Insulin Aspart and Insulin Degludec (Subcutaneous)

Overview

Insulin aspart and insulin degludec are respectively a fast-acting insulin and a slow-acting insulin that are used in tandem to manage and regulate blood sugar levels in patients who have diabetes. Insulin degludec often works over 24 hours, and thus the medication is often prescribed to be used one to two times a day.

The body requires insulin, a type of hormone, to transform food and drink into energy that the body can use. However, diabetes makes it difficult for the body to produce or use insulin properly, which can lead to spikes in blood sugar level. Antidiabetic medication such as insulin aspart and insulin degludec help to keep blood sugar levels in the body at normal levels and is available to the patient only via a doctor's prescription.

During treatment, patients with diabetes are encouraged to stick closely to instructions given by their doctor; these instructions can include diet plans and exercise plans in addition to dosing schedules, as diabetes can only be effectively managed with a multi-prong approach to treatment. What the patient consumes, as well as their daily activity, will impact the medication they need, and how the medication will affect them.

Conditions Treated

  • Diabetes

Type Of Medicine

  • Antidiabetics

Side Effects

When using insulin aspart and insulin degludec, as with almost any other medication, patients may experience side effects, ranging from mild to severe. They should monitor themselves carefully during treatment in order to catch any unwanted effects before it continues for too long. It is important to note that not all patients will encounter these side effects.

Medication is often prescribed if the doctor feels that the benefits of the medicine outweigh the negative effects that it may cause.

The following is a list of side effects that should go away on their own after a while. However, if they persist or become worse, or if the patient has any questions or concerns, they should contact their doctor for further medical advice.

  • Aches or pain in the body

If the patient encounters any of the following side effects, they should check with their doctor as soon as possible:

  • Chills

While unusual, insulin aspart and insulin degludec may cause a severe allergic reaction in some patients. If the patient notices any of the following symptoms of an allergic reaction, they should call for emergency medical treatment as it may become life-threatening:

  • Rashes or itching

The above do not list all symptoms and effects that the patient may experience with insulin aspart and insulin degludec. If the patient encounters any unusual side effects, they should call their doctor as fast as possible.

Dosage

Initial dosage of insulin aspart and insulin degludec should be given by a trained medical professional such as a doctor or nurse, as an injection under the skin. The patient may be directed or choose to receive their medicine at home, in which case they, or their caregiver, should be very familiar with the procedure before they begin treatment with the insulin.

Prior to using insulin aspart and insulin degludec, patients should read all available information on their medicine and familiarize themselves with the usage, preparation and disposal of the medication. It is important to note that concentration and dosage are not the same; the dosage denotes how many units of insulin is required, and the concentration indicates how many units of insulin are present in each milliliter (ml). For example, the concentration may be 100 units/ml or U-100, but it does not signify a dosage of 100 units.

When receiving treatment, it is recommended that patients rotate the site of injection to lessen the risk of irritation or unusual bleeding at the area. The doctor will show different areas the patient can inject into, such as the upper arm, thigh or abdominal area. If the patient has any queries or doubts, they should inform their doctor or nurse to get their advice.

Before injecting the insulin, patients or their caregivers should check the solution visually to ensure that it is uncontaminated, i.e. clear and colorless. If they notice any particles in them, or if the solution has thickened or become cloudy, they should throw the solution away and use a fresh package of insulin.

For each use, a new needle should be used. The prefilled pen should not be transferred to any other syringe or pump, and it should not be shared with any other person as there is a risk of diseases being transferred, such as HIV or hepatitis.

Insulin aspart and insulin degludec should not be mixed with other substances such as other insulin or water.

This medication should be taken with a main meal, i.e. breakfast, lunch or dinner. If it has been prescribed by a doctor, patients may also use another insulin with other meals if it is required. Patients should especially take care to follow their prescribed meal plans as controlling their diet is the most essential part of being able to regulate their condition. The patient's diet is also key to allowing the insulin to work as intended.

It is also important for the patient to exercise frequently and to go for blood sugar level tests as directed.

Dosage for each patient may vary and the use and strength will be determined by their doctor. Patients should take care to follow their prescriptions closely and to clarify any questions with their doctor as soon as possible. Doses for each patient are determined by several factors, such as the strength of the medication, the number of doses required per day, the time required between doses, as well as how long the patient should take insulin aspart and insulin degludec for.

