NovoMix 30 Penfill - Injection Insulin Aspart Biphasic - 100IU/ml 1 3ml Cartridge(s) / 3ml Cartridge Novo Nordisk Indication: Diabetes mellitus Administration: Administer subcutaneously in the upper arm, thigh or abdominal wall. A subcutaneous injection into the abdominal wall results in a faster absorption than from other injection sites. Adult Dose: Subcutaneous Diabetes Mellitus Combination rapid-onset (faster than regular insulin) and intermediate-acting insulins in fixed dose Typical daily insulin requirements range between 0.5-1 unit/kg Dose regimen varies among patients depending on metabolic needs; Administer SC q12hr (ie, before breakfast and evening meal); each dose intended to cover 2 meals or a meal and snack Dosing Considerations: Insulin naive patients: For patients with type 2 diabetes, the recommended starting dose of Insulin Aspart 30/70 is 6 Units at breakfast and 6 Units at dinner (evening meal). Insulin Aspart 30/70 can also be initiated once daily with 12 units at dinner (evening meal).... Child Dose: Safety and efficacy not established Renal Dose: Renal impairment: Dose adjustments may be needed. Contraindication: Hypoglycaemia.Hypersensitivity to any of the components. Mode of Action: Insulin Aspart Biphasic is a biphasic suspension of soluble insulin aspart (rapid-acting human insulin analogue) and protamine-crystallised insulin aspart (intermediate-acting human insulin analogue). The blood glucose lowering effect of Insulin Aspart Biphasic is due to the facilitated uptake of glucose following binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver. Soluble insulin aspart which has a rapid onset of action, thus allowing it to be given closer to a meal (within zero to 10 minutes of the meal) when compared to soluble human insulin. The crystalline phase consists... Precaution: Rapid changes in serum glucose may induce symptoms of hypoglycemia Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions (eg, long duration of diabetes, diabetic nerve disease, use of beta-blockers or intensified diabetes control) Caution in conditions with decreased insulin requirements (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment) Caution in conditions with increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery) May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium Frequent glucose monitoring and... Side Effect: >10% Hypoglycemia (47-69%) Headache (12-35%) Influenza-like symptoms (12-13%) 1-10% Headache (9%) Dyspepsia (9%) Diarrhea (7-8%) Back pain (7%) Pharyngitis (6-7%) Frequency Not Defined Insulin resistance Lipodystrophy Lipohypertrophy Local allergic reaction Hypokalemia Weight gain Peripheral edema Pregnancy Category Note: Pregnancy (insulin requirements tend to fall during the 1st trimester, increase during the 2nd and 3rd) and lactation. Regular monitoring of HbA1c and blood glucose concentrations. Caution with increased insulin requirements: Fever, hyperthyroidism, trauma, infection, surgery Lactation: Unknown whether distributed in breast milk; compatible with breast feeding, but lactating women may require dosage adjustment; caution advised Interaction: Reduce insulin requirements w/ oral hypoglycemics, octreotide, MAOIs, nonselective ?-adrenergic blockers, ACE inhibitors, salicylates, alcohol, anabolic steroids & sulfonamides; increase insulin requirements w/ OCs, thiazides, glucocorticoids, thyroid hormones, sympathomimetics & danazol. ?-blocking agents may mask the symptoms of hypoglycaemia. Alcohol may intensify & prolong the glucose lowering effect of insulin.