Aspart Insulin


Article Author:
Rochelle Rubin


Article Editor:
Lindsey McIver


Editors In Chief:
Chaddie Doerr


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
9/27/2019 1:38:00 PM

Indications

 Insulin aspart is a rapid-acting, human insulin analog that is FDA approved for the treatment of type-1 and type-2 diabetes mellitus to improve glycemic control in adults and children. Insulin aspart may also be used to treat diabetic ketoacidosis (DKA), though this is not an FDA-approved indication. Insulin aspart should be used in addition to a long-acting (basal) insulin for complete therapy unless used in a continuous subcutaneous (insulin pump) or intravenous insulin infusion. Rapid-acting insulin products target-controlling, after-meal, blood glucose levels, or reducing blood glucose in response to an elevated blood glucose measurement, as in a correctional scale.[1][2][3]

Insulin aspart, or any rapid or short-acting insulin, is a mainstay of therapy in type-1 diabetes. Total daily insulin doses are usually between 0.4 to 1 units/kg per day, divided into long-acting insulin and rapid-acting insulin, such as insulin aspart. An initial breakdown of 50% basal insulin, 50% rapid-acting insulin is a starting place for most patients with type-1 diabetes and adjusted based on blood glucose. Doses are highly patient specific. Type-2 diabetes patients often use more basal insulin than bolus insulin compared to type-1 diabetes patients.

In type-2 diabetes, insulin aspart may be added for further glycemic control in addition to oral medications or long-acting insulin. Recommended starting doses for type-2 diabetes mellitus patients may be any of the following options: 4 units per meal, 0.1 units/kg per meal, or 10% of the basal dose. If A1c is less than 8%, consider reducing basal insulin dose when adding insulin aspart with meals.

Insulin aspart is also available commercially in a combination product with insulin degludec (long-acting insulin) or insulin aspart protamine (intermediate action insulin). Insulin degludec plus insulin aspart is dosed once or twice a day with the main meal. Insulin-naive patients should start insulin degludec/insulin aspart at 0.2 to 0.4 units/kg per day. Insulin aspart/insulin aspart protamine is 30% insulin aspart, 70% insulin aspart protamine. Dosing for the protamine product starts at 0.5 units/kg per day, divided into 2 doses before meals with 70% of the total daily dose before breakfast and 30% of the total daily dose before dinner.[4][5][6]

Mechanism of Action

Insulin aspart regulates the metabolism of glucose. It promotes the storage and inhibits the breakdown of glucose, fat, and amino acids. Insulin lowers blood glucose by increasing peripheral glucose uptake, particularly in the skeletal muscle and fat. Insulin enhances the storage of fat (lipogenesis) and protein synthesis. Insulin aspart also inhibits gluconeogenesis (hepatic glucose production), lipolysis (breakdown of fat/lipids to fatty acids), and proteolysis (breakdown of proteins into amino acids). Maximum glucose lowering effects are seen within 1 to 2 hours and endure for 3 to 5 hours. Insulin aspart is equipotent to regular insulin with faster onset and shorter duration of action. Thus insulin aspart is preferred for mealtime insulin coverage as it can be administered up to every 4 hours.

Administration

Insulin aspart should be administered subcutaneously (SC) within 5 to 10 minutes before a meal, with 1 to 4 meals per day. Rotate injection sites between the top of thighs, back of upper arms, buttocks, or abdomen to avoid lipodystrophy. Avoid injecting within 2 inches of the naval. Insulin aspart may also be administered using a continuous subcutaneous infusion through an insulin pump or intravenously (IV) as a diluted solution with close monitoring of blood glucose and serum potassium. Insulin aspart may be mixed with NPH insulin only, but may only be administered SC once mixed.

