What are the hold parameters for Novolog (insulin aspart)?

Hold Parameters for NovoLog (Insulin Aspart)

Hold NovoLog when blood glucose is low (<70 mg/dL) or when the patient cannot eat, and temporarily discontinue during acute illness with vomiting, diarrhea, or inability to maintain oral intake until symptoms resolve and normal eating resumes.

Primary Hold Criteria

Hypoglycemia

• Hold NovoLog if blood glucose is <70 mg/dL until glucose recovers to safe levels 1
• If a patient has already taken their dose of rapid-acting insulin and develops low blood glucose, they should consume 4-8 oz of juice or soda, recheck glucose in 15-20 minutes, and seek further treatment if needed 1
• Patients with recurrent low blood glucose readings should seek assistance from their healthcare provider 1

Inability to Eat

• Hold NovoLog if the patient cannot maintain normal food intake, as this rapid-acting insulin is designed to cover meals 1
• NovoLog has an onset of 5 minutes, peaks at 1-2 hours, and lasts 3-4 hours, making it highly dependent on concurrent food intake 1

Sick Day Management

When to Hold During Acute Illness

• Temporarily stop NovoLog if the patient cannot keep up with intake of foods or fluids 1
• Hold if there is persistent vomiting or diarrhea preventing oral intake 1
• Patients should seek healthcare provider assistance when symptoms last >72 hours 1

When to Continue or Adjust

• If blood glucose is more elevated than usual during illness, consider an empirical 10-20% increase in insulin doses rather than holding 1
• Resume NovoLog at usual doses as soon as symptoms improve and normal eating and drinking resume 1
• For medications that can cause hypoglycemia like NovoLog, they should be resumed within 24-48 hours of eating and drinking normally 1

Monitoring Requirements

Frequency During Illness

• Patients receiving insulin should perform more frequent self-monitoring of blood glucose (every 4-6 hours) while awake and for the duration of symptoms 1
• Check ketones if unable to eat or if blood glucose remains elevated despite insulin 1

Target Parameters

• Target fasting blood glucose of 90-150 mg/dL for most patients 2
• If blood glucose drops below target range on multiple occasions, the dose should be decreased by 2 units 2

Common Pitfalls to Avoid

• Never administer rapid-acting insulin at bedtime to avoid nocturnal hypoglycemia 2
• Do not continue NovoLog if the patient has taken their dose but then becomes unable to eat—provide glucose/carbohydrates to prevent severe hypoglycemia 1
• Major nocturnal hypoglycemia (midnight to 6 AM) is significantly reduced with rapid-acting insulins like NovoLog compared to regular insulin, but vigilance is still required 3
• Patients must understand that NovoLog's rapid onset (5 minutes) means hypoglycemia can develop quickly, giving less time to recognize symptoms compared to regular insulin 1