Novolog: Uses, Side Effects, Precautions & Interactions

Introduction

What is Novolog?

NovoLog is a synthetic insulin that helps adults and children with diabetes mellitus manage their excessive blood sugar levels. Novolog belongs to the class of drugs known as rapid-acting insulins. Combining this medicine with dietary and exercise modifications is common. This medication may also be utilized for other conditions. Novolog (Insulin Aspart) injectable is a sterile, transparent, and colorless liquid that can be administered intravenously or subcutaneously. The human insulin analog Novolog lowers blood sugar quickly. Except for the single aspartic acid alteration in B28 position, Novolog is identical to conventional human insulin. ⁴ Introduction | Researched based study from Cleveland Clinic

Mode of Action

How does Novolog function?

• The modulation of glucose metabolism is Novolog’s main function. 
• Novolog and other insulins attach to the receptors for insulin on fat and muscle cells to lower blood sugar by promoting cellular uptake of glucose while also preventing the liver’s production of glucose. ¹ Mechanism of Action | Researched based study from Food and Drug Administration
• It functions by raising our body’s insulin levels, which lowers the level of blood sugar (glucose).

Uses

Uses of Novolog

Treatment for Type 2 Diabetes

• Novolog is an insulin analog that helps to enhance glycemic control in people with diabetes mellitus, that includes adults and children. ² Uses | Researched based study from National Institutes of Health

Dosage

Dosage of Novolog

• Injection: Insulin Aspart is available as 100 units/mL (U-100)
• 10 mL vial with several doses
• Prefilled cartridges for the 3 mL, for a single patient
• Prefilled pen, 3 mL, for a single patient. ² Dosage | Researched based study from National Institutes of Health

Storage

Storage of Novolog

• Novolog should be kept in a refrigerator between 2° and 8°C (36° and 46°F) when not in use. ⁴ Storage | Researched based study from Cleveland Clinic
• Novolog should not be frozen, and in case if Novolog is frozen, then it must not be used. 
• It is not recommended to draw Novolog into a syringe and it can be stored for later use.
• After 28 days if kept at room temperature, the vial must be thrown away. 
• After the expiration date, discard any unopened, unused medication that was kept in the refrigerator. ⁴ Storage| Researched based study from Cleveland Clinic

Administration

How is Novolog used?

• Use precisely as instructed. It is vital to follow the instructions the care team gives you. 
• Start eating within 5 to 10 minutes of your Novolog injection if you are using it.
• Subcutaneous injections should be used to give Novolog under the skin in the upper arm, buttocks, thigh, or abdomen area. 
• For subcutaneous administration, dilute Novolog with an insulin diluting medium.
• Novolog should be administered right away (within 5 to 10 minutes before a meal), as it begins working faster and wears out faster than normal insulin. 
• To lower the danger of lipodystrophy, injection locations within the same area should be switched around. 
• Novolog’s duration of effect varies depending on the dose, injection site, circulation, temperature, and level of vigorous activity, as it does with all insulins. 

Continuous Subcutaneous Insulin Infusion that is done using External Pump:

• External insulin pumps should not be utilized with diluted insulin. 
• Rotating infusion sites within the same location will lessen the likelihood of developing lipodystrophy.
• After every 3 days the infusion sets along with the infusion set insertion site must be altered.
• At least every six days, replace the Novolog in the reservoir. 

Intravenous Injection:

• Novolog should be used in infusion systems with polypropylene infusion bags at insulin Aspart concentrations. 
• Before administering Novolog through the parenteral route, check for debris and discoloration. ¹Administration | Researched based study from Food and Drug Administration

What to do in Case of Missed Dose?

• It is necessary to inject Novolog just before or just after eating. 
• Administer the missed dose as soon as possible if you remember to take it just before or directly after eating. 
• If it has been some time since your last meal, call your doctor to inquire about whether or not you should inject the missed dose or follow your doctor’s advice. 
• Do not administer a second injection to make up for a missed dosage. ³ Administration | Researched based study from Medline Plus

Side Effects

Possible Side Effects of Novolog :

• Perspiration
• Difficulty focusing
• Dizziness or confusion
• Lightheadedness
• Shakiness
• Hunger
• Slurred speech
• Irritability
• Fast heartbeat
• Blurred vision
• Changes in mood
• Tingling in the lips and tongue

Other side effects are as follows:

Hypoglycemia:

• The most frequent adverse response in individuals using insulin, including Novolog, is hypoglycemia.

Escalation of Glycemic Control and Introduction of Insulin:

• An immediate painful peripheral neuropathy, a temporary, reversible ophthalmologic refraction problem, and an intensification or quick improvement in glucose management have all been linked. 
• Long-term glycemic management does, however, reduce the incidence of retinopathy and diabetic neuropathy.

Peripheral Edema: 

• If previously poor metabolic control gets better by enhanced insulin therapy, insulin may lead to salt retention and edema. 

Adverse Drug Reactions:

Patients with type 1 and type 2 diabetes mellitus experienced adverse medication responses.

Lipodystrophy:

• Novolog and other long-term insulin users may get lipodystrophy at the site of recurrent insulin injections or infusions. 
• Lipodystrophy, which can impair insulin absorption, includes lipohypertrophy and lipoatrophy.
• To lessen the danger of lipodystrophy, switch up the locations where insulin injections or infusion sites are placed.

