insulin aspart

insulin /in·su·lin/ (in´sdbobr-lin)

1. a protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans. The major fuel-regulating hormone, it is secreted into the blood in response to a rise in concentration of blood glucose or amino acids. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis.

Insulin. The precursor proinsulin is cleaved internally at two sides (arrows) to yield insulin and C peptide.

2. a preparation of insulin, either of porcine or bovine origin or a recombinant form with sequence the same as or similar to that in humans, used in the treatment of diabetes mellitus; classified as rapid-acting, intermediate-acting, or long-acting on the basis of speed of onset and duration of activity.

3. regular insulin; a rapid-acting, unmodified form of insulin prepared from crystalline bovine or porcine insulin.

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insulin aspart  a rapid-acting analogue of human insulin created by recombinant DNA technology.

buffered insulin human  insulin human buffered with phosphate; used particularly in continuous infusion pumps.

extended insulin zinc suspension  a long-acting insulin consisting of porcine or human insulin in the form of large zinc-insulin crystals.

insulin glargine  an analogue of human insulin produced by recombinant DNA technology, having a slow, steady release over 24 hours.

insulin human  a protein corresponding to insulin elaborated in the human pancreas, derived from pork insulin by enzymatic action or produced synthetically by recombinant DNA techniques; sometimes used specifically to denote a rapid-acting regular insulin preparation of this protein.

isophane insulin suspension  an intermediate-acting insulin consisting of porcine or human insulin reacted with zinc chloride and protamine sulfate.

Lente insulin  insulin zinc suspension.

insulin lispro  a rapid-acting analogue of human insulin synthesized by means of recombinant DNA technology.

NPH insulin  isophane i. suspension.

prompt insulin zinc suspension  a rapid-acting insulin consisting of porcine insulin with zinc chloride added to produce a suspension of amorphous insulin.

regular insulin  insulin (3).

Semilente insulin  prompt insulin zinc suspension.

Ultralente insulin  extended insulin zinc suspension.

insulin zinc suspension  an intermediate-acting insulin consisting of porcine or human insulin with a zinc salt added such that the solid phase of the suspension contains a 7:3 ratio of crystalline to amorphous insulin.

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insulin aspart,

a rapid-acting analog of human insulin created by recombinant DNA technology, in which an aspartate residue has been substituted for the usual proline at position 28 on the insulin B chain. It is administered subcutaneously for the treatment of diabetes mellitus.

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insulin aspart (rDNA origin) Warning - High-alert drug!

NovoLog

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.

Route	Onset	Peak	Duration
Subcut.	15 min	1-3 hr	3-5 hr

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.