minutes or if you are fasting.
Do not Freeze insulin aspart.
Do not mix with other insulin preparations when given by pump or intravenously.
Do not share or reuse injection needles.
Do not use one FlexPen for two patients.
Do not use aspart if it had been previously frozen, if it has a color or particles, if it looks cloudy or thick.
Do not use expired aspart or any expired medicine.
Do not combine use of insulin pump with a regimen of long or intermediate acting insulin.
A major adverse reaction of Novolog insulin
is hypoglycemia or low blood glucose
Hypokalemia or decreased blood potassium level is another adverse reaction of aspart insulin, especially when it is given as IV infusion.
Allergic reactions in those with allergy to aspart or any of its components. This can be in the form of redness, itch, trouble breathing, wheezing, hypotension or low blood pressure, sweating, increased heart rate or even anaphylaxis.
Some localized reactions and generalized myalgias are allergic reactions to metacresol, which is a component of aspart known as its excipient.
There may be infusion site reactions in those using insulin pump. This can be in the form of itch, redness, or swelling.
Blurred vision- this may be due to sudden drop in blood pressure levels and will get better or resolve over time.
Weight gain results from better use of blood glucose due to the presence of insulin.
Swelling in hands and feet, also called peripheral edema.
Novolog side effects may include:
Drugs that lower blood glucose like oral diabetes medications, ACE inhibitors, salicylates like aspirin, monoamine oxidase inhibitors, sulfonamide antibiotics, fluoxetine, ACE inhibitors, propoxyphene, oral antibiotics, and other drugs that lower blood sugar may cause the hypoglycemia in patients receiving insulin aspart.
Drugs that increase blood sugar may cause hyperglycemia in patients who are taking insulin aspart. Examples of these medications are corticosteroids like prednisone, diuretics, niacin, albuterol, epinephrine, glucagon, isoniazid, thyroid hormones, oral contraceptives, atypical antipsychotics, including olanzapine and clozapine, thyroid hormones, protease inhibitors, somatropin and others.
Other drugs can affect the drug lowering effects in an unpredictable manner. These medications include beta blockers, clonidine, lithium, alcohol and Pentamidine. Pentamidine may be so erratic that it may cause hypoglycemia which is quickly followed by hyperglycemia.
Some medications like beta blockers, guanethidine, clonidine and reserpine may make it difficult for the patient to recognize the symptoms of hypoglycemia early.
If you are prone to hypoglycemia, use caution when driving or operating heavy machinery.
Novolog dose may need to be lowered in patients with kidney and liver problems.
Novolog insulin can be used to control diabetes in pregnant women. Caution should be exercised because the insulin need fluctuates during pregnancy. Insulin need reduces in early pregnancy, increases in the second trimester and third trimester, and then reduces again after delivery. Close monitoring of blood sugar is especially important and includes the postprandial blood sugar or blood glucose after meals, in addition to fasting blood sugar.
Aspart insulin can be used during breastfeeding by the mother with caution. The breastfeeding mother may need the dose of aspart lowered from previous dose as determined by the doctor.
Insulin aspart can be used for pediatric patients both by subcutaneous route and by insulin pump. Use cautiously in pediatric patients who are less than 2 years of age as this rapid-acting insulin has not been studied in that population.
Insulin aspart can be used in elderly patients as studies did not show difference in response between this population and other adult patients.
Use cautiously in patients who are on other medications that reduce blood potassium.
Overdose of Novolog can result in both hypoglycemia and hypokalemia.
Hypoglycemia, which is low blood glucose, can be either mild or severe. In mild hypoglycemia, the patient should take foods that offer rapid release of glucose into the blood stream. These foods can include glucose tablets, orange juice, sugar, skim milk or regular soda. Patients with severe hypoglycemia should be taken to the nearest hospital emergency room and treated in a hospital environment. These patients can be treated with IV high concentration glucose, up to Dextrose 50%, glucagon and/or any others as the physicians see fit. All episodes of hypoglycemia should be reported to the patient’s doctor.
Hypokalemia is low blood potassium and needs to be treated immediately to bring up potassium levels to normal. Severe hypokalemia may cause changes in the heart’s rhythm, problems with breathing or even death and should be treated in a hospital setting.
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