Generic Name

NovoLog

Mechanism

• Rapid on‑set insulin analog: Substitutes the B28 proline with aspartic acid, preventing fibril formation and allowing near‑instant absorption after subcutaneous injection.
• Insulin receptor binding: Activates the receptor tyrosine kinase, inducing glucose transport via GLUT4, glycogen synthesis by glycogen synthase, and inhibition of gluconeogenesis.
• Glucose‑dependent effect: Does not increase insulin secretion; its action is strictly exogenous, providing tight post‑prandial glucose control.

Pharmacokinetics

• Onset: ~10 minutes post‑subcutaneous injection.
• Peak effect: 30–90 minutes.
• Duration: ~3–5 hours.
• Absorption: Rapid; no measurable entero‑hepatic recirculation.
• Metabolism: Cleaved by insulin‑specific proteases into inactive peptides; 95 % eliminated unchanged via the kidneys.
• Half‑life: ~2–3 hours (systemic circulation).
• Special Populations:
• Renal impairment: Reduced clearance; prolongs effect, but hypoglycemia risk remains low.
• Pediatrics & lactation: Safe; used in infants and children with appropriate dosing.
• Pregnancy: Category B; recommended for maternal glycemic control.

Indications

• Type 1 Diabetes Mellitus (T1DM) – basal‑bolus or intensive insulin therapy.
• Type 2 Diabetes Mellitus (T2DM) – add‑on to basal insulin or as part of a mealtime correction strategy.
• Pre‑Surgical & ICU Settings – tight glucose control in critically ill patients.
• Diabetic Ketoacidosis (DKA) – rapid correction with insulin infusion supported by NovoLog.

Contraindications

• Contraindications:
• Hypoglycemia or known hypoglycemic episodes.
• Severe hypoglycemia unresponsive to dextrose.
• Warnings:
• Hidden insulin: Careful dose calculations if other insulin analogs are used concurrently.
• Intra‑arterial injection: Risk of local tissue necrosis; avoid arterial sites.
• Pregnancy: Although considered safe, monitor maternal glycemia closely.
• Severe renal impairment: Potential for hypoglycemia due to prolonged action; adjust dosing.
• Diabetic neuropathy: Altered absorption; consider monitoring glucose more frequently.

Dosing

• Administration: SC injection in abdomen, thigh, or upper arm; rotate sites weekly.
• Storage: 2–8 °C; no refrigeration required; can be stored at room temp (<25 °C) for up to 28 days after first use.
• Refill‑and‑run: 18 U/mL vial; use a syringe with an outer plastic syringe for safety; discard after 40 days if unused.

Adverse Effects

• Common:
• Hypoglycemia (most frequent and serious concern)
• Injection site reactions: erythema, pruritus, lipohypertrophy
• Weight gain (average 0.2–0.3 kg/month with adequate diet)
• Serious:
• Severe hypoglycemia leading to seizures or unconsciousness
• Hyperkalemia (rare, but monitor in renal dysfunction)
• Allergic reactions (rash, anaphylaxis) – rare

Monitoring

• Blood glucose:
• Self‑monitoring (SMBG) pre‑meal, 2 h post‑meal, bedtime, and as advised.
• Continuous Glucose Monitoring (CGM) preferred in high‑risk or inpatient settings.
• HbA1c: Every 3 months or as per individualized plan.
• Renal function: eGFR at baseline and annually; more frequently if >60 ml/min/1.73 m².
• Lipid profile: Once yearly; monitor due to potential weight gain.
• Liver function tests: Baseline, then yearly or if clinically indicated.
• Site evaluation: Weekly rotating injection sites; identify lipohypertrophy.

Clinical Pearls

• Aspart’s 10‑minute onset makes it ideal for post‑prandial glucose spikes; pair with a basal insulin that has a longer duration.
• Use of a syringe adapter or safety injector reduces needle reuse and infection risk – especially pertinent for adolescent or self‑injecting patients.
• “Hidden insulin” vigilance: When switching from a long‑acting analog, compute the equivalent dose carefully—the rapid‑acting dose does not fully compensate for residual basal insulin.
• Avoid intramuscular injection: Rapid‑acting insulins are formulated for SC absorption; IM can prolong onset and increase hypoglycemia risk.
• Pregnancy Tip: Weight‑based sliding‑scale dosing in the first trimester reduces neonatal hypoglycemia risk.
• In ICU settings, aim for a target glucose range of 140–180 mg/dL; use CGM when available to reduce glycemic excursions without frequent arterial draws.
• Patient education: Emphasize the importance of consistent timing—inject right before meals and avoid large delays.

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• *For detailed prescribing information, consult the latest FDA labeling and your institutional protocols.*