Weight Gain:

• Due to the anabolic properties of insulin and the drop in glucosuria, weight gain has been linked to several insulin therapies, notably Novolog. ¹ Side Effects | Researched based study from Food and Drug Administration

Contraindications

Who should not take Novolog?

Patients who have hypersensitivity to Novolog or any of its excipients should not take Novolog during periods of hypoglycemia. 

Precautions

Warnings & Precautions for Novolog

Even if the needle is replaced, never exchange a Novolog Flex Touch, Novolog cartridge, Novolog Flex Pen, or Pen Fill cartridge among patients.

Hypoglycemia or Hyperglycemia brought on by adjustments to the insulin regimen: 

• Change the insulin regimen for a patient while closely monitored by a doctor and with more frequent blood glucose testing.

Hypoglycemia: 

• This condition might be fatal. 
• In individuals who have impairments and hypoglycemic unawareness, glucose monitoring should be performed more often with changes to insulin dosage, concurrently administered glucose-lowering medicines, meal patterns, and physical activity.
• Driving a car or using machinery requires caution. Inquire with your doctor if you can drive if you frequently have low blood sugar; diminished or absent indications of lower blood sugar. ² Precautions | Researched based study from National Institutes of Health

Medication Mistakes: 

• Accidental insulin product mismatches might happen. 
• Tell patients to read the labels on their insulin before injecting.

Hypersensitivity Reactions: 

• Anaphylaxis, a severe, life-threatening form of widespread allergy, is possible.
• Novolog should be stopped, treated, and monitored as needed.

Hypokalemia: 

• This condition could be fatal. 
• Patients who are at risk of hypokalemia should have their potassium levels checked and treated as necessary.

Thiazolidinediones (TZDs):

• Thiazolidinediones concurrently with retention of fluid and heart failure have been linked.
• Keep an eye out for heart failure symptoms, and if any appear, think about reducing or stopping the medication.

Diabetes and Ketoacidosis:

• If the insulin pump device malfunctions, keep an eye on the blood sugar and inject Novolog under the skin. ² Precautions | Researched based study from National Institutes of Health  

Pregnancy:

• Regardless of medication exposure, there is a baseline risk for birth abnormalities, miscarriage, or other unfavorable outcomes in every pregnancy. 
• With appropriate metabolic control, this background risk may be reduced in pregnancies affected by hyperglycemia.
• Patients with diabetes or a history of gestational diabetes must keep their metabolism under control both before and during pregnancy.

Lactating Mothers:

• If Insulin Aspart is eliminated in human milk is unknown. Although Novolog can be used while breastfeeding, diabetic lactating women may need to alter their insulin dosage. 

Pediatric Use:

• Children may use Novolog for subcutaneous continuous administration by an external insulin pump as well as for subcutaneous daily injections. 
• Younger than 2-years-old pediatric patients have not been investigated with Novolog. No research has been done on Novolog in children with type 2 diabetes.

Geriatric Use:

• Age did not affect the HbA1c effect of Novolog compared to conventional human insulin. 

Renal Dysfunction:

• Patients having renal dysfunction could need Novolog dose adjustments and more frequent blood sugar monitoring due to an increased risk of hypoglycemia.

Hepatic Impairment:

• Patients might have increased risk of hypoglycemia.
• People may need frequent checking of blood glucose and Novolog dose adjustments. ¹ Precautions | Researched based study from Food and Drug Administration

Overdose

Overdose with Novolog

• When delivered intravenously, excessive insulin delivery might result in hypokalemia and hypoglycemia. 
• Oral glucose is typically effective in the treatment of mild hypoglycemia episodes.
• Adjustments to medication dose, eating habits, or exercise regimens may be required. 
• Treatment options for more severe episodes that include coma, seizures, or neurologic impairment include intramuscular or subcutaneous glucagon injections or concentrated intravenous glucose. 
• After a seemingly complete clinical recovery, hypoglycemia may return, necessitating continued carbohydrate intake and monitoring. Suitable action must be taken for hypokalemia. ⁴ Overdose | Researched based study from Cleveland Clinic

Interactions

Drug Interactions with Novolog

Numerous drugs have an impact on how the body processes glucose, necessitating possible insulin dose adjustments and extra close observation. 

• Oral diabetes medications, pramlintide, fibrates, monoamine oxidase inhibitors, ACE inhibitors, disopyramide, fluoxetine, propoxyphene, the salicylates somatostatin analog, and sulfonamide antibiotics may increase the blood-glucose-lowering impact and chances of hypoglycemia. 
• Clonidine, beta-blockers, lithium salts, and other drugs may either strengthen or reduce the ability of insulin to drop blood sugar. 
• When using Novolog, alcohol, especially wine, and beer, may impact your blood sugar levels. 
• Pentamidine has the potential to produce hypoglycemia, which could occasionally be followed by hyperglycemia. 
• Patients receiving sympatholytic medications such as reserpine, beta-blockers, clonidine, and guanethidine may experience less or no symptoms of hypoglycemia. ¹ Interactions | Researched based study from Food and Drug Administration