The drug NovoRapid (insulin) is a completely new drug. Replenishes the lack of human insulin and has several advantages over other types of hormones. It is quickly acquired and in an instant reduces sugar. It can be used regardless of the meal. It is considered ultrashort insulin.
The composition of the diabetic
The NovoRapid diabetic product (insulin) is produced in two forms - these are replaceable Penfill cartridges and ready-made FlexPen pens.
The composition of the cartridge and pen is the same - it is a clear liquid for injection, where 1 ml contains the active component insulin aspart in an amount of 100 PIECES. One replaceable cartridge, like one pen, contains about 3 ml of solution, which is 300 units.
Cartridges are made of hydrolytic glass of the I class. Closed on one side with polyisoprene and bromobutyl rubber disks, on the other hand with special rubber pistons. There are five replaceable cartridges in an aluminum blister, and one blister is embedded in a cardboard box. In the same way, Flexpen pen syringes are made. They are disposable and are designed for several doses. In a cardboard box there are five of them.
The drug is stored in a cold place at a temperature of 2-8 ° C. It should not be placed next to the freezer, nor should it be frozen. Also, replaceable cartridges and syringe pens should be protected from the heat of the sun. If NovoRapid insulin (cartridge) is opened, it cannot be stored in the refrigerator, but should be used within four weeks. Storage temperature should not exceed 30 ° C. Shelf life of unopened insulin is 30 months.
Pharmacology
The NovoRapid medication (insulin) has a hypoglycemic effect, and the active component, insulin aspart, is an analogue of the short-acting hormone produced by humans. This substance is obtained by using special biotechnology of recombinant DNA. A strain of Saccharomyces cerevisiae is added here, and an amino acid called "proline" is temporarily replaced by an aspartic one.
The medicine comes into contact with the receptors of the outer cytoplasmic membrane of the cells, where it forms a whole complex of insulin endings, activates all the processes that occur inside the cells. After reducing the amount of glucose in plasma, an increase in intracellular transport, an increase in the digestibility of various tissues, an increase in glycogenogenesis and lipogenesis occur. The rate of glucose production by the liver decreases.
Replacing the amino acid proline with aspartic acid when exposed to insulin aspart reduces the ability of molecules to create hexamers. This type of hormone is better absorbed by subcutaneous fat, affects the body faster than the influence of soluble standard human insulin.
In the first four hours after a meal, insulin aspart reduces plasma sugar levels faster than soluble human hormone. But the effect of NovoRapida with subcutaneous administration is shorter than that of soluble human.
How long does NovoRapid work? This question worries most people with diabetes. So, the effect of the drug occurs after 10-20 minutes after the injection. The highest concentration of the hormone in the blood is observed 1-3 hours after the use of the drug. The tool affects the body for 3-5 hours.
Studies of individuals with type I diabetes have shown a several-fold reduction in the risk of nocturnal hypoglycemia when using NovoRapida, especially compared with the administration of soluble human insulin. In addition, there was a significant decrease in postprandial glucose in plasma when injected with insulin aspart.
Indications and contraindications
The drug NovoRapid (insulin) is intended for people with type 1 diabetes, which is insulin-dependent, and for patients with type 2 diabetes - non-insulin-dependent (stage of resistance to hypoglycemic drugs taken orally, as well as intercurrent pathologies) .
Contraindication to the use of the drug is hypoglycemia and excessive sensitivity of the body to insulin aspart, excipients of the drug.
Do not use NovoRapid for children under six years of age due to a lack of necessary clinical studies.
The medicine "NovoRapid": instructions for use
The drug NovoRapid is an analogue of insulin. It begins to act immediately after the injection. The dosage for each patient is individual and is selected by the doctor. To achieve the best result, this hormone is combined with prolonged or medium-acting insulin.
In order to control glycemia, the amount of glucose in the blood is constantly measured and the dose of insulin is carefully selected. As a rule, the daily dose for adults and children ranges from 0.5-1 U / kg.