If the patient is taking their medicine at home and has missed a dose, they should take it as soon as possible. However, if the timing is too close to their next dosage, they should simply skip the missed dose and resume their dosing schedule. They may take their next dose with the next main meal of the day. It is important that patients do not double dose as an insulin overdose may lead to hypoglycemia, which can be fatal.

Aside from an overdose, hypoglycemia, or low blood sugar, can also happen from other factors. Patients are advised to carry with them a source of sugar at all times. These can include hard candy, fruit juice, raisins or non-diet soda, which should be consumed if the patient feels hunger, sweating, confusion, headaches, dizziness, weakness or irritability. Patients should look out for symptoms of severe hypoglycemia and seek immediate medical attention if they experience the following:

  • Extreme weakness

In the case of severe hypoglycemia, and if the patient is unable to eat or drink, they should use a glucagon injection, which they may ask for from their doctor as a prescription.

The reverse of hypoglycemia is hyperglycemia, or high blood sugar. Patients should monitor their blood sugar levels carefully, especially if they are ill, stressed, traveling, or if they are about to undergo surgery or have a medical emergency. Vigorous exercise, skipping meals and drinking of alcohol may also adversely affect blood sugar levels. Signs of hyperglycemia include:

  • Increase in thirst

Interactions

Drugs may interact with each other, with various supplements or herbal products to produce unwanted effects and lowered efficiency of the medication. Patients should keep a list of all drugs, supplements or herbal products they have recently consumed or are consuming to share with their doctor so that they can prevent such interactions.

However, in some cases, the doctor may prescribe medications that are known to interact, if they feel that the interactions are required or if the benefits of such an interaction are enough to override the negative effects of it.

The following is an incomplete list of drugs that may interact with insulin aspart and insulin degludec:

  • Acebutolol

Other consumables may also interact with insulin aspart and insulin degludec. Substances such as alcohol and tobacco are especially likely to interact with medicines. If the patient drinks or smokes regularly, they should consult with their doctor on the consumption of alcohol and tobacco while being treated with insulin aspart and insulin degludec. Alcohol especially may cause severe low blood sugar.

Patients may also wish to avoid ethanol as it has been shown to interact with insulin aspart and insulin degludec.

Certain medical problems may interact negatively with the medication. Patients with the following conditions should inform their doctor prior to starting treatment with insulin. This is to ensure that the correct dosage can be administered, or in certain situations, to find alternative treatments if insulin aspart and insulin degludec cannot be used with the presence of the illness. Some of these medical problems may worsen the patient's condition or slow the removal of the medicine from the body.

  • Hypoglycemia (low levels of sugar in the blood)

Warnings

Insulin aspart and insulin degludec come in the form of insulin pens. These pens should never be shared with anyone else, as it may cause the spread of bloodborne illnesses, such as HIV or hepatitis viruses. After usage, the pens should be disposed of properly. Needles should be contained in disposable containers known as'harps' containers.

During the first few weeks of treatment with insulin aspart and insulin degludec, patients may be required to take blood tests on top of regular progress checks by their doctors. This is to check for the development of any unwanted effects.

Diabetes requires constant monitoring and careful control of diet. It is important that patients follow instructions from their doctor, especially in regards to what they consume. The consumption of alcohol, for example, may cause severe hypoglycemia, and using other medications that have not been prescribed or approved by the doctor may lead to higher risks of side effects. These medicines include over the counter (or non-prescription) drugs such as allergy pills, painkillers or asthma control medication.

Patients with diabetes may also need to undergo counseling on lifestyle and pregnancy (if the patient intends to become pregnant or is already pregnant), as problems unique to the illness may arise over time. Changes in lifestyle, exercise and diet may lead to a change in the dosage of insulin as well.

It is advised for family members of the patient to learn about potential side effects, how to avoid them or to alleviate them.

If the patient is making plans for traveling, they should keep a recent prescription as well as a copy of their medical history with them at all times. They should be prepared for an emergency as well. Time zones may prove difficult to navigate, and patients may wish to consult with their doctors on adjusting their meal times as well as their dosing schedule.

Patients with diabetes may encounter emergency situations, which can be helped by the following:

  • Having sugary foods on hand to combat hypoglycemia

Both hypoglycemia and hyperglycemia can be likely to occur if the patient does not monitor their food and drink intake or their exercise and daily habits carefully.

