Blood Sugar Hold Parameters for Fiasp (Insulin Aspart)
Hold Fiasp when blood glucose is <70 mg/dL (3.9 mmol/L) until glucose recovers to safe levels. 1
Primary Hold Threshold
- Blood glucose <70 mg/dL (3.9 mmol/L) is the absolute hold parameter for Fiasp, as this represents Level 1 hypoglycemia requiring immediate intervention. 2, 3, 1
- This threshold aligns with the standard definition of hypoglycemia in both outpatient and inpatient settings, correlating with the initial release of counterregulatory hormones. 2
Clinical Action Points for Insulin Modification
Blood glucose <100 mg/dL should trigger reassessment of the insulin regimen, as fasting glucose below this level predicts hypoglycemia within the next 24 hours. 3
- Blood glucose <70 mg/dL (3.9 mmol/L) requires modification of the insulin regimen unless the hypoglycemic event is easily explained by other factors such as a missed meal. 2, 3
- More severe hypoglycemia thresholds include Level 2 (<54 mg/dL or 3.0 mmol/L) and Level 3 (any level with altered mental/physical functioning requiring assistance). 2, 3
Special Circumstances Requiring Hold
Hold Fiasp if the patient cannot maintain oral intake due to persistent vomiting or diarrhea preventing food consumption. 1
- If a patient has already taken their Fiasp dose but then becomes unable to eat, provide 4-8 oz of juice or soda immediately to prevent severe hypoglycemia rather than simply holding the next dose. 1
- The rapid onset of Fiasp (5 minutes) means hypoglycemia can develop quickly, giving less time to recognize symptoms compared to regular insulin. 1
Monitoring Requirements When Approaching Hold Parameters
- Recheck glucose in 15-20 minutes after treating hypoglycemia <70 mg/dL. 1
- Patients receiving insulin should perform more frequent self-monitoring (every 4-6 hours) during illness or when glucose values are unstable. 1
- Check ketones if unable to eat or if blood glucose remains elevated despite insulin. 1
Common Pitfalls to Avoid
Never continue Fiasp if the patient has taken their dose but then becomes unable to eat—this is a critical error that can lead to severe hypoglycemia requiring immediate carbohydrate administration. 1
- During illness, if blood glucose is more elevated than usual, consider an empirical 10-20% increase in insulin doses rather than automatically holding, but only if the patient can maintain oral intake. 1
- Document all hypoglycemic episodes in the medical record, including duration, associated symptoms, amount of glucose administered, and the next blood glucose concentration. 3