When injected with NovoRapid medicine (the instructions for use describe in detail the order of administration of the drug), the human need for insulin is provided by 50-70%. The rest is satisfied by the administration of long-acting (prolonged) insulin. An increase in the patient’s physical activity and a change in diet, as well as existing concomitant pathologies, often necessitate a change in the administered dose.
The hormone NovoRapid, in contrast to the soluble human, begins to act quickly, but not continuously. Slow administration of insulin is indicated. The injection algorithm involves the use of medication immediately before a meal, and if there is an urgent need, the drug is used immediately after a meal.
Due to the fact that NovoRapid acts on the body for a short time, the risk of hypoglycemia at night in patients with diabetes is significantly reduced.
In elderly patients, as well as in people with renal or hepatic insufficiency, monitoring of blood glucose concentration should occur more often, and the amount of aspart insulin is selected individually.
Children "NovoRapid" replace human soluble insulin, but only if you need a drug with quick action. It is used when the child does not maintain the desired interval between injections and food. If the patient is transferred to NovoRapid from other drugs containing insulin, dose adjustment, as well as basal insulin, is required .
Subcutaneous administration of insulin (the hormonal injection algorithm is described in detail in the instructions for use) involves the injection in the anterior abdomen, thigh, brachial and deltoid muscles, as well as in the buttocks. The area in which injections are made should be changed to prevent lipodystrophy.
With the introduction of the hormone in the anterior region of the peritoneum, the drug is absorbed faster than injections in other parts of the body. The duration of the hormone effect is affected by the dose, injection site, degree of blood flow, body temperature, level of physical activity of the patient.
NovoRapid is also used for long subcutaneous infusions, which are carried out by a special pump. The drug is injected into the anterior peritoneum, but the places are periodically changed. If an insulin pump is used, NovoRapid should not be mixed with other types of insulin in it. Patients receiving a hormone using an infusion system should have a supply of medicine in case of a breakdown of the device.
NovoRapid can be used for intravenous administration, but the procedure should be carried out by a qualified health professional. For this type of administration, infusion complexes are sometimes used where insulin is contained in an amount of 100 PIECES / ml, and its concentration is 0.05-1 PIECES / ml. The drug is diluted in 0.9% sodium chloride, 5- and 10% dextrose solution, which contains potassium chloride up to 40 mmol / L. Mentioned funds are stored at room temperature for no more than a day. With insulin infusions, you need to regularly donate blood for glucose in it.
How to calculate the dose of insulin?
To calculate the dosage, you need to know that insulin is combined, long (extended), medium, short and ultrashort. The first normalizes blood sugar. It is introduced on an empty stomach. It is indicated for persons with type 1 and type 2 diabetes. There are people who use only one type of insulin - extended. Some people use only NovoRapid to avoid sudden surges in glucose. Short, long insulins can be used simultaneously in the treatment of diabetes, but they are administered at different times. For some patients, only the combined use of drugs helps to achieve the desired effect.
When selecting extended insulin, several nuances should be taken into account. For example, it is necessary that without injecting a short hormone and basic meals, the sugar should remain at the same level throughout the day only due to the action of long insulin.
The selection of a dose of prolonged insulin is as follows:
- In the morning, without breakfast, measure the level of sugar.
- Lunch is eaten, and after three hours, the plasma glucose level is determined. Further measurements are carried out every hour before going to bed. On the first day of dose selection skip lunch, but have dinner.
- On the second day, breakfast and lunch are allowed, but dinner is not allowed. Sugar, as well as on the first day, must be monitored every hour, including at night.
- On the third day, they continue to take measurements, eat normally, but do not administer short insulin.
Ideal morning indicators are:
- on the 1st day - 5 mmol / l;
- on the 2nd day - 8 mmol / l;
- on the 3rd day - 12 mmol / l.