Hypoglycemia can be caused by too much intake of insulin aspart and insulin degludec, or if the patient uses additional antidiabetics, among other factors (such as skipping meals or snacks, excessive exercise or consumption of alcohol). If not caught or treated in time, patients experiencing hypoglycemia may pass out. As symptoms may vary from person to person, patients should familiarize themselves with the signs of hypoglycemia and how they react personally to them. Generally, hypoglycemia symptoms include:

  • Dizziness or lightheadedness

If patients experience these symptoms, they can consume drinks or food high in sugar to relieve them. These can include non-diet soft drinks, sugar (in cubes or dissolved in water), fruit juice, glucose tablets and gel as well as corn syrup or honey.

They should seek immediate medical care if the symptoms do not improve after a short while and also be sure to check their blood for their current blood sugar level. Severe symptoms such as seizures or fainting may render the patient unable to seek help by themselves, in which case someone near them should seek medical help on their behalf as quickly as possible. It is advised for the patient to have a glucagon kit on hand, as well as a syringe and a needle, and that their family or caregivers should be familiar with their use.

As hypoglycemia can cause dizziness, patients are advised to stay away from activities that require mental alertness such as operating machinery or driving, until they are certain that they are able to resume them safely.

The opposite of hypoglycemia is hyperglycemia, which can happen if the patient either misses a dose of their medication or if they did not take enough of it. It can also occur if the patient does not follow their meal plan, overeats, develops a fever or an infection, or if they exercise less than their usual. If patients encounter symptoms of hypoglycemia, they should check their blood for sugar levels, before contacting their doctor for any further instructions. Signs of hyperglycemia include:

  • Blurring of vision

The use of insulin aspart and insulin degludec with other antidiabetic medications such as rosiglitazone or pioglitazone may lead to fluid retention (also known as edema), or even serious heart problems. If the patient notices any of the following symptoms, they should seek medical help right away:

  • Difficulties with breathing

While uncommon, use of this medication can cause a serious allergic reaction. Patients who develop the following signs in a short period after receiving their medication should call their doctor immediately:

  • Rashes or itching

Insulin aspart and insulin degludec may lead to low levels of potassium in the blood, also known as hypokalemia. Patients should discuss their medical history as well as any drugs, supplements or salt substitutes that they are using with their doctor in order not to exacerbate their condition.

Storage

Unopened FlexTouch disposable prefilled pens may be kept in the refrigerator until they expire. Patients may check for the expiration date on the carton of the medicine. If they are keeping the pens at room temperature, they may do so for up to 28 days only. The medication should be kept away from light, and should not be exposed to freezing temperatures.

FlexTouch disposable prefilled pens that are in use by the patient should be kept at room temperature, in a cool and dry place, for up to 28 days. They should not be exposed to direct heat or light, nor should they be refrigerated.

Insulin aspart and insulin degludec should be kept out of the reach of children and animals.

Patients should discard the medicine once it has expired or when it is no longer needed. If they are unsure of how to properly dispose of their medical waste, they should consult their doctor or their local waste management. Needles especially should be disposed of in a designated sharps container.

Summary

Patients with diabetes mellitus are prescribed insulin aspart and insulin degludec, a combination of both fast-acting and slow-acting insulin to help manage their condition. Insulin aspart and insulin degludec are often taken together with the main meals of the day, but may also be supplemented with another fast-acting insulin during smaller meals or snacks if the doctor feels it is necessary.

Aside from strictly taking their medication according to their dosing schedule, patients should also take care to eat according to diet plans that their doctor has set out for them, as well as exercise regularly in order to maximize the effect of their medicine and maintain normal levels of blood sugar levels. They should take care to avoid alcohol and to watch their intake of sugary foods as these, in particular, can overly raise the amount of blood sugar levels.

Insulin aspart and insulin degludec come in a solution form, in a prefilled insulin pen. Initial dosages are often given by a nurse or doctor. Patients may choose to receive the medicine at home, once they or their caregiver are familiar with the procedure of giving the medicine. These insulin pens should never be shared as there is an elevated risk of bloodborne disease transfer, such as HIV or hepatitis.

While on this medication, it is advised that patients monitor their blood sugar levels in order to ensure that they do not develop either hypo- or hyperglycemia. They should check in with their doctor at regular intervals to ensure that their medicine is working as intended.

Links

As diabetes inhibits or even stops the production of insulin in the body, external insulin combinations like insulin aspart and insulin degludec are used to regulate blood sugar levels in the body.

