If there is anything that we have to be very careful while handling or dealing with is medicines. No matter how useful they are, if handled carelessly, the resulting effect can be devastating.
The rate at which Diabetes is increasing in the world and especially in young people is a call for concern. At first, this medical condition was thought to be the disease of the rich; however, statistics have shown that, it’s also hereditary.
Diabetes is a medical condition caused by the lack of insulin (one of the pancreatic hormones) production. This lack of insulin (the hormone that works by lowering levels of glucose or sugar in the blood) generally results in high sugar levels (diabetic) in the blood. Such high levels are the cause of early death, thus, in order to calm or arrest the situation, artificial insulin, in the form of suspension (injection) must be administered to the individual.
The maintenance of near-normal or normal glucose level is the NovoLog Mix 70/30 treatment goal in diabetes Type 1 and 2 and has been associated with a reduction in the number of diabetic complications. However, patients should be informed about the benefits and risks associated with NovoLog Mix 70/30 intake including their side effects. Also, patients should be offered continued education and information on insulin therapies, lifestyle management, injection technique, regular glucose monitoring, recognition and management of hypoglycemia and hyperglycemia, periodic glycosylated hemoglobin testing, complications of insulin therapy, adherence to meal planning, instruction for uses of NovoLog Mix 70/30 FlexPen, proper storage of the insulin and timing of doses.
What is NovoLog Mix 70/30 Flex?
NovoLog Mix 70/30 Flex is an artificial insulin medication that is made up of a 70% insulin aspart protamine (which is a suspension) and a 30% insulin aspart injection (which is of rDNA origin). The insulin aspart protamine is intermediate-acting insulin while the insulin aspart injection is fast-acting insulin. The combination known as NovoLog Mix 70/30 Flex insulin will start working within 10 to 20 minutes after injection, reaching it peaks in 2 hours, and continue working for up to 24 hours.
The NovoLog Mix 70/30 Flex is a combination medicine used to control blood sugar levels in adults with diabetes (type 1 or type 2).
Since this medication is very important in controlling blood sugar level, its overdose is also dangerous as it may lead to a situation known as hypoglycemia (low blood sugar). For this reason, we are going to be looking at the various side effects of NovoLog Mix 70/30 FlexPen, uses of NovoLog Mix 70/30 FlexPen, and dosage of NovoLog Mix 70/30 FlexPen.
Dosage of NovoLog Mix 70/30 FlexPen
NovoLog Mix 70/30is insulin with an early onset and an intermediate duration of action. The addition of the protamine to the aspart insulin analog resulted in a specific type of insulin that is composed of a 70% long-acting component and 30% short-acting component (70/30). NovoLog Mix 70/30 is usually administered following a twice daily dosage regimen. However, the dosage of NovoLog Mix 70/30must be individualized and every prescription must carry the full name of the drug. This is to avoid confusion between NovoLog (insulin aspart) and NovoLog 70/30 (human premix).
Check your NovoLog Mix 70/30 before used. It should appear uniformly white and cloudy. If your NovoLog Mix 70/30 looks different (clear or contains solid particles), do not take it. It should not be used after the expiration date.
The required dosage of NovoLog Mix 70/30 FlexPen should be administered by subcutaneous injection in the buttocks, thigh, upper arm, or abdominal region.
NovoLog Mix 70/30 has a faster onset of action as compared with human insulin premix 70/30 and thus should be administered within 15 minutes before meals for patients with type 1 diabetes. For diabetes type 2 patients, it should be administered 15 minutes before or after meal.
We recommend that you rotate the injection within the same region to reduce the risk of lipodystrophy. Bear in mind that, many factors, such as blood flow, the injection site, temperature, level of activities and a dose administered may affect the duration of action of this drug.,.
The NovoLog Mix 70/30should never be administered intravenously or Do not use an insulin infusion pump to give this medicine.
Administering NovoLog Mix 70/30 FlexPen
In order to administer your insulin, you need to handle the pen. Make sure your hands are clean (wash them well with soap) before starting this process. Start by verifying the label on the pen to make sure that you are taking the right type of insulin and the right dose.
Never place a disposable needle on your pen when you are not ready to take your injection
Make sure you always use a new needle for every injection
Prepare Your Pen: Let the insulin rest in the room for some time such that it gets to room temperature before you use it. By doing this, it would be easier to mix. Remove the cap of the Pen now.
Mix your Insulin: In order to mix your insulin well, place the Pen between your hands and roll it about 10 times. Now, keep the pen horizontal and gently move it up and down about 10 times such that the ball moves from one end of the cartridge to the other.
Attach a new needle: Start by removing the protective tab from the disposable needle and twist the needle on, with a little force until it is tight. Now, pull off both needle caps.
Prime your pen: In order to remove any air in the cartridge, turn the dose selector two units. Now, press and hold the dose button until a drop appears.
