What is the proper dosing and administration of Novolog (insulin aspart) for patients with diabetes?

From the Guidelines

NovoLog (insulin aspart) should be administered subcutaneously within 5-10 minutes before meals, with a typical starting dose of 0.2-0.6 units/kg/day for type 1 diabetes or 0.1-0.2 units/kg/day for type 2 diabetes, and dose adjustments should be made based on blood glucose monitoring, with target pre-meal glucose of 80-130 mg/dL and post-meal levels below 180 mg/dL, as recommended by the American Diabetes Association standards of medical care in diabetes 1.

Key Considerations for NovoLog Administration

• The total daily insulin requirement is often divided with 50-70% as basal insulin and the remainder as mealtime NovoLog.
• Patients should rotate injection sites within the abdomen, thigh, or upper arm to prevent lipodystrophy.
• NovoLog works quickly, with onset in 15 minutes, peak action in 1-3 hours, and duration of 3-5 hours, mimicking the body's natural insulin response to meals and helping to control post-meal glucose spikes.
• Hypoglycemia is the most common side effect, so patients should always have fast-acting carbohydrates available and be educated on recognizing and treating low blood sugar.

Dose Adjustments and Monitoring

• Dose adjustments should be made based on blood glucose monitoring, with target pre-meal glucose of 80-130 mg/dL and post-meal levels below 180 mg/dL.
• Providers should consider regimen flexibility when devising a plan for the initiation and adjustment of insulin therapy for patients with type 2 diabetes, and may consider adding a single injection of rapid-acting insulin analogue before the largest meal, or stopping basal insulin and starting twice-daily premixed insulin 1.
• The FDA recently approved once-daily, fixed-ratio combination products containing basal insulin plus a GLP-1–receptor agonist, which may be considered for patients with type 2 diabetes who require more intensive therapy 1.

From the Research

Proper Dosing and Administration of Novolog (Insulin Aspart)

• Novolog (insulin aspart) is a short-acting insulin analogue with a faster onset and shorter duration of action than regular human insulin 2.
• It is recommended to administer Novolog immediately before meals to provide better postprandial glycaemic control than regular human insulin administered 30 minutes before meals 2, 3.
• The dosage of Novolog should be individualized based on the patient's needs and should be adjusted to achieve optimal glycaemic control 2, 3.

Efficacy in Type 1 and Type 2 Diabetes

• Novolog has been shown to be effective in improving glycaemic control in patients with type 1 diabetes mellitus, with a faster onset of action and a shorter duration of action than regular human insulin 2, 3.
• In patients with type 2 diabetes, Novolog has been shown to provide similar glycaemic control to regular human insulin, with a trend towards lower HbA1c levels 3, 4.

Administration Regimens

• Novolog can be administered via continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) 2, 3.
• CSII with Novolog has been shown to provide better glycaemic control than MDI in patients with type 1 diabetes, but not in patients with type 2 diabetes 2, 3.

Safety and Tolerability

• Novolog has been shown to have a tolerability profile similar to that of regular human insulin, with a lower incidence of major or nocturnal hypoglycaemic events 2, 3.
• The risk of hypoglycaemia with Novolog is lower than or similar to that of regular human insulin, with a trend towards a lower occurrence of nocturnal hypoglycaemia and severe hypoglycaemic events 2, 3.