Insulin Aspart Insulin Aspart Protamine Brand Name– NovoLog Mix 70/30
What is Insulin Aspart Insulin Aspart Protamine
Insulin aspart protamine and insulin aspart mixtures are a combination of a rapid-acting insulin analog (insulin aspart) and intermediate-acting insulin (insulin aspart protamine). insulin aspart protamine and insulin aspart mixtures are equipotent to similar insulin mixtures such as regular insulin; isophane insulin (NPH) mixture and insulin lispro protamine; insulin lispro mixture. Insulin aspart is produced from a chemical modification of regular human insulin; the amino acid proline at position B28 is substituted with aspartic acid.
Similar to isophane insulin (NPH), protamine is added to insulin aspart to prolong the onset and duration of action; the pharmacodynamics and pharmacokinetics of insulin aspart protamine are similar to isophane insulin (NPH). The insulin aspart protamine and insulin aspart mixtures are indicated to improve glycemic control in patients with type 1 and type 2 diabetes mellitus (DM).
Pre-mixed insulin mixtures may decrease the overall number of injections required by patients daily. However, because such mixtures are available in fixed ratios only, some patients may not be able to achieve glycemic control with their use.
Insulin aspart protamine; insulin aspart mixture is often administered twice daily in the treatment of patients with type 2 DM.
When compared to NPH insulin-regular insulin mixtures, the insulin mixtures containing rapid-acting analogs (insulin aspart or insulin lispro) result in improved postprandial glucose control and a lower incidence of hypoglycemia, including nocturnal hypoglycemia.
However, overall improvements in glycemic control have not been consistently demonstrated. The rapid-acting analog mixtures may be more convenient for patients to use as the injections can be given within 15 minutes before a meal.
In the treatment of type 1 diabetes mellitus (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 the A1C remains above target, prandial insulin or pre-mixed insulin, such as insulin aspart protamine; insulin aspart mixture should be added.
Consider 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 levels (greater than 10%) or blood glucose levels (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
- type 1 diabetes mellitus
- type 2 diabetes mellitus
Side Effects
- abdominal pain
- anaphylactoid reactions
- antibody formation
- back pain
- cutaneous amyloidosis
- diaphoresis
- diarrhea
- dyspepsia
- dyspnea
- erythema
- headache
- hyperinsulinemia
- hypertension
- hypoglycemia
- hypokalemia
- hypotension
- infection
- influenza
- injection site reaction
- insulin resistance
- insulin shock
- lipodystrophy
- musculoskeletal pain
- peripheral edema
- peripheral neuropathy
- pharyngitis
- pruritus
- rash
- rhinitis
- sinus tachycardia
- Somogyi effect
- weight gain
- wheezing
Monitoring Parameters
- blood glucose
- glycosylated hemoglobin A1c (HbA1c)
Contraindications
- breast-feeding
- children
- coma
- continuous subcutaneous insulin infusion (CSII) administration
- cresol hypersensitivity
- diabetic ketoacidosis
- diarrhea
- fever
- geriatric
- hepatic disease
- hyperosmolar hyperglycemic state (HHS)
- hypoglycemia
- hypokalemia
- infants
- 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
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
- Atenolol; Chlorthalidone
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- atypical antipsychotic
- Azelastine; Fluticasone
- Azilsartan
- Azilsartan; Chlorthalidone
- Beclomethasone
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Beta-blockers
- Betamethasone
- Betaxolol
- Bexarotene
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bortezomib
- Brexpiprazole
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide
- Budesonide; Formoterol
- Bumetanide
- Canagliflozin; Metformin
- Candesartan
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Cariprazine
- Carteolol
- Carvedilol
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroquine
- Chlorothiazide
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Chromium
- Ciclesonide
- Cisapride
- Clarithromycin
- Clonidine
