Novolog/Novorapid (Insulin Aspart)

What is this medication?

NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart)
Rapid Acting Insulin

Brand Name US: Novolog
Canadian Equivalent: NovoRapid

NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart) is officially indicated for Diabetes mellitus types 1 and 2.

What is a biosimilar biologic drug?

Manufacturers have found cost-efficient ways to recreate the molecules used in the original or “reference” biologic drug.  Biosimilars are highly “similar” to a reference biological drug despite differing in their chemical composition.  

The FDA approval of biosimilar drugs is based on a totality of evidence which is used by regulators in the approval of reference and biological drugs.  The FDA uses the same approach in evaluating biosimilars to confirm that there are no clinically meaningful differences in safety and efficacy between the reference biologic drug and the biosimilar.  The rigorous standard for authorization means that you can have confidence knowing that the quality, safety, and efficacy of a biosimilar is the same as any other biologic drug.

TRURAPI is a biosimilar to NOVORAPID (Insulin Aspart)

What is the difference between the brands?

The confusion stems from FIASP having the same main ingredient as NOVORAPID/NOVOLOG (Insulin Aspart). The difference is that FIASP also has vitamin B3, known as niacinamide, which makes it more fast-acting.

How does this medication work? 

NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart) works on liver, muscle and adipose (fat) tissue to regulate the metabolism of carbohydrates, protein, and fats.  In the liver and muscles, it increases glycogen synthesis which is the immediate storage form of glucose.  It increases fat production by increasing fatty acid release from the liver in the form of lipoproteins which adipose tissue converts to fatty acids then to triglycerides for storage whilst also stopping the metabolism of triglycerides (fat).  Insulin also increases the cellular uptake of amino acids and some electrolytes such as potassium into the cell.  In muscle tissue protein synthesis is increased.

Normally insulin is produced by the pancreas however insulin products for pharmaceutical use have been produced via recombinant DNA technology using certain bacteria (they splice the gene for insulin production into bacterial DNA so the cell produces insulin – a gene is a portion of DNA or RNA that produces one specific protein).  Insulin Aspart is different from human insulin as it has some modifications to make it work faster.  This is done by exchanging the proline at location B28 with aspartic acid in human insulin (these are all names of amino acids which are the building blocks of proteins such as insulin).

How should I take this medication? 

NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart) is a rapid acting mealtime insulin.  It is injected subcutaneously in multiple daily dosages depending on the number of meals the patient consumes.  It should be given 5-10 minutes prior to the meal.  FIASP is a different formulation that may be given at the start of a meal up to 20 minutes after the first bite.  In type 2 diabetes someone usually starts around 4-5 units per day or 10% of basal insulin dose prior to largest meal of the day and the dosage is slowly increased until glucose control is achieved.  In type 1 diabetes 50-60% of total daily insulin is given as fast acting mealtime insulin with the rest going to intermediate or long acting basal insulins.  If converting from another insulin the number of units given may need to be lowered as a precaution.

How to Take: Follow instructions provided by physician/pharmacy label, use consistently at same times each day unless otherwise directed.  Injection generally into abdomen, thighs, buttocks, or arms with absorption rates varying from site to site.  Be consistent with the part of body you inject into but rotate injection site to avoid redistribution of fat and excessive irritation to the area.  For example, if you choose abdomen which is the most common, inject in circular order at least 2 inches from navel.

You Need to Avoid: Do not use if solution seems viscous (thick) or appears cloudy, only use if clear, colorless and with no visible particles.  Avoid injecting cold insulin as it may be painful.  

What should I watch for while using this medication? 

Before starting NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart), make sure your physician is aware of any allergies or medications you currently take, if you have had bariatric surgery, cardiovascular disease, have kidney disease, liver disease, are pregnant or breastfeeding.

What is the difference between a prefilled pen and a cartridge?

The prefilled pen is in a ready to use format including a fixed needle, whereas a cartridge needle is separate from the glass body.

What if I miss a dose?

Since Insulin Aspart is used before meals, you may not be on a timed dosing schedule. Whenever you use Insulin Aspart, be sure to eat a meal within 5 to 10 minutes. Do not use extra insulin to make up for a missed dose.

Keep insulin on hand at all times. Get your prescription refilled before you run out of medicine completely.

How should I store this medication?

Store between 2-8°C (36° to 46°F) in a refrigerator, but not in or near a freezing compartment. Insulin Aspart should not be exposed to heat or light. Do not freeze and do not use if it has been frozen. Insulin Aspart should not be drawn into a syringe and stored for later use.

What are the possible side effects of using this medication?

Hypoglycemia, antibody development, nasopharyngitis, headaches, hyporeflexia, and increased risk of accidental injury.  Hypoglycemia is the largest concern with rapid acting insulin and can be life-threatening so extra care should be taken when using insulin.  If you feel unsure of your dose contact your health care professional and always err on the side of caution.

Note this is not a complete list of side effects for NOVOLOG/NOVORAPID/FIASP/TRUAPI (Insulin Aspart), only common ones.