Comparison of IAsp with human insulin:
- higher concentrations of serum insulin are achieved in a shorter period of time
- the decrease in serum insulin concentration is more rapid
- the control of glucose values during the day is more successful
- the minimum glucose values at night are not so low
-
hypoglycemia occurs less frequently
- type 1 diabetics have fewer postprandial glucose excursions (Simpson 1999)
- IAsp does not need to be mixed thoroughly before injection (Herold 2018).
Pharmacodynamics
DNA- synthesis occurs in normal insulin exclusively via activation of the insulin receptor. In IAsp, however, signal induction by the IGF- I receptor plays an important role (Eckhardt 2007). A mitogenic effect feared as a result could not be confirmed so far (Haak 2018).
A variation of the amino acid sequence prevents the subcutaneous formation of hexamers in insulin aspart. This causes the more rapid absorption (Herold 2018). IAsp, like all short-acting insulin analogues, best mimics the physiological secretion of insulin in the first postprandial phase (Jahn 2020 / Rodbard 2020).
Indication
IAsp can be used in all forms of insulin therapy of type 1 diabetes or type 2 diabetes (Prinz 2012) such as:
- SIT (supplemental insulin therapy)
- Intensified insulin therapy (both ICT and insulin pump therapy [Herold 2020]).
- basic bolus concept (Alawi 2019)
- conventional insulin therapy (Greten 2005)
Dosage and mode of administration
IAsp can be administered by pen, pump, and closed-loop systems (Jahn 2020).
IAsp is usually administered s.c.. However, it is also approved for i.v. application, which does not provide any clinical advantage (Danne 2016).
Insulin aspart can be injected into the abdominal wall (faster absorption) and into the front or outer thigh (slower absorption).
(Schubert 2009)
Injection sites should be changed constantly to avoid lipohypertrophy (Marischler 2020).
In the case of aspartic mixed insulins, it is recommended that they be administered in the abdominal wall in the morning and in the thigh in the evening (Schubert 2009).
The daily insulin requirement of a healthy person is 0.67 I. E. / kg / d = approx. 40 I. E. Of this, about 40% is for basal secretion and about 60% for postprandial (Dellas 2018 / Seifert 2018).
Lowering blood glucose:
To achieve a reduction in blood glucose of 30 - 40 mg / dl (1.6 - 2.2 mmol / l), 1.0 I.U. normal ins ulin or rapid-acting analog insulin is required (Haak 2018).
For more details, see. Insulin
Raising blood glucose:
To achieve an elevation of blood glucose by 30 - 40 mg / dl (1.6 - 2.2 mmol / l), 10 g of carbohydrate = 1 KE is required (Haak 2018).
The size of the meal is measured in carbohydrate units = KE, the outdated term is bread unit = BE [Dellas 2018]) (Herold 2021).
A higher dose of insulin may be required, for example, for:
- Blood glucose > 270 mg / dl
- dehydration
- infections
- fever
- Detection of ketone bodies (Haak 2018).
A lower dose of insulin may be needed in cases such as:
- insufficiency of the adrenal cortex
- severe renalinsufficiency
- liver insufficiency
- physical stress (Haak 2018)
Adverse effects
- hypoglycemia
- Antibody formation is comparable to that with human insulin
Corresponding studies with regard to long-term damage are still pending (Mehnert 2003)
Contraindication
Absolute contraindications:
- hypoglycemia
- Insulinoma (Flake 2021)
Preparations
- Insulin Aspart (NovoRapid):
Onset of action with s. c. Injection occurs after 20 - 25 min, duration of action is 4 - 5 h (Haak 2018).
- Insulin Faster Aspart (Fiasp):
The onset of action is already after 4.9 min (Meißner 2021/ Haak 2018). The duration of action is approximately 3.5 h (Herold 2018).
Insulin Faster Aspart comes closest to the physiological secretion of insulin during a meal and thus improves postprandial glucose control in diabetics (Haahr 2019).
Premixed insulin analogues include:
- 70 / 30 Novolog / Novo Nordisk: 70% protamine-aspart, 30% aspart (Ferri 2021 / Hartman 2008). Onset of action after 20 - 25 min, duration of action 10 - 14 h (Haak 2018).
- Combination insulin degludec (70) / aspart (30) = IdegAsp.
IdegAsp is the first combination insulin of two insulin analogues. It provides both basal and mealtime insulin delivery with a single injection (Haahr 2017). The onset of action occurs after 20 - 25 min, and the duration of action is > 30 h (Haak 2018).