What are some special considerations when using aspart insulin?

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 1, 2024.

Contraindications And Precautions Insulin aspart may be given via continuous subcutaneous insulin infusion (CSII) administration using external pumps; extra caution may be advised. Patients should be advised that self-monitoring of blood glucose is especially important when using CSII. Insulin aspart should not be diluted or mixed with any other insulins when used in an external pump. Physicians and patients should carefully evaluate information on pump use in the insulin aspart physician package insert, the insulin aspart patient package insert, and in the pump manufacturer's manual. Specific information for the insulin aspart product and the insulin pump used should be followed for in-use time, frequency of changing infusion sets, or other details as this information may differ from other products or pumps. Pump or infusion set malfunction or insulin degradation can lead to hyperglycemia and DKA or HHS in a short time because of the small subcutaneous depot of insulin. This is especially important for rapid-acting insulin analogs that are more quickly absorbed through skin and have a shorter duration of action (e.g., insulin aspart). These differences may be particularly relevant when patients are switched from multiple injection therapy or infusion with buffered regular insulin. If hyperglycemia during CSII occurs, prompt identification of the cause of hyperglycemia is necessary. Interim therapy with subcutaneous insulin injections may be required.

Contraindications And Precautions Insulin aspart differs from regular insulin by a more rapid onset and a shorter duration of activity. When used as a mealtime subcutaneous insulin, care should be taken in the timing of administration with regard to meals and snacks. For Novolog insulin aspart products, inject within within 5 to 10 minutes before a meal. Because of the faster onset, inject Fiasp insulin aspart products at the start of a meal or within 20 minutes after starting a meal. Dose adjustments may be needed when there are changes in meal patterns (i.e., macronutrient content or timing of food intake). Regular self-monitoring of blood glucose is recommended in all patients with diabetes mellitus, especially those on insulin therapy.

Contraindications And Precautions Changes in insulin products like insulin aspart should be made by experienced medical personnel. When changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site, method of administration) are made, glycemic control may be affected; dosage adjustments may be required. The physiologic response resulting from the mixing together of different insulins for subcutaneous administration may differ from the response occurring when the insulins are administered separately. Treatment must be individualized. Instruct patients to avoid repeated insulin injection into areas of lipodystrophy or localized cutaneous amyloidosis as this may result in hyperglycemia; and a sudden change in injection site to an unaffected area may result in low blood glucose. Diabetic patients must follow a regular, prescribed diet and exercise schedule to avoid either hypo- or hyperglycemia. The timing of meals and exercise with insulin doses is extremely important, and should remain consistent, unless prescribed otherwise. Fever, thyroid disease, infection, recent trauma or surgery, diarrhea secondary to malabsorption, vomiting, and certain medications can also affect insulin requirements, requiring dosage adjustments. Diabetic patients should be given a 'sick-day' plan to take appropriate action with blood glucose monitoring and insulin therapy when acute illness is present.

Contraindications And Precautions Insulin aspart use is contraindicated in patients during episodes of hypoglycemia. Hypoglycemia is the most common adverse effect of insulin therapy; hypoglycemia is the major barrier to achieving optimal glycemic control long term. Severe or frequent hypoglycemia in a patient is an indication for the modification of treatment regimens, including setting higher glycemic goals. Hypoglycemia may occur with overdose of insulin, a delayed or decreased food intake, or following intense exercise. Patients at risk for severe, iatrogenic hypoglycemia include those with insulin deficiency (i.e., Type 1 diabetes mellitus and advanced Type 2 diabetes mellitus), those with a history of severe hypoglycemia or hypoglycemia unawareness, the elderly, and those undergoing intensive insulin therapy. Patients with a body mass index (BMI) more than 32 may also be at increased risk for hypoglycemia when using insulin aspart due to a reduction in insulin aspart clearance. When insulin aspart is administered IV, patients should be monitored closely for hypoglycemia. Changes in insulin, manufacturer, type, or method or site of administration may also affect glycemic control. It is essential that clinicians and patients ensure the correct insulin is dispensed and administered; this includes the correct insulin brand and concentration. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia. Make any changes to a patient's insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia.

