insulin aspart

NovoLOG

Novorapid

insulin aspart protamine suspension/insulin aspart injection mixture

NovoLOG Mix 70/30

Novomix 30

Indications

Action

Pharmacokinetics

Time/action profile (hypoglycemic effect)

Contraindications/Precautions

Adverse Reactions/Side Effects

Endocrinologic

• hypoglycemia (life-threatening)

Local

• lipodystrophy
• pruritis
• erythema
• swelling

Miscellaneous

• allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in 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; 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.
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

Implementation

• high alert: Medication errors involving insulins have resulted in serious patient 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 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.
• Subcutaneous: 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.

• Intravenous Administration

• pH: 7.2–7.6.
• Intravenous: May be given IV in selected clinical situations under appropriate medical supervision. 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, 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.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, 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 breastfeeding or planning to breastfeed.
• 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 hyperglycemic episodes.