insulin aspart and insulin aspart protamine

insulin aspart and insulin aspart protamine Warning - High-alert drug!

NovoLog Mix 70/30

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.