NovoLog Vials (NovoRapid Vials)

NovoLog Vials
Insulin Aspart
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Description

NovoLog Vials (NovoRapid in Canada) by Novo Nordisk is an insulin used to treat diabetes in adults, adolescents, and children of 1 year and above. Its active ingredient is insulin aspart which is a rapid-acting insulin.

The insulin solution NovoLog (NovoRapid) is injected under the skin (subcutaneously). Injections are most commonly given into the abdomen, thigh, upper arm, or buttock. Diabetes educators and doctors can give you guidance on how to properly administer insulin.

Vials of NovoLog are typically taken before meals, but can also be taken after meals. A combined long-acting or intermediate insulin and NovoLog is often used to treat Type 2 diabetes. To determine the correct dosage for a patient, glucose levels should be tested regularly.

The dosage amount is commonly based on body weight, usually between 0.5 – 1.0 units per kg body weight per day. When taken with meals, 50-70% of the insulin requirement may be a combination of 50-70% of the NovoRapid insulin and the remainder with long-acting or intermediate insulin.

A pump system can be used with NovoLog Insulin to provide continuous insulin infusion under the skin (subcutaneously) or into a vein (intravenously) by a doctor or nurse.

NovoLog (NovoRapid) products are also available in KwikPens and cartridges.

Warnings and Precautions

To ensure proper usage and avoid side effects, speak with your doctor or pharmacist before taking this medication.

The injection site should be changed after every injection.

NovoLog (NovoRapid) is safe to be used by pregnant women however should be taken with the guidance of a doctor. See the pregnancy tab for more information.

Diabetes patients are recommended to monitor glucose levels regularly.

Any adjustments to insulin dosages should be made cautiously and under the guidance of a doctor.

Insulin should never be injected directly into a vein.

Do not share your prescription insulin with others, even if the needle has been changed. This can lead to spreading infections or blood pathogens. Your medicine may also be harmful to their health.

Usage

Check the label on your insulin medication before use to ensure you have the correct type of insulin.

Should be injected immediately before meals for fast onset of action. Injection of insulin should be 5-10 minutes before starting your meal).

NovoLog (NovoRapid) insulin should be injected in the front of the thigh, abdomen, upper arm, or buttocks. Insulin will work quicker if injected into the stomach.

Blood sugar levels should be measured regularly.

Due to NovoLog’s fast onset of action, it should be taken within 5-10 minutes of starting your meal. When necessary, NovoRaid can also be taken soon after a meal.

To prevent contamination, always use a new needle with every injection.

Side Effects

A side effect is an unwanted response when taking medication in regular doses. Like any medication, side effects can occur.

With the guidance and precautions by doctors and healthcare professionals, patients can experience safe and effective use.

The most common side effect with NovoRapid, as with any insulin, is hypoglycemia (low blood sugar levels).

If hypoglycemia is not treated early, it can result in loss of consciousness, coma, and even fatal.

Seek medical attention immediately if you suddenly feel unwell, start vomiting, have difficulty breathing, dizziness, start sweating or rapid heartbeat, or if you are experiencing severe allergic reactions.

Vision problems may occur. Vision disturbance may happen at the start of your treatment but eventually, go away.

If you repeatedly inject the same site, the fatty tissue under the skin may become thick (lipohypertrophy) or shrink (lipoatrophy). By rotating the site of injection, you can avoid these skin issues from happening. If you notice any pitting or thickening of the skin, notify your doctor as these can change insulin absorption if these reactions become more severe.

Patients may experience swollen joints caused by water retention. This often happens around the ankles or other joints.

If you have diabetic retinopathy (changes in eye background) and your blood sugar levels improve quickly, your retinopathy may worsen.

Painful neuropathy is usually transient. If your blood glucose levels improve quickly, you may experience nerve-related pain.

If you experience any severe side effects or side effects not listed, it’s essential to notify your doctor.

Allergic Reactions

As with any insulin therapy, injection site reactions may occur and include pain, redness, itching, hives, swelling, bruising, and inflammation. Continuous rotation of the injection site within a given area reduces the risk of developing these reactions. Reactions usually resolve in a few days to a few weeks. On rare occasions, injection site reactions may require discontinuation of NovoLog (NovoRapid). Localized reactions and generalized myalgias have been reported with injected metacresol, an excipient in NovoLog (NovoRapid). 