Select your dose: Starting from zero, turn the dose selector until you get to the number of units you need to inject. For example, if you have to inject 10 units, your dose selector should be turned to 10 units.
Give the injection: This should be done by an authorized pharmacist, nurse or doctor. You are not allowed self-inject yourself. In case of any doubt, seek medical advice and do not inject this drug if you are not certain about the dose.
After the injection: Now, carefully remove the needle and place it in a sharps container and put the pen cap back on the NovoLog Mix 70/30 FlexPen.
Note: Make sure that after the counter reaches zero, you wait after 6 seconds or 6 counts. If you remove the pen before the 6 second or 6 count is completed, you risk getting underdoes by as much as 20%. This may result in the need for increasing frequency of checking your blood sugar levels with the possibility of additional insulin administration.
Resuspension Preparation techniques
NovoLog Mix 70/30 is a suspension that must always be visually inspected and resuspended just before it’s administer. Resuspension is easily done when the insulin is at room temperature
NovoLog Mix 70/30 FlexPen: Gently mix the insulinby alternating rolling pen in a horizontal position 10 times between palms and also 10 times vertically by moving pen up and down. Repeat these processes until the liquid appears uniformly white and cloudy. At sure moment, you should immediately administer the insulin. If there is a delay, you may be required to remix the insulin again.
Subsequent injections: For subsequent injection, move the pen vertically, up and down at least 10 times until the liquid appears uniformly white and cloudy. Make sure you are left with a minimum of 12 units in the cartridge to make sure the remaining insulin is evenly mixed. If you have less than 12 units left, then get a new pen.
NovoLog Mix 70/30 Vials: Resuspension can easily be done when the insulin is at room temperature at 25oC.
Gently roll the vial 10 times in your hands in a horizontal position to resuspend the suspension. Avoid shaking it. Repeat the process until the vial suspension appears uniformly white and cloudy prior to immediate administration.
- Store your in-use NovoLog Mix 70/30at room temperature for up to 14 days.
- Store without the needle attached. Keep it away from excessive heat or direct rays of sunlight.
- Any opened pen must be discarded after 14 days, even if you still have some insulin left in them.
- In-use NovoLog Mix 70/30vials may be stored in the refrigerator 2oC to 8oC (36F to 46F) or at room temperature up to 30oC (86F).
- Any opened vials should be discarded after 28 days, even if you still have some insulin left in them.
In-use NovoLog Mix 70/30 must not be stored in the refrigerator.
NovoLog Mix 70/30pens/vials not in use should be stored in the refrigerator at 2oC to 8oC (36F to 46F). All unopened refrigerated NovoLog Mix 70/30 pens/vials may be used until the expiration date, as printed on the label.
It is very important to monitor the blood glucose levels for patients receiving insulin therapy. Also, the Glycosylated hemoglobin measurements are recommended every 3 months.
NovoLog Mix 70/30 FlexPen Side Effects
NovoLog Mix 70/30 FlexPen has major and minor side effects.
Major Side Effects
If you notice any of the side effects of NovoLog Mix 70/30 FlexPen listed below when taking this drug, we recommend that you call the emergency line as soon as possible for immediate help. These effects include:
Redness or swelling at the side the injection was given, swelling in your throat or tongue, difficulty in breathing, dizziness, confusion, feeling like you might pass out, wheezing, rapid pulse, sweating, increase hunger, anxiety, or itchy skin rash over the entire body.
But if you notice any of the side effects listed below, which are less severe, however, we recommend that you immediately see a doctor. These effects include:
Low potassium: Associated with leg cramps, fluttering in your chest, numbness or tingling, constipation, muscle weakness or limp feeling and irregular heartbeats
Weight gain: This can occur with some insulin intake, including NovoLog Mix 70/30. This effect of NovoLog Mix 70/30 has been attributed to the anabolic effects of insulin and the decrease in glycosuria.
Peripheral edema or Fluid retention: Insulin, including NovoLog Mix 70/30 may cause sodium retention and edema. This mostly occurred if insulin therapy was previously used to improve poor metabolic control. Swelling or edema is mostly seen in the feet or hands.
Minor Side Effects
Some NovoLog Mix 70/30 Flex side effects may not require any medical attention. Most of these effects are simply due to your body’s adaptation process which will normally reduce and disappears as your body gets used to the medicine. Also, your physician may be able to help you reduce or prevent these side effects of NovoLog Mix 70/30 FlexPen. However, we recommend you to check with a doctor if you notice any of the NovoLog Mix 70/30 Flex side effects listed below.
Hypoglycemia: Also known as Low blood glucose (sugar) is the most commonly observed side effect of NovoLog Mix 70/30 in patients using insulin. NovoLog Mix 70/30 should not be used or discontinue during episodes of hypoglycemia.
