Insulin Aspart

Insulin Aspart is indicated for glycemic control in diabetes mellitus:

Approved Indications:

• Type 1 Diabetes Mellitus (T1DM):
  Used to control postprandial glucose levels as part of a basal-bolus regimen.
• Type 2 Diabetes Mellitus (T2DM):
  For patients inadequately controlled on oral antidiabetic drugs or other insulin regimens, particularly to manage post-meal hyperglycemia.

Clinically Accepted Off-Label Uses:

• Selected cases of gestational diabetes under strict clinical supervision.
• Inpatient hyperglycemia management when rapid-acting insulin is needed.

Administration Route: Subcutaneous injection into the thigh, upper arm, or abdomen. Rotate injection sites to minimize lipodystrophy. Can also be administered via insulin pump for continuous subcutaneous infusion.

Adults:

• Typically administered subcutaneously within 5–10 minutes before meals.
• Initial dose individualized based on body weight, prior insulin therapy, and blood glucose levels.
• Dose titration: Adjust based on pre-meal and postprandial glucose monitoring.

Pediatrics (≥1 year):

• Dose individualized according to weight and prior insulin regimen.
• Frequent glucose monitoring is essential during initiation and titration.

Elderly:

• Initiate cautiously; may require lower doses due to increased risk of hypoglycemia.
• Close monitoring recommended.

Special Populations:

• Renal Impairment: Dose adjustment may be necessary; monitor blood glucose frequently.
• Hepatic Impairment: Initiate cautiously and titrate according to glucose response.
• Transition from Other Insulins: Adjust dose according to basal and prandial needs.

Insulin Aspart is a rapid-acting insulin analog that mimics physiological prandial insulin secretion. Upon subcutaneous injection, it binds to insulin receptors on target cells, facilitating glucose uptake in skeletal muscle and adipose tissue and suppressing hepatic glucose production. Its rapid onset allows effective control of postprandial glucose excursions, complementing basal insulin in a complete insulin regimen.

• Absorption: Rapidly absorbed after subcutaneous injection; onset ~10–20 minutes.
• Distribution: Distributed in extracellular fluid; minimal plasma protein binding.
• Metabolism: Proteolytically degraded in the liver and kidneys; no active metabolites.
• Elimination: Primarily renal; half-life approximately 1 hour.
• Onset of Action: 10–20 minutes.
• Peak Action: 1–3 hours.
• Duration: 3–5 hours.
• Bioavailability: High when administered subcutaneously.

• Pregnancy: Insulin is the preferred treatment for glycemic control. Insulin Aspart has limited pregnancy-specific data but is generally considered safe under clinical supervision.
• Lactation: Compatible with breastfeeding; minimal transfer into milk. Monitor infants for hypoglycemia.
• Caution: Adjust dose based on frequent glucose monitoring during pregnancy and lactation.

• Primary Class: Antidiabetic Agent
• Subclass: Insulin analog, rapid-acting

• Known hypersensitivity to Insulin Aspart or any excipients.
• Severe hypoglycemia.
• Diabetic ketoacidosis unless used as part of a comprehensive insulin regimen.

• Hypoglycemia: Most common adverse effect; monitor high-risk patients (elderly, renal/hepatic impairment, or concomitant hypoglycemic therapy).
• Allergic Reactions: Rare anaphylaxis possible; discontinue if severe.
• Injection Site Reactions: Rotate sites to minimize lipodystrophy.
• Fluid Retention/Heart Failure: Monitor if used with thiazolidinediones.
• Monitoring: Frequent glucose and HbA1c checks recommended; ketone monitoring if hyperglycemia persists.

Common:

• Hypoglycemia
• Injection site reactions: redness, swelling, itching
• Weight gain

Less Common:

• Edema
• Allergic reactions
• Lipodystrophy at injection sites

Rare/Severe:

• Severe hypoglycemia with neuroglycopenic symptoms
• Anaphylaxis

• Sulfonylureas, meglitinides: Increased risk of hypoglycemia.
• Beta-blockers: May mask hypoglycemia symptoms.
• Alcohol: Can potentiate or reduce hypoglycemic effect.
• Corticosteroids, thiazide diuretics: May decrease insulin efficacy.
• CYP450: Minimal involvement; metabolized via proteolytic degradation.

• Rapid-acting insulin analogs, including Aspart, recommended for postprandial glucose control in basal-bolus regimens.
• Guidelines emphasize individualized dosing and frequent glucose monitoring to prevent hypoglycemia.
• Supported for use in insulin pumps for continuous subcutaneous infusion therapy.

• Temperature: Store 2°C–8°C (refrigerated); do not freeze.
• Room Temperature Use: Can be kept at ≤30°C for up to 4 weeks (pen/vial).
• Light Protection: Keep in original pen/vial; protect from direct sunlight.
• Handling: Roll gently before use; do not shake vigorously.
• Reconstitution: Not required; solution is clear and ready-to-use.