RUDY, who has type 2 diabetes, is recommending NovoLog®, for mealtime control

Starting patients on NovoLog®

NovoLog® (insulin aspart [rDNA origin] injection) has been studied in multiple approaches when insulin intensification is needed. The two intensification approaches below describe how to add mealtime insulin to your patient’s basal insulin therapy:

  • The FullSTEP® approach adds mealtime bolus injections sequentially to a basal regimen as needed
  • The 4-T approach starts by adding 3 bolus doses to a basal regimen
     
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FullSTEP® Approach

Intensify to a basal-bolus regimen using a stepwise approach

With FullSTEP®, patient-led titration fostered patients' active involvement.1,2 Patients initiated NovoLog®with just 1 dose and managed titration with a 1-0-1 algorithm.
 

Chart showing insulin dosage and management algorithm

Overview of NovoLog® patient-led titration.

Patients start by taking NovoLog® at only 1 meal each day (largest meal of the day) at the starting dose you prescribe. Patients keep taking NovoLog® at that same meal each day. Then patients make daily NovoLog® dose adjustments using a straightforward 1-0-1 algorithm.

Chart showing adjustment of next day's insulin dose

Intensify

After 11 weeks, patients add a dose to their next largest meal if A1C is >= 7% (two main meals a day).

After 22 weeks, patients add a dose to their third largest meal if A1C is >= 7% (three main meals a day).
 

Chart showing self titrated doses algorithm



self titration FULLSTEP dosing tool download

FullSTEP® Dosing Tool

Download the FullSTEP® dosing tool to learn about this patient self-titration regimen


 



 

FullSTEP® e-Learning Program

A self-guided, interactive, e-learning program that explains the manageable, patient-titrated, stepwise approach in the FullSTEP® study.


 


Related Prescribing Topics:

Selected Important Safety Information

Contraindications

  • NovoLog® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® or one of its excipients.

Warnings and Precautions

  • Never Share a NovoLog® FlexPen, NovoLog® FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.
  • Administration: NovoLog® should generally be given immediately (within 5-10 minutes) prior to the start of a meal. Any change of insulin dose should be made cautiously and only under medical supervision. Changing from one insulin product to another or changing the insulin strength may result in the need for a change in dosage. As with all insulin preparations, the time course of action of NovoLog® may vary in different individuals or at different times in the same individual and is dependent on many conditions, including injection site, local blood supply, temperature, and level of physical activity. NovoLog® should be used with a longer-acting insulin.

NovoLog® (insulin aspart [rDNA origin] injection) Indications and Usage

  • NovoLog® (insulin aspart [rDNA origin] injection) is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus.

Important Safety Information

Contraindications

  • NovoLog® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® or one of its excipients.

Warnings and Precautions

  • Never Share a NovoLog® FlexPen, NovoLog® FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.
  • Administration: NovoLog® should generally be given immediately (within 5-10 minutes) prior to the start of a meal. Any change of insulin dose should be made cautiously and only under medical supervision. Changing from one insulin product to another or changing the insulin strength may result in the need for a change in dosage. As with all insulin preparations, the time course of action of NovoLog® may vary in different individuals or at different times in the same individual and is dependent on many conditions, including injection site, local blood supply, temperature, and level of physical activity. NovoLog® should be used with a longer-acting insulin.
  • Hypoglycemia: Hypoglycemia is the most common adverse effect of insulin therapy. The timing of hypoglycemia may reflect the time-action profile of the insulin formulation. Glucose monitoring is recommended for all patients with diabetes and is particularly important for patients using external pump infusion therapy. Any change of insulin dose should be made cautiously and only under medical supervision.
  • Hypokalemia: Insulin, particularly when given intravenously or in settings of poor glycemic control, can cause hypokalemia. Use caution in patients predisposed to hypokalemia.
  • Renal and Hepatic Impairment: Like all insulins, NovoLog® requirements may be reduced in patients with renal impairment or hepatic impairment.
  • Hypersensitivity and Allergic Reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, may occur with insulin products, including NovoLog®
  • Continuous Subcutaneous Insulin Infusion by External Pump: When used in an external subcutaneous insulin infusion pump, NovoLog® should not be mixed with any other insulin or diluent.
  • Fluid retention and heart failure with concomitant use of PPAR-gamma agonists: Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including NovoLog®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered.

Adverse Reactions

  • Adverse reactions observed with NovoLog® include hypoglycemia, allergic reactions, local injection site reactions, lipodystrophy, rash, and pruritus.

Use in Specific Populations

  • NovoLog® has not been studied in children with type 2 diabetes or in children with type 1 diabetes who are younger than 2 years of age.
  • The background risk of birth defects, pregnancy loss, or other adverse events that exists for all pregnancies is increased in pregnancies complicated by hyperglycemia.

Please click here for Prescribing Information.

 

References

  1. Rodbard HW, Visco VE, Andersen H, Hiort LC, Shu DHW. Treatment intensification with stepwise addition of prandial insulin aspart boluses compared with full basal-bolus therapy (FullSTEP Study): a randomised, treat-to-target clinical trial. Lancet Diabetes Endocrinol. 2014;2:30-37.
  2. Data on file. Novo Nordisk Inc, Plainsboro, NJ.