Systemic allergic reactions have not been reported during the clinical development of NovoLog (NovoRapid). Systemic allergic reactions have rarely occurred with NovoLog (NovoRapid) as with other insulin treatments. These reactions may be characterized by a generalized rash (with pruritus), shortness of breath, wheezing, and a drop in blood pressure. Severe cases of generalized allergy, including anaphylactic reaction, may be life-threatening.

Drug Interactions

The drugs listed below are based on either drug interaction case reports or studies or potential interactions due to the expected magnitude and seriousness of the exchange (i.e., those identified as contraindicated).

The following substances may reduce the insulin requirements: Oral anti-diabetic drugs, monoamine oxidase inhibitors (MAOI), beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, salicylates, anabolic steroids, sulfonamides, and alcohol.

The following substances may increase insulin requirements: Oral contraceptives, thiazides, glucocorticosteroids, thyroid hormones, sympathomimetics growth hormone, and danazol.

Beta-blocking agents may mask the symptoms of hypoglycemia and delay recovery from hypoglycemia.

Octreotide/lanreotide may either increase or decrease insulin requirements.

To avoid the risk of developing new or worsening heart failure, the use of TZDs in combination therapy with NovoLog is not indicated.

Overdose

Excess insulin administration may cause hypoglycemia and, particularly when given intravenously, hypokalemia. Hypoglycemia may occur due to an excessive dose of insulin relative to food intake, energy expenditure, or both. Omission of a meal or unplanned strenuous physical exercise may lead to hypoglycemia. Symptoms of hypoglycemia may occur suddenly. They may include cold sweat, cool pale skin, fatigue, nervousness or tremor, anxiousness, unusual tiredness or weakness, confusion, difficulty concentrating, drowsiness, excessive hunger, vision changes, headache, nausea, and pulse. Severe hypoglycemia may lead to unconsciousness and convulsions and may be fatal.

Mild episodes of hypoglycemia can be treated by oral administration of glucose or sugary products. It is therefore recommended that patients with diabetes always carry some sugar candy.

Severe hypoglycemic episodes, where the patient has become unconscious, can be treated with glucagon (0.5-1 mg) given intramuscularly or subcutaneously by a trained person or glucose given intravenously by a medical professional. Glucose must also be given intravenously if the patient does not respond to glucagon within 10-15 minutes. Upon regaining consciousness, administration of an oral carbohydrate is recommended for the patient to prevent relapse. Hypokalemia must be corrected appropriately.

Pregnancy

Congenital anomalies are 3-4 times more prevalent in diabetic pregnancy than in non-diabetic pregnancies and with two-fold higher mortality from significant cardiovascular abnormalities.

In a clinical trial of 157 pregnant women with type 1 diabetes treated with NovoLog (NovoRapid), ten congenital malformations were reported in 9 (5.7%) patients treated with NovoLog (NovoRapid). Cardiac patients treated with NovoRapid® were central nervous system anomaly, ankyloglossia, and fetal disorders.

Of the women who received NovoRapid®, fetal exposure throughout the entire pregnancy occurred in 44 women. One child exposed to NovoRapid® had an anomaly neck edema resulting in fetal loss.

In a clinical trial of 14 women with gestational diabetes who received NovoLog (NovoRapid) treatment, two infants had abnormal findings. All results were felt to be unrelated to the treatment. 

NovoLog (NovoRapid) can be used in pregnant women with type 1 diabetes if clinically indicated. It is essential for patients with type 1 diabetes to maintain reasonable metabolic control before conception and throughout pregnancy. Insulin requirements usually decrease during the first trimester and increase during the second and third trimesters. Patients should be advised to inform their health care professional if they are pregnant or are contemplating pregnancy. Careful monitoring of glucose control is essential in these patients.

Storage

Insulin should be kept out of reach from children and pets.

NovoLog (NovoRapid) insulin can be stored in the refrigerator between 2°C-8°C. Do not store near a cooling element for the freezer and do not freeze insulin.

Keep away from extreme heat or direct sunlight.

Do not use NovoLog insulin after the expiry date printed on the label or carton.

Do not dispose of medication down wastewater (i.e., toilet, sink) or in the trash bin.

Speak to your pharmacist about how to properly dispose of medication. This can help protect the environment.