Management of NovoLog (Insulin Aspart) Therapy

Primary Hold Criteria

The American Academy of Family Physicians recommends holding NovoLog if blood glucose is <70 mg/dL until glucose recovers to safe levels 1, 2
Patients who have taken their dose of rapid-acting insulin and develop low blood glucose should consume 4-8 oz of juice or soda, recheck glucose in 15-20 minutes, and seek further treatment if needed, as advised by the American Academy of Family Physicians 1, 2
The American Journal of Kidney Diseases suggests that patients with recurrent low blood glucose readings should seek assistance from their healthcare provider 3

The American Journal of Kidney Diseases recommends temporarily stopping NovoLog if the patient cannot keep up with intake of foods or fluids 3
Hold NovoLog if there is persistent vomiting or diarrhea preventing oral intake, as suggested by the American Journal of Kidney Diseases 3
Patients should seek healthcare provider assistance when symptoms last >72 hours, according to the American Journal of Kidney Diseases 3
Consider an empirical 10-20% increase in insulin doses rather than holding if blood glucose is more elevated than usual during illness, as recommended by the American Journal of Kidney Diseases 3

The American Journal of Kidney Diseases suggests that patients receiving insulin should perform more frequent self-monitoring of blood glucose (every 4-6 hours) while awake and for the duration of symptoms 3
Check ketones if unable to eat or if blood glucose remains elevated despite insulin, as advised by the American Journal of Kidney Diseases 3

The American Academy of Family Physicians advises against continuing NovoLog if the patient has taken their dose but then becomes unable to eat—provide glucose/carbohydrates to prevent severe hypoglycemia 1, 2
Patients must understand that NovoLog's rapid onset (5 minutes) means hypoglycemia can develop quickly, giving less time to recognize symptoms compared to regular insulin, as noted by the American Academy of Family Physicians 1, 2