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03/04/2014 10:51AM
High Alert
insulin aspart (in-su-lin as-spart)
NovoLOG,
Novorapid
insulin aspart protamine suspension/insulin
aspart injection mixture
NovoLOG Mix 70/30, Novomix 30
Classification
Therapeutic: antidiabetics, hormones
Pharmacologic: pancreatics
Pregnancy Category B (insulin aspart), C (insulin aspart protamine
suspension/insulin aspart injection mixtures)
Indications
Control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus.
Action
Lowers blood glucose by : stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production. Other actions of insulin: inhibition of lipolysis
and proteolysis, enhanced protein synthesis. A rapid-acting insulin with more rapid
onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin. Therapeutic Effects: Control of hyperglycemia in
diabetic patients.
Pharmacokinetics
Absorption: Rapid acting.
Distribution: Identical to endogenous insulin.
Metabolism and Excretion: Metabolized by liver, spleen, kidney, and muscle.
Half-life: Approximately 60– 90 min.
ONSET
PEAK
DURATION
Subcut
within 15 min
1–2 hr
3–4 hr
⫽ Genetic Implication.
pg 1 # 1
Contraindications/Precautions
Contraindicated in: Hypoglycemia; Allergy or hypersensitivity to insulin aspart.
Use Cautiously in: Stress and infection, which may temporarilyqinsulin requirements; Renal/hepatic impairment (maypinsulin requirements); Must be used with a
longer-acting insulin in patients with type 1 diabetes; Concomitant use with pioglitazone or rosiglitazone (qrisk of fluid retention and worsening HF); OB: May temporarilyqinsulin requirements; Pedi: Children ⬍6 yr (safety not established).
Adverse Reactions/Side Effects
Endo: HYPOGLYCEMIA. Local: lipodystrophy, pruritis, erythema, swelling. Misc: allergic reactions including ANAPHYLAXIS.
Interactions
Drug-Drug: Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia. Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin mayqinsulin requirements. Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents,
and salicylates, maypinsulin requirements. Concurrent use with pioglitazone or
rosiglitazone mayqrisk of fluid retention and worsening HF.
Drug-Natural Products: Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic
effects.
Route/Dosage
Subcut (Adults and Children): Determined by needs of the patients; generally
0.5– 1 units/kg/day total. 50– 70% may be given as insulin aspart, and the remainder
as intermediate- or long-acting insulin. May also be given via subcutaneous infusion
pump; initial programming based on total daily dose of insulin given in previous regimen with 50% of total daily dose given as premeal boluses and 50% of total daily dose
given as basal infusion; dose can then be adjusted based on response.
NURSING IMPLICATIONS
Assessment
● Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in
TIME/ACTION PROFILE (hypoglycemic effect)
ROUTE
⫽ Canadian drug name.
Plate # 0-Composite
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;
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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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.
● Toxicity and Overdose: 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
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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
Plate # 0-Composite
pg 2 # 2
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.
● Subcut: 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.
IV Administration
● pH: 7.2– 7.6.
● IV: May be given IV in selected clinical situations under appropriate medical su-
pervision. 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,
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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.
䉷 2015 F.A. Davis Company
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insulin aspart
● Advise patient to notify health care professional of all Rx or OTC medications, vita●
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mins, 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 breast feeding or planning to breast feed.
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 hy-
perglycemic episodes.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.