Contraindications And Precautions In clinical trials of insulin aspart, no overall differences in safety or effectiveness were observed between older and younger adults. However, geriatric adults are especially at risk for hypoglycemic episodes when using insulin. The initial dosing and dosing increments of any insulin product should be conservative. Severe or frequent hypoglycemia is an indication for the modification of treatment regimens, including setting higher glycemic goals. Risk factors for hypoglycemia in the older adult include intensive insulin therapy, use of an excessive insulin dose, improper timing of insulin administration with regard to meals, injection of the wrong type of insulin, renal failure, severe liver disease, alcohol ingestion, defective counter-regulatory hormone release, missing meals/fasting, and gastroparesis. Use caution when prescribing insulin to older adults or other patients with compromised vision. Patients who suffer from visual impairment may rely on audible clicks to dial their dose from an insulin pen; preparing the injection by using audible clicks may result in dosing errors. According to the Beers Criteria, the sole use of short- or rapid-action insulin to manage or avoid hyperglycemia in the absence of basal or long-acting insulin is considered a potentially inappropriate medication (PIM) in geriatric patients and should be avoided due to a higher risk of hypoglycemia and no improvement in hyperglycemia management regardless of care setting. The recommendation does not apply to the use of short- or rapid-acting insulin in conjunction with scheduled insulin.

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 1, 2024.

Contraindications And Precautions Do not administer insulin aspart; insulin aspart protamine mixtures by intravenous administration. Insulin aspart; insulin aspart protamine mixtures should not be used for diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), diabetic coma, or other emergencies requiring rapid onset of insulin action. Several types, routes, and frequencies of administration of insulin have been studied in patients with DKA and HHS; however, the American Diabetes Association recommends that regular insulin (versus the rapid-acting analogs) by continuous intravenous infusion be used to treat these conditions unless they are considered mild. Regular insulin is also preferred for those patients with poor tissue perfusion, shock, or cardiovascular collapse, or in patients requiring insulin for the treatment of hyperkalemia. Longer-acting insulins including insulin aspart; insulin aspart protamine mixtures should not be used for continuous subcutaneous insulin infusion (CSII) administration; only quick acting insulins (e.g., regular insulin, insulin lispro, insulin glulisine, and insulin aspart) should be used by this route of administration.

3.

Food and Drug Administration (DailyMed).

Publish date: June 3, 2023.

Dosage And Administration • Use PenFill cartridges with caution in patients with visual impairment. • Do not mix Fiasp (insulin aspart injection) with any other insulin. 2.2 Route of Administration Instructions Subcutaneous Injection: • Inject Fiasp (insulin aspart injection) at the start of a meal or within 20 minutes after starting a meal subcutaneously into the abdomen, upper arm, or thigh. • Rotate injection sites within the same region from one injection to the next to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not inject into areas of lipodystrophy or localized cutaneous amyloidosis [see Adverse Reactions ( 6.1, 6.2 )]. • Fiasp (insulin aspart injection) given by subcutaneous injection should generally be used in regimens with intermediate or long-acting insulin. • Instruct patients on basal-bolus treatment who forget a mealtime dose to monitor their blood glucose level to decide if an insulin dose is needed, and to resume their usual dosing schedule at the next meal. • The Fiasp (insulin aspart injection) FlexTouch pen dials in 1 unit increments. Continuous Subcutaneous Infusion (Insulin Pump): • Refer to the continuous subcutaneous insulin infusion pump user manual to see if Fiasp (insulin aspart injection) or Fiasp (insulin aspart injection) PumpCart can be used with the insulin pump. Use Fiasp (insulin aspart injection) and Fiasp (insulin aspart injection) PumpCart in accordance with the insulin pump system’s instructions for use. • Administer Fiasp (insulin aspart injection) by continuous subcutaneous infusion in a region recommended in the instructions from the pump manufacturer. Rotate infusion sites within the same region to reduce the risk of lipodystrophy and localized cutaneous amyloidosis. Do not infuse into areas of lipodystrophy or localized cutaneous amyloidosis [see Warnings and Precautions ( 5.2 ) Adverse Reactions ( 6.1 )]. • Train patients using continuous subcutaneous insulin infusion therapy to administer insulin by injection and have alternate insulin therapy available in case of insulin pump failure [see Warnings and Precautions ( 5.8 )].

4.

Evans M, Ceriello A, Danne T, et al. Diabetes, Obesity & Metabolism. 2019;21(9):2039-2047. doi:10.1111/dom.13798. Copyright License: CC BY

Publish date: September 0, 2019.

A numerical imbalance in severe hypoglycaemic episodes between faster aspart and IAsp was seen in the treatment (21 vs 7) and the 4-week run-in periods (4 vs 0). Experience from clinical practice indicates that all pump settings should be reviewed when initiating faster aspart with CSII, and that the use of continuous glucose monitoring or flash glucose monitoring, along with a good understanding of meal content and bolus type, may also facilitate optimal use. This review summarizes the available clinical evidence for faster aspart administered via CSII and highlights practical considerations based on clinical experience that may help healthcare providers and individuals with T1D successfully initiate and adjust faster aspart with CSII.