Insulin initiation & glucose control intensification: Rapid improvement and a high level in glucose control has been known to cause worsening of diabetic retinopathy, acute painful peripheral neuropathy, and transitory, reversible ophthalmologic refraction disorder. However, long-term glycemic control reduces the risk of diabetic neuropathy and retinopathy.
Lipodystrophy: Repeated or long-term use of NovoLog Mix 70/30 can result in lipodystrophy at the area of the repeated insulin injection. These NovoLog Mix 70/30 FlexPen side effects consist of the thickening of the adipose tissue known as lipohypertrophy and the thinning of the adipose tissue known as lipoatrophy, which may as a consequence affect insulin absorption. This condition of NovoLog Mix 70/30 FlexPen side effects can be eliminated or reduced by rotating insulin injection site around the same region.
Other minor side effects of NovoLog Mix 70/30 FlexPen include: blistering, bleeding, scarring, soreness, coldness, feeling of pressure, burning, hives, infection, inflammation, discoloration of the skin, stinging, swelling, tenderness, itching, numbness, pain, rash, lumps, redness, tingling, ulceration, or warmth at the injection site and accumulation or redistribution of body fat
Overdosage with NovoLog Mix 70/30 may result in hypoglycemia. This is simply due to the excess of insulin relative to energy expenditure, food intake, or both. Mild degree or levels of hypoglycemia can easily be treated or reversed with an oral glucose intake. Adjustments in the dosage of NovoLog Mix 70/30 FlexPen, meal patterns, or exercise, may be required. The more severe hypoglycemic levels may result in seizure, coma, or neurologic impairment. These effects can be treated with intramuscular or subcutaneous glucagon or concentrated intravenous glucose. Also, because hypoglycemia may reoccur after apparent clinical recovery, sustained carbohydrate intake and observation may be necessary.
NovoLog Mix 70/30 FlexPen Used in Specific Population
Pregnancies in general have some risk of birth defects, loss, or other undesirable outcome regardless of drug exposure. These risks are increased in pregnancies complicated by hyperglycemia. However, they may be decreased with good metabolic control. It is important for diabetic patients or women with a history of gestational diabetes to maintain good metabolic control before conception and throughout pregnancy. Insulin levels generally saw a decline during the first trimesters, increases during the second and third trimesters, and rapidly drop after delivery. Thus, a careful monitoring of glucose level and control is vital in such patients.
Female patients are advised to discuss with their health care provider if they intend to, or if they become pregnant. There is no proper and well-controlled study of the use of NovoLog Mix 70/30 FlexPen in pregnancy.
There are no documented facts to prove whether or not insulin aspart is excreted in human milk as occurs with human insulin. Also, there are no adequate and well-controlled studies of the used of NovoLog Mix 70/30 FlexPen or NovoLog in breastfeeding women. Thus, women with diabetes who are breastfeeding may need adjustments of their insulin doses.
The safety and effectiveness of NovoLog Mix 70/30 have not been established in pediatric patients.
The clinical studies of NovoLog Mix 70/30 didn’t include the right number of patients older than 65 years to be able to determine whether they respond differently than younger patients. However, the dosage of NovoLog Mix 70/30 FlexPen for an elderly patient should be cautious, typically starting at the low end of the dosing range. This reflects the greater frequency of decreased cardiac, renal, and hepatic function, and of concomitant disease or other drug therapy in this population.
Warnings and Precautions
NEVER share NovoLog Mix 70/30 FlexPen:
You “MUST NEVER” use the same NovoLog Mix 70/30 FlexPen for more than one patient, even if you changed the needle. By sharing a pen, you risk getting blood-borne pathogens to other subjects.
Since NovoLog Mix 70/30 is a drug that has its max pharmacodynamics activity in the 1 – 4 hours range after injection, it is recommended to administer it within 15 minutes of meal initiation. However, the dose of NovoLog Mix 70/30 needed to provide adequate glycemic control for one of the meals may result in hypoglycemia or hyperglycemia for the other meal.
- Don’t mix NovoLog Mix 70/30 with other drugs
- Don’t use NovoLog Mix 70/30 intravenously
- Don’t use NovoLog Mix 70/30 with an insulin infusion pump.
- Glucose monitoring is a must for all diabetes patients and any change in the dosage of NovoLog Mix 70/30 FlexPen should be made cautiously and only under medical supervision.
This is the most common NovoLog Mix 70/30 FlexPen side effects. If severe, it may lead to convulsions and/or unconsciousness which may as such lead to permanent or temporary impairment of brain functioning or worse still, it may result in death. Severe cases of hypoglycemia require the assistance of another person and/or parenteral glucose infusion or glucagon administration.
The duration of hypoglycemia may reflect the time-action profile of the NovoLog Mix 70/30 formulation. However, other factors like injection site, dