Generic Name

Gvoke HypoPen

Mechanism

• Insulin aspart is a short‑acting insulin analogue that binds the insulin receptor on adipocytes and hepatocytes.
• Rapid receptor engagement stimulates:
• GLUT‑4 translocation → glucose uptake in muscle and fat.
• Inhibition of hepatic gluconeogenesis and glycogenolysis.
• The rapid onset (≈5‑15 min) makes it ideal for reversing hypoglycemia.

Pharmacokinetics

> *Note: The prefilled pen delivers insulin aspart in 0.05 mL increments (0.25–1.0 units per dose).*

Indications

• Acute treatment of severe hypoglycemia (blood glucose ≤ 55 mg/dL) in patients with type 1 or type 2 diabetes.
• Use in clinical, pharmacy, or home settings when rapid glucose rise is needed.
• Approved for patients ≥ 6 months old.

Contraindications

• Contraindications
• Known hypersensitivity to insulin or excipients (e.g., protamine sulfate).
• Severe hypoglycemia unawareness—use with heightened vigilance.
• Warnings
• Hypoglycemia: Reversible but may require repetitive dosing.
• Pregnancy/Lactation: Use only if the benefit outweighs potential fetal risk.
• Weight‑loss or metabolic disease: Monitor insulin sensitivity changes.
• Renal/Hepatic impairment: No dosage adjustment required, but cautious monitoring is advised.

Dosing

• First‑time use:

1. Shake the pen gently; do not tap or shake hard.

2. Prime by setting the dose to 0.25 U and delivering into an empty vial or the air to ensure no air bubbles remain.

3. Inject 0.25–1.0 units (0.05 mL increments) intramuscularly into the vastus lateralis (thigh) or subcutaneously into abdomen, thigh, or buttocks.
• Repeat dosing:
• If hypoglycemia persists, repeat 15 minutes after the first dose.
• No more than three 1‑unit doses in a 24‑hour period unless directed by a clinician.
• Storage:
• Store at 2–8 °C up to the expiry date; can be kept at room temperature (≤ 25 °C) for 28 days after first use.
• Do not freeze; protect from light.

Adverse Effects

Monitoring

• Blood glucose: Check before administration, 1 hour after, and repeat if symptomatic.
• Signs & symptoms of hypoglycemia: Tingling, tremor, sweating, confusion.
• Injection‑site inspection: Look for erythema, swelling, or hematoma.
• Patient/caregiver education: Ensure they can recognize and treat hypoglycemia.

Clinical Pearls

• Avoid over‑dosage: Use the minimum effective dose. A 0.25‑unit intramuscular injection can raise glucose by 60–90 mg/dL in a typical adult.
• Timing matters: If the pen is used near bedtime, choose a non‑fasting dose; an excess may cause nocturnal hypoglycemia.
• Documentation: Record dose, time, and insulin concentration for audit trails and continuity of care.
• Carry‑on readiness: Keep the pen in a readily accessible “emergency kit” for both patients and caregivers.
• Re‑priming is unnecessary after first use for up to 28 days: the device continuously primes at the time of dosing.

> *For further reading, consult the Gvoke HypoPen prescribing information, Novo Nordisk’s technical brief, and recent ADA clinical practice guidelines.*