What is the recommended dosing and management of Aspart (insulin aspart) insulin for diabetes?

From the Guidelines

Insulin aspart should be dosed based on individual patient needs, with initial dosing often starting at 0.1 to 0.2 units/kg of body weight, and adjusted based on carbohydrate intake and blood glucose levels, as recommended by the American Diabetes Association standards of medical care in diabetes 1. The dose is adjusted based on carbohydrate intake, typically using an insulin-to-carbohydrate ratio (often starting at 1 unit per 10-15g of carbohydrates) and a correction factor for high blood glucose (typically 1 unit to lower glucose by 50 mg/dL) 1.

• Patients should monitor blood glucose before meals and at bedtime, aiming for pre-meal targets of 80-130 mg/dL and post-meal levels below 180 mg/dL.
• Dose adjustments should be made in small increments (1-2 units) every 3-4 days based on patterns in glucose readings.
• Insulin aspart works rapidly (onset within 10-20 minutes, peak at 1-3 hours, duration 3-5 hours) because its molecular structure allows faster absorption than regular human insulin.
• Patients should be aware of hypoglycemia risk, properly store insulin (refrigerated until opening, then at room temperature for up to 28 days), and understand proper injection technique, including site rotation to prevent lipohypertrophy 1. When basal insulin has been titrated to appropriate fasting blood glucose levels but the HbA1c level remains above target, combination injectable therapy should be considered to reduce postprandial glucose excursions, using a GLP-1 receptor agonist or prandial insulin, such as 1 to 3 injections of a rapid-acting insulin (lispro, aspart, or glulisine) administered immediately before meals 1.
• Twice-daily premixed insulin analogues (70/30 aspart mix or 75/25 or 50/50 lispro mix) may also be considered; their pharmacodynamic profiles make them suboptimal for covering postprandial glucose excursions.
• A common conundrum for providers is whether to continue oral and injectable agents when insulin therapy is initiated, with sulfonylureas, dipeptidyl peptidase-4 inhibitors, and GLP-1 receptor agonists usually withdrawn when more complicated insulin regimens (beyond basal insulin) are used 1.

From the Research

Recommended Dosing and Management of Aspart Insulin

The recommended dosing and management of Aspart (insulin aspart) insulin for diabetes can be summarized as follows:

• Insulin aspart should be administered immediately before meals to achieve optimal postprandial glucose control 2, 3, 4, 5.
• The dose of insulin aspart should be adjusted based on the actual meal size consumed to maintain postprandial glucose concentrations within recommended treatment guidelines 2.
• Insulin aspart can be administered via continuous subcutaneous infusion or multiple daily injections 3, 5.
• The efficacy of insulin aspart is similar to that of insulin lispro when administered via continuous subcutaneous infusion 3, 5.
• Biphasic insulin aspart (30% soluble and 70% protamine-bound insulin aspart) provides significantly better postprandial glucose control than a similar mixture of biphasic regular human insulin 3, 5.

Administration Timing and Dose Adjustment

• Administering insulin aspart immediately before a meal results in significantly lower mean glycosylated hemoglobin (HbA1c) levels than regular human insulin administered 30 minutes before a meal 3, 5.
• Adjusting the dose of insulin aspart based on the actual meal size consumed maintains postprandial glucose concentrations within recommended treatment guidelines 2.
• Insulin aspart is absorbed twice as fast as human insulin, with a median time to maximum concentration of approximately 40 minutes 4.

Comparison with Other Insulins

• Insulin aspart provides more rapid absorption than regular human insulin after subcutaneous administration 3, 5.
• The overall incidence of hypoglycemia with insulin aspart is lower than or similar to that of regular human insulin 3, 5.
• Insulin aspart tends to be associated with a lower occurrence of nocturnal hypoglycemia and severe hypoglycemic events than regular human insulin 3, 5.

Clinical Trials and Studies

• Clinical trials have demonstrated the efficacy and safety of insulin aspart in patients with type 1 and 2 diabetes mellitus 2, 3, 4, 5, 6.
• A randomized trial of insulin aspart with intensified basal NPH insulin supplementation showed improved post-prandial glycaemic control and treatment satisfaction compared to human regular insulin with standard basal NPH insulin 6.