Insulin Aspart

Insulin Aspart Brand Names

Fiasp | Fiasp Flex Touch | Fiasp PenFill | NovoLog | NovoLog Flexpen 

What is Insulin Aspart

Insulin aspart is a rapid-acting insulin analog that is produced from a chemical modification of regular human insulin; the amino acid proline at position B28 in human insulin is replaced by aspartic acid. Insulin aspart is considered equipotent to regular insulin; however, it has a quicker onset of action, reaches maximum concentration faster, has less absorption variation, and has a shorter duration of action.

Insulin aspart is often used as prandial or snack boluses in combination with longer-acting insulins or in external insulin pumps in children and adults with type 1 diabetes mellitus (DM).

Two formulations of insulin aspart are available and are FDA-approved in pediatric patients as young as 2 years of age.

Faster-acting insulin aspart (Fiasp) differs from NovoLog due to its onset of action after subcutaneous administration; the product has different instructions for timing of administration concerning meals.

Because of their quicker onset and shorter duration of action, the rapid-acting analogs like insulin aspart more closely mimic endogenous human insulin secretion after meals providing improvements in post-prandial glucose control (a decrease of glucose concentrations postprandially of 21% to 57% when compared to regular insulin) and a lesser need for snacks in between meals.

Use of rapid-acting analogs also decreases the incidence of hypoglycemia including nighttime and severe hypoglycemia, even when A1C values are lower.

One meta-analysis of patients with type 1 DM found that the incidence of severe hypoglycemia was 30% lower in patients treated with a fast-acting insulin analog when compared to regular insulin.

In direct comparisons of insulin aspart with insulin lispro, the 2 insulins have been found to be equally effective in patients with type 1 DM. 

Insulin aspart is also a treatment option for adult and pediatric patients with type 2 DM who have failed to achieve or maintain glycemic goals on maximally tolerated doses of oral medication.

In the treatment of type 1 DM, insulin therapy may be initiated with a basal-bolus regimen and then further individualized to achieve treatment goals.

In the treatment of type 2 DM, insulin is generally reserved for patients who continue to have an A1C above target despite dual/triple therapy with metformin and other antidiabetic agents. In patients who need the greater glucose-lowering effect of an injectable medication, GLP-1 receptor agonists (GLP-1 RA) are the preferred choice to insulin.

Evidence from trials comparing GLP-1 RAs and insulin (basal, premixed, or basal-bolus) shows similar or even better efficacy in A1C reduction; GLP-1 RAs have a lower risk of hypoglycemia and are associated with reductions in body weight compared to weight gain with insulin.

In patients who cannot tolerate a GLP-1 RA, or who fail to meet glycemic targets with dual/triple therapy, insulin therapy with basal insulin should be initiated and titrated to target. If A1C remains above target, prandial insulin, such as insulin aspart should be added.

Consider an initial injectable combination (i.e., GLP-1 RA plus basal insulin or prandial/basal insulin) if A1C is greater than 10% and 2% above target.

Consider the early introduction of insulin if there is evidence of ongoing catabolism, if symptoms of hyperglycemia are present, or when A1C concentrations (greater than 10%) or blood glucose concentrations (300 mg/dL or more) are very high. In patients who are starting on insulin therapy and are taking a thiazolidinedione or sulfonylurea, discontinue or reduce the dose of the oral medication.

Indications

1. diabetic ketoacidosis
2. gestational diabetes
3. type 1 diabetes mellitus
4. type 2 diabetes mellitus

Side Effects

1. abdominal pain
2. anaphylactoid reactions
3. antibody formation
4. back pain
5. chest pain (unspecified)
6. cutaneous amyloidosis
7. diarrhea
8. dyspnea
9. fever
10. headache
11. hyperinsulinemia
12. hypertension
13. hypoglycemia
14. hypokalemia
15. hyporeflexia
16. hypotension
17. infection
18. influenza
19. infusion-related reactions
20. injection site reaction
21. insulin resistance
22. insulin shock
23. lipodystrophy
24. nausea
25. peripheral edema
26. pharyngitis
27. pruritus
28. rash
29. rhinitis
30. sinusitis
31. Somogyi effect
32. urticaria
33. vomiting
34. weight gain
35. wheezing

Monitoring Parameters

• blood glucose
• glycosylated hemoglobin A1c (HbA1c)

Contraindications

• breast-feeding
• continuous subcutaneous insulin infusion (CSII) administration
• cresol hypersensitivity
• diabetic ketoacidosis
• diarrhea
• fever
• geriatric
• hepatic disease
• hyperosmolar hyperglycemic state (HHS)
• hypoglycemia
• hypokalemia
• infection
• intravenous administration
• neonates
• pregnancy
• renal failure
• renal impairment
• surgery
• thyroid disease
• tobacco smoking
• trauma
• visual impairment
• vomiting

Interactions

• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetazolamide
• Acrivastine; Pseudoephedrine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminosalicylate sodium, Aminosalicylic acid
• Amlodipine; Benazepril
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amprenavir
• Androgens
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
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• Bendroflumethiazide; Nadolol
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• Benzphetamine
• Beta-blockers
• Betamethasone
• Betaxolol
• Bexarotene
• Bismuth Subsalicylate
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• Bisoprolol
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• Bortezomib
• Brexpiprazole
• Brimonidine; Timolol
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
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• Chlorpheniramine; Dihydrocodeine; Phenylephrine
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• Chlorpheniramine; Hydrocodone; Phenylephrine
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• Garlic, Allium sativum
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• Glimepiride; Rosiglitazone
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• Green Tea
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guaifenesin; Phenylephrine
• Guaifenesin; Pseudoephedrine
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• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydrocortisone
• Hydroxychloroquine
• Hydroxyprogesterone
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Pseudoephedrine
• Iloperidone
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• Linagliptin; Metformin
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• Meperidine; Promethazine
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• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
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• Metformin; Saxagliptin
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• Methamphetamine
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• Moexipril
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• Monoamine oxidase inhibitors
• Nadolol
• Nandrolone Decanoate
• Naproxen; Pseudoephedrine
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• Nicotine
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• Norgestrel
• Octreotide
• Olanzapine
• Olmesartan
• Ombitasvir; Paritaprevir; Ritonavir
• Orlistat
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• Pasireotide
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• Pemoline
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• Pentamidine
• Pentoxifylline
• Perindopril
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• Perphenazine
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• Phendimetrazine
• Phenelzine
• Phenothiazines
• Phentermine
• Phentermine; Topiramate
• Phenylephrine
• Phenylephrine; Promethazine
• Phenytoin
• Pindolol
• Pioglitazone
• Pramlintide
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Prednisolone
• Prednisone
• Prilocaine; Epinephrine
• Prochlorperazine
• Progesterone
• Progestins
• Promethazine
• Propoxyphene
• Propranolol
• Protease inhibitors
• Pseudoephedrine
• Pyrimethamine; Sulfadoxine
• Quetiapine
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• Quinolones
• Racepinephrine
• Ramipril
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