Adverse Effects

The primary adverse effect of insulin aspart is hypoglycemia, defined as blood glucose less than 70 mg/dL. Signs and symptoms of hypoglycemia include dizziness, light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, tachycardia, irritability, or hunger. Severe cases of hypoglycemia (blood glucose less than 30 mg/dL) may lead to seizures or death. Hypoglycemia is a dose-dependent adverse effect and can be avoided in the future with lower doses of insulin. After any hypoglycemic event, insulin doses and food (glucose) intake should be evaluated to adjust therapy and prevent future hypoglycemia. [7][8][9]

Additional adverse reactions may include allergic reactions including local injection site reactions, lipodystrophy, rash, pruritus, and hypokalemia. Hypokalemia is dose-dependent, though the other additional adverse drug reactions are not dose-dependent.

Contraindications

Insulin aspart is contraindicated in patients with documented hypersensitivity to the drug or component of the formulation. It is also contraindicated during episodes of hypoglycemia, though may be resumed at lower doses once the hypoglycemia resolves. Patients with hypersensitivity to other insulin products may try insulin aspart with the appropriate support in case of a reaction (antihistamine and/or epinephrine as needed).

Monitoring

Critically ill patients receiving insulin aspart should have their glucose monitored every 1 to 2 hours. Non-critically ill patients using insulin aspart should monitor their blood glucose level routinely at home or in the hospital to assess the efficacy of the insulin dose. Preferably, this should be done either before a meal or 2 hours after a meal. Insulin doses should be adjusted based on the monitored blood glucose levels, generally a 105 to 20% adjustment in either direction. All patients on insulin therapy should receive biannual A1c monitoring and annual electrolyte monitoring. Hemoglobin A1c should be monitored quarterly in patients not meeting treatment goals or after changes in therapy.

Monitoring goals according to the American Diabetes Association include fasting blood glucose 80 to 130 mg/dL, peak postprandial (1 to 2 hours after a meal) blood glucose less than 180 mg/dL, and hemoglobin A1c less than 7.0% for non-pregnant adult patients. Glycemic goals may change for individual patients based on the patient’s age, duration of diabetes, comorbid conditions, hypoglycemia unawareness, risks of hypoglycemic events and other individual patient considerations, with less stringent goals for patients with more comorbid conditions or higher risk of harm in a hypoglycemic event.

Toxicity

Toxic effects of insulin aspart include hypoglycemia, which is treated by giving glucose, dextrose, or oral carbohydrates to increase the blood glucose. Patients who can consume oral carbohydrates including glucose gel, tablets, or glucose-containing food should consume 15 grams of carbohydrates to treat the hypoglycemic episode. Wait 15 minutes after eating the glucose to recheck blood glucose, and if it remains hypoglycemic repeat the treatment. Once the glucose returns to normal, the patient should eat a meal within the next hour to prevent recurrence of hypoglycemia.  If the patient is unable or unwilling to consume oral glucose, intramuscular glucagon is used for ambulatory patients, either administered by themselves or a caregiver. Intravenous dextrose can be used in conscious and unconscious hospitalized patients with hypoglycemia, administering 10 to 25 g per dose of IV dextrose. Blood glucose level should be monitored 15 minutes after receiving dextrose, and repeat doses of IV dextrose or intramuscular (IM) glucagon may be necessary until blood glucose returns to normal. Additionally, after any hypoglycemic event, doses of insulin should be evaluated and adjusted to prevent additional hypoglycemia.

Enhancing Healthcare Team Outcomes

 All healthcare workers including nurse practitioners who use insulin aspart should be familiar with is indications and adverse effects. Insulin aspart is a rapid-acting, human insulin analog that is FDA approved for the treatment of type-1 and type-2 diabetes mellitus to improve glycemic control in adults and children. Insulin aspart may also be used to treat diabetic ketoacidosis (DKA), though this is not an FDA-approved indication. Insulin aspart should be used in addition to a long-acting (basal) insulin for complete therapy unless used in a continuous subcutaneous (insulin pump) or intravenous insulin infusion. Rapid-acting insulin products target-controlling, after-meal, blood glucose levels, or reducing blood glucose in response to an elevated blood glucose measurement, as in a correctional scale. It is important for healthcare workers to monitor glucose levels closely when administering insulin aspart as it can induce hypoglycemia. Thus, it is always important to have some type of glucose fluid or a meal ready in case hypoglycemia develops.[10]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Aspart Insulin - Questions

Take a quiz of the questions on this article.

