Insulin aspart

FDA label

Read the full label on DailyMed ↗

Renal Increased risk of hypoglycemia - may require more frequent dose adjustment and more frequent blood glucose monitoring.

Hepatic Increased risk of hypoglycemia - may require more frequent dose adjustment and more frequent blood glucose monitoring.

Dosage differs by route (SC injection / pump / IV). Pump reservoir must be changed at least every 7 days and pump insulin must not be diluted or mixed.

Instructions

• Inject SC into the abdominal area, thigh, buttocks or upper arm within 5-10 minutes before a meal; rotate sites within the same region and never inject into areas of lipodystrophy or localized cutaneous amyloidosis.
• Always check the insulin label before administration; inspect - use only if clear and colorless.
• Generally use in a regimen with an intermediate- or long-acting insulin when given by SC injection.
• For SC injection only, may be diluted with Insulin Diluting Medium for Garzulys: 1 part drug to 9 parts diluent = U-10; 1 part to 1 part = U-50.
• For SC injection, may be mixed only with NPH insulin - draw the insulin aspart into the syringe first and inject immediately after mixing.
• Pump: do not dilute or mix with any other insulin; change the reservoir at least every 7 days (or per pump manual, whichever is shorter); change the infusion set and site per the manufacturer's manual; do not expose the reservoir to temperatures above 98.6 F (37 C).
• Train pump users to give insulin by injection and keep alternate insulin available in case of pump failure.
• IV use only under medical supervision with close blood glucose and potassium monitoring.
• The prefilled pen dials in 1-unit increments - use with caution in visual impairment where the patient relies on audible clicks.
• Increase the frequency of blood glucose monitoring during any change to the insulin regimen.

Contraindications

• During episodes of hypoglycemia

Cautions

• Never share a prefilled pen, needle or syringe between patients, even if the needle is changed - risk of bloodborne pathogen transmission.
• Hyperglycemia or hypoglycemia with changes in insulin regimen (strength, manufacturer, type, injection site or route) - change only under close supervision with more frequent glucose monitoring.
• Hypoglycemia may be life-threatening; risk rises with dosage changes, other glucose-lowering drugs, meal or activity changes, renal or hepatic impairment, and hypoglycemia unawareness.
• Hypoglycemia due to medication errors - accidental mix-ups between insulin products; instruct patients to check labels before every injection.
• Severe, life-threatening generalized allergy including anaphylaxis - discontinue, treat and monitor.
• Hypokalemia - insulin shifts potassium intracellularly; monitor and treat in patients at risk.
• Fluid retention and heart failure with concomitant PPAR-gamma agonists (thiazolidinediones).
• Hyperglycemia and ketoacidosis from insulin pump device malfunction.

Adverse reactions

• Hypoglycemia (most common)
• Allergic reactions, including systemic allergy
• Injection or infusion site reactions
• Lipodystrophy and localized cutaneous amyloidosis
• Rash, pruritus
• Hypokalemia

Pregnancy Published randomized-trial data with insulin aspart products (second trimester) have not shown an association with major birth defects or adverse maternal/fetal outcomes; poorly controlled diabetes itself carries substantial maternal and fetal risk.

Lactation No data on insulin aspart in human milk; one small study found exogenous insulin including insulin aspart present in milk - weigh benefits of breastfeeding against maternal need.