Blood Sugar Hold Parameters for Fiasp (Insulin Aspart)

Primary Hold Threshold

The American Diabetes Association recommends holding Fiasp when blood glucose is <70 mg/dL (3.9 mmol/L) until glucose recovers to safe levels, as this represents Level 1 hypoglycemia requiring immediate intervention 1, 2, 3
This threshold aligns with the standard definition of hypoglycemia in both outpatient and inpatient settings, correlating with the initial release of counterregulatory hormones, with a moderate level of evidence 4

The American Diabetes Association suggests that blood glucose <100 mg/dL should trigger reassessment of the insulin regimen, as fasting glucose below this level predicts hypoglycemia within the next 24 hours, based on a low level of evidence 3
Blood glucose <70 mg/dL (3.9 mmol/L) requires modification of the insulin regimen unless the hypoglycemic event is easily explained by other factors such as a missed meal, with a moderate level of evidence 4, 3
More severe hypoglycemia thresholds include Level 2 (<54 mg/dL or 3.0 mmol/L) and Level 3 (any level with altered mental/physical functioning requiring assistance), based on a high level of evidence 5, 3

Fiasp should be held if the patient cannot maintain oral intake due to persistent vomiting or diarrhea preventing food consumption, with a low level of evidence 1
If a patient has already taken their Fiasp dose but then becomes unable to eat, providing 4-8 oz of juice or soda immediately can prevent severe hypoglycemia, based on a moderate level of evidence 1

Glucose should be rechecked in 15-20 minutes after treating hypoglycemia <70 mg/dL, with a low level of evidence 1
Patients receiving insulin should perform more frequent self-monitoring (every 4-6 hours) during illness or when glucose values are unstable, based on a moderate level of evidence 1

The American Diabetes Association recommends never continuing Fiasp if the patient has taken their dose but then becomes unable to eat, as this is a critical error that can lead to severe hypoglycemia requiring immediate carbohydrate administration, with a high level of evidence 1
During illness, if blood glucose is more elevated than usual, considering an empirical 10-20% increase in insulin doses rather than automatically holding may be appropriate, but only if the patient can maintain oral intake, based on a low level of evidence 1