Such indicators of glucose should be obtained without a short-acting hormone. For example, if in the morning blood sugar is 7 mmol / l, and in the evening - 4 mmol / l, then this indicates the need to lower the dose of the long hormone by 1 or 2 units.
Often, patients use the Forsham formula to determine the daily dose. If glycemia ranges from 150-216 mg /%, then 150 is taken from the measured blood sugar level and the resulting number is divided by 5. As a result, a single dose of a long hormone is obtained. If glycemia exceeds 216 mg /%, then 200 is subtracted from the measured sugar, and the result is divided by 10.
To determine the dose of short insulin, you need to measure the level of sugar throughout the week. If all the daily values are normal, except for the evening, then short insulin is administered only before dinner. If the sugar level jumps after each meal, then injections are given immediately before meals.
To determine the time for which the hormone should be administered, glucose must first be measured 45 minutes before meals. Next, you should control the sugar every five minutes until its level reaches the level of 0.3 mmol / l, only after that you should eat. This approach will prevent the onset of hypoglycemia. If after 45 minutes the sugar does not decrease, you must wait with food until the glucose drops to the desired level.
To determine the dose of ultrashort insulin, people with type 1 and type 2 diabetes are advised to follow a diet for a week. Keep track of how much and what foods they consume. Do not exceed the allowed amount of food. You should also consider the physical activity of the patient, medication, the presence of chronic diseases.
Ultrashort insulin is administered 5-15 minutes before a meal. How to calculate the dose of NovoRapid insulin in this case? It should be remembered that this drug reduces the glucose level by 1.5 times more than its short substitutes. Therefore, the amount of NovoRapid is 0.4 of the dose of a short hormone. The norm can be determined more precisely only by experiment.
When selecting an insulin dose, the degree of the disease should be taken into account, as well as the fact that the need for any diabetic in the hormone does not exceed 1 U / kg. Otherwise, an overdose may occur, which will cause a number of complications.
Basic rules for determining the dose for diabetics:
- At an early stage of type 1 diabetes mellitus, the dose of the hormone should be no more than 0.5 U / kg.
- In type 1 diabetes, which is observed in the patient for a year or more, the one-time rate of insulin administered is 0.6 U / kg.
- If type 1 diabetes mellitus is accompanied by a number of serious diseases and has unstable blood glucose levels, the amount of the hormone is 0.7 U / kg.
- In decompensated diabetes mellitus, the amount of insulin is 0.8 U / kg.
- If diabetes is with ketoacidosis, then about 0.9 U / kg of the hormone is required.
- During pregnancy, a woman in the third trimester needs 1.0 U / kg.
To calculate a single dose of insulin, the daily dose should be multiplied by body weight and divided by two, and the final indicator should be rounded.
The use of the drug "NovoRapid Flexpen"
The introduction of the hormone can be carried out using a syringe pen "NovoRapid Flexpen." It has a color coding and a dispenser. The dose of insulin administered can be from 1 to 60 units, one step of the syringe is 1 unit. In the drug "NovoRapid" needles are used TM "Novotvist" or "Novofine" with a length of 8 mm. If you use a pen-syringe, remember: you always need to have a spare system for injection with you - in case the syringe is damaged or lost.
Before administering the hormone with a syringe pen, you need to:
- Read the label and make sure that NovoRapid is exactly the insulin you need.
- Remove the cap from the pen.
- Remove the sticker that is on the disposable needle.
- Screw the needle to the handle. A new needle is needed for each injection to prevent the growth of bacteria. The needle must not be bent or damaged.
- In order to avoid accidental injections on the needle after insulin administration, the cap is not worn.
The NovoRapid syringe pen may contain a small amount of air inside. So that oxygen bubbles do not accumulate, and the dose is correctly administered, certain rules should be followed:
- Dial 2 PIECES of hormone by turning the dosage selector.
- Position the syringe pen with the needle up and tap the cartridge with your fingertip. So the air bubbles will move to the upper region.