Take Quiz
What type of duration of action is insulin aspart?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which insulin has the most rapid onset of action?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which medication should be used to treat a patient in a diabetic ketoacidosis coma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best time to inject insulin aspart?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 15-year-old male admitted to the hospital for newly diagnosed type 1 diabetes mellitus with a hemoglobin A1c of 11.5%. He has no significant past medical history. His weight is 66 kg and height is 1.55 m (61"). The medical team wants to start the patient on a basal/bolus insulin regimen. Which regimen should be recommended?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
How long after insulin aspart administration should a patient monitor their blood glucose?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Aspart Insulin - References

References

Kildegaard J,Buckley ST,Nielsen RH,Povlsen GK,Seested T,Ribel U,Olsen HB,Ludvigsen S,Jeppesen CB,Refsgaard HHF,Bendtsen KM,Kristensen NR,Hostrup S,Sturis J, Elucidating the Mechanism of Absorption of Fast-Acting Insulin Aspart: The Role of Niacinamide. Pharmaceutical research. 2019 Feb 11;     [PubMed]
Wen WL,Tsai KB,Lin YH,Hwang SJ,Hsiao PJ,Shin SJ,Hung WW, Successful management of type IV hypersensitivity reactions to human insulin analogue with injecting mixtures of biphasic insulin aspart and dexamethasone. Journal of the Formosan Medical Association = Taiwan yi zhi. 2019 Jan 28;     [PubMed]
You W,Yang J,Liu Y,Wang W,Zhu L,Wang W,Yang J,Chen F, Fulminant type 1 diabetes mellitus: Two case reports. Medicine. 2019 Feb;     [PubMed]
Siebel S,Galderisi A,Patel NS,Carria LR,Tamborlane WV,Sherr JL, Reversal of Ketosis in Type 1 Diabetes Is Not Adversely Affected by SGLT2 Inhibitor Therapy. Diabetes technology     [PubMed]
Melo KFS,Bahia LR,Pasinato B,Porfirio GJM,Martimbianco AL,Riera R,Calliari LEP,Minicucci WJ,Turatti LAA,Pedrosa HC,Schaan BD, Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetology     [PubMed]
Misra S,Mathieu C, Are newer insulin analogues better for people with Type 1 diabetes ? Diabetic medicine : a journal of the British Diabetic Association. 2018 Dec 26;     [PubMed]
Fullerton B,Siebenhofer A,Jeitler K,Horvath K,Semlitsch T,Berghold A,Gerlach FM, Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus. The Cochrane database of systematic reviews. 2018 Dec 17;     [PubMed]
Shi C,Sun L,Bai R,Wang H,Liu D,Du J, Comparison of a twice-daily injection of insulin aspart 50 with insulin aspart 30 in patients with poorly controlled type 2 diabetes. Current medical research and opinion. 2018 Dec 14;     [PubMed]
Nunez Lopez YO,Retnakaran R,Zinman B,Pratley RE,Seyhan AA, Predicting and understanding the response to short-term intensive insulin therapy in people with early type 2 diabetes. Molecular metabolism. 2019 Feb;     [PubMed]
Buse JB,Carlson AL,Komatsu M,Mosenzon O,Rose L,Liang B,Buchholtz K,Horio H,Kadowaki T, Fast-acting insulin aspart versus insulin aspart in the setting of insulin degludec-treated type 1 diabetes: Efficacy and safety from a randomized double-blind trial. Diabetes, obesity     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Child Health PN. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Child Health PN, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Child Health PN, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Child Health PN. When it is time for the Nurse-Child Health PN board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Child Health PN.