- Clozapine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Colesevelam
- Conjugated Estrogens
- Conjugated Estrogens; Bazedoxifene
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- Cyclosporine
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- Darunavir
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- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deflazacort
- Desloratadine; Pseudoephedrine
- Dexamethasone
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Diazoxide
- Dienogest; Estradiol valerate
- Diethylpropion
- Diethylstilbestrol, DES
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Disopyramide
- Dobutamine
- Dopamine
- Dorzolamide; Timolol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Edetate Calcium Disodium, Calcium EDTA
- Edetate Disodium, Disodium EDTA
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Ephedrine
- Epinephrine
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Ertugliflozin; Metformin
- Erythromycin; Sulfisoxazole
- Esmolol
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estramustine
- Estrogens
- Estropipate
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethotoin
- Etonogestrel
- Exenatide
- Fenofibrate
- Fenofibric Acid
- Fexofenadine; Pseudoephedrine
- Fibric acid derivatives
- Fludrocortisone
- Flunisolide
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluoxymesterone
- Fluphenazine
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosamprenavir
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Furosemide
- Garlic, Allium sativum
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide; Metformin
- Glucagon
- Glyburide; Metformin
- Green Tea
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Hydralazine; Hydrochlorothiazide, HCTZ
- 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
- Indapamide
- Indinavir
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Irbesartan
- Isocarboxazid
- Isoproterenol
- Labetalol
- Lanreotide
- Ledipasvir; Sofosbuvir
- Leuprolide; Norethindrone
- Levobetaxolol
- Levobunolol
- Levonorgestrel
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linagliptin; Metformin
- Linezolid
- Liothyronine
- Liraglutide
- Lisdexamfetamine
- Lisinopril
- Lithium
- Lixisenatide
- Lomefloxacin
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lorcaserin
- Losartan
- Lovastatin; Niacin
- Lumateperone
- Lurasidone
- Macimorelin
- Magnesium Salicylate
- Mecasermin rinfabate
- Mecasermin, Recombinant, rh-IGF-1
- Medroxyprogesterone
- Meperidine; Promethazine
- Mepivacaine; Levonordefrin
- Mesoridazine
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methamphetamine
- Methazolamide
- Methohexital
- Methyclothiazide
- Methylphenidate
- Methylprednisolone
- Methyltestosterone
- Metoclopramide
- Metolazone
- Metoprolol
- Metreleptin
- Metyrapone
- Midodrine
- Moexipril
- Mometasone
- Monoamine oxidase inhibitors
- Nadolol
- Nandrolone Decanoate
- Naproxen; Pseudoephedrine
- Nebivolol
- Nebivolol; Valsartan
- Nelfinavir
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicotine
- Norepinephrine
- Norethindrone
- Norgestrel
- Octreotide
- Olanzapine
- Olmesartan
- Ombitasvir; Paritaprevir; Ritonavir
- Orlistat
- Oxandrolone
- Oxymetholone
- Paliperidone
- Pasireotide
- Pegvisomant
- Pemoline
- Penbutolol
- Pentamidine
- Pentoxifylline
- Perindopril
- Perindopril; Amlodipine
- Perphenazine
- Perphenazine; Amitriptyline
- 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
- Quinapril
- Quinolones
- Racepinephrine
- Ramipril
- Reserpine
- Risperidone
- Ritodrine
- Ritonavir
- Rosiglitazone
- Sacubitril; Valsartan
- Salicylates
- Salsalate
- Saquinavir
- Segesterone Acetate; Ethinyl Estradiol
- Sodium Polystyrene Sulfonate
- Sofosbuvir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Somatropin, rh-GH
- Sotalol
- Sparfloxacin
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfinpyrazone
- Sulfisoxazole
- Sulfonamides
- Sympathomimetics
- Tacrolimus
- Tegaserod
- Telmisartan
- Testolactone
- Testosterone
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Thyroid hormones
- Timolol
- Tipranavir
- tobacco
- Torsemide
- Trandolapril
- Trandolapril; Verapamil
- Tranylcypromine
- Triamcinolone
- Triamterene
- Trifluoperazine
- Valsartan
- Ziprasidone