- Holding the Flexpen syringe upside down with the needle, press the start button all the way. The dosing selector at this time will return to the "0" position. One drop of the hormone will appear on the needle. If this does not happen, the procedure can be repeated six times. If insulin does not flow, then the syringe is defective.
Before setting the dose, you need to make sure that the dosing selector is in the "0" position. Next, you need to dial the required number of units, the volume of the drug is regulated by a selector in both directions. When setting the dose, you need to be careful and try not to accidentally touch the start button, otherwise a premature release of the hormone will occur. It is impossible to establish a norm more than that which is in the preparation "NovoRapid". Also, do not use the residue scale to determine the dose of the hormone.
During the administration of insulin, the technique recommended by the attending physician is followed subcutaneously. To perform an injection, press the start button. Hold it until the dosage selector is in position “0”. During the injection, only the start button is held. During normal rotation of the dosage indicator, insulin delivery does not occur.
After the injection, the needle under the skin should be held for another six seconds without releasing the start button. So the dose of insulin is introduced completely. After the injection, the needle is sent to the outer cap, and when it enters it, it is unscrewed and thrown away, taking all precautions. Then the syringe is closed with a cap. The needle is removed after each injection and cannot be stored with a pen. Otherwise, fluid will leak, which may lead to the introduction of the wrong dose. The instructions for use will tell you more about how to inject NovoRapid insulin.
Side effects
The drug NovoRapid can cause a number of side effects. This is hypoglycemia, which manifests itself in the form of excessive sweating, pallor of the skin, nervousness, unreasonable feelings of anxiety, tremor of the extremities, weakness in the body, impaired orientation and decreased concentration. Dizziness, hunger, malfunction of the visual apparatus, nausea, headache, tachycardia also occur. Glycemia can lead to loss of consciousness, cramps, impaired brain activity and death.
Infrequently, patients talk about such allergic manifestations as urticaria, rashes. Possible disruption of the stomach and intestines, the appearance of angioedema, tachycardia, difficulty breathing. Patients experienced a decrease in blood pressure.
Among local reactions, itching in the injection zone, redness, and swelling of the skin were noted. Infrequently, symptoms of lipodystrophy have occurred. The medicine can cause edema at the initial stage of treatment, as well as a violation of refraction.
Doctors say that all manifestations are temporary and are observed mainly in dose-dependent patients and are caused by the drug effect of insulin.
Analogs
If the hormone does not work, then you can always replace the NovoRapid Flexpen drug. Analogues, of course, should be selected by the doctor. The most popular are:
- Novomiks.
- Apidra.
- Humalog.
- "Actrapid."
- "Ryzodeg".
- "Protafan."
- "Gensulin N".
Hormone cost
The medicine NovoRapid is released strictly according to the doctor’s prescription. The price of five Penfill cartridges is around 1800 rubles. The cost of the hormone Flexpen is 2,000 rubles. One pack contains five Novorapid insulin pens. The price depending on the distribution network may vary slightly.
Patient Reviews
What are the reviews about NovoRapid? People say that it is good and mild insulin. Acts fast. Suitable for the treatment of type 1 diabetes, in which blood sugar is difficult to reduce. Many patients use it in the treatment of type 2 diabetes. Most diabetics find Flexpen pen syringes very convenient. They eliminate the need to buy syringes separately.
As a rule, patients use the drug NovoRapid against the background of the action of long insulin, which helps maintain normal sugar levels throughout the day. It helps lower blood glucose levels after meals, which makes life easier for many diabetics and allows you to eat outside school hours. Some people advise at the initial stage of the disease to use only this hormone.
There are people who say that when administered to young children, the drug causes sudden changes in blood sugar in the latter, as a result of which the children feel unwell. To prevent this from happening, many parents prefer NovoRapida long-term insulin.
More patients note that an incorrectly selected dose often provokes the occurrence of hypoglycemia and worsens well-being. To avoid such effects, do not self-medicate, but seek help from specialists.