  • Congestion in the ear(s)
  • Stuffed or running nose
  • Loss of voice
  • Fever
  • Bleeding, irritation or warmth at the injection site
  • Redistribution or gaining of fat
  • Cold or pale skin
  • Cold sweating
  • Feeling confused
  • Changes in mood such as anxiety or depression
  • Blurring of vision
  • Quickened heartbeat
  • Feeling of constriction in chest
  • Dizziness
  • Headaches
  • Convulsions
  • Trembling
  • Slurring of speech
  • Feeling unusually weak or tired
  • Difficulties with breathing or swallowing
  • Coughing
  • Dry mouth
  • Nausea or vomiting
  • Constipation
  • Increase in appetite or thirst
  • Loss of appetite
  • Swelling in face, arms, hands, calves or feet
  • Itching, rashes, or hives
  • Tingling in the extremities
  • Unusual or rapid gains or loss in body weight
  • Decrease in urination
  • Reddening skin, especially if around the ears
  • Swelling, especially of the face, tongue and throat
  • Trouble with breathing
  • Chest pain after treatment with the insulin combination
  • Blurring of vision
  • Sweating
  • Trouble with speaking
  • Trembling
  • Pain in stomach
  • Confusion
  • Convulsions
  • Coma
  • Increase in urination
  • Increase in appetite
  • Dry mouth
  • Fruity breath odor
  • Feeling drowsy or weak
  • Dry skin
  • Blurring of vision
  • Weight loss
  • Albiglutide
  • Atenolol
  • Balofloxacin
  • Besifloxacin
  • Betaxolol
  • Bisoprolol
  • Bitter melon
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Ciprofloxacin
  • Dulaglutide
  • Enoxacin
  • Esmolol
  • Exenatide
  • Fenugreek
  • Fleroxacin
  • Flumequine
  • Furazolidone
  • Gatifloxacin
  • Gemifloxacin
  • Glucomannan
  • Guar gum
  • Iproniazid
  • Isocarboxazid
  • Labetalol
  • Lanreotide
  • Levobunolol
  • Levofloxacin
  • Linezolid
  • Liraglutide
  • Lixisenatide
  • Lomefloxacin
  • Metipranolol
  • Metoprolol
  • Methylene blue
  • Metreleptin
  • Moclobemide
  • Moxifloxacin
  • Nadifloxacin
  • Nadolol
  • Nebivolol
  • Nialamide
  • Norfloxacin
  • Octreotide
  • Ofloxacin
  • Oxprenolol
  • Pasireotide
  • Pazufloxacin
  • Pefloxacin
  • Penbutolol
  • Phenelzine
  • Pindolol
  • Pioglitazone
  • Practolol
  • Pramlintide
  • Procarbazine
  • Propanolol
  • Prulifloxacin
  • Psyllium
  • Rasagiline
  • Rosiglitazone
  • Rufloxacin
  • Safinamide
  • Selegiline
  • Sotalol
  • Sparfloxacin
  • Thioctic acid
  • Timolol
  • Tosufloxacin
  • Tranylcypromine
  • Hypokalemia (low levels of potassium in the blood)
  • Kidney problems
  • Liver problems
  • Keeping a glucagon kit (prescribed by the doctor) by their side if they are unable to eat or drink
  • Having back-ups of insulin aspart and insulin degludec in case of high blood pressure or contaminated medication
  • Wearing a medical identification neck chain or bracelet
  • Carrying identification cards that list the patient's medications and conditions
  • Drowsiness
  • Feeling excessively hungry
  • Quickened heartbeat
  • Trembling
  • Feeling of being drunk
  • Slurring of speech
  • Behavioural changes such as anxiety or confusion
  • Easily irritated
  • Experiencing nightmares
  • Difficulty with sleep
  • Difficulty with thinking
  • Blurring of vision
  • Cold sweating
  • Headaches
  • Tingling in the hands and feet, or lips and tongue
  • Feeling drowsy
  • Feeling tired
  • Dry mouth
  • Flushed or dry skin
  • Fruity breath odor
  • Trouble with breathing
  • Increase in urination
  • Ketones in urine
  • Loss of appetite
  • Increase in thirst
  • Pain in stomach
  • Nausea or vomiting
  • Fainting
  • Pain or discomfort in the chest
  • Unusual tiredness or weakness
  • Uneven heartbeat
  • Swelling in the extremities
  • Rapid weight gain
  • Trouble breathing
  • Pain in the chest
  • Swelling, especially of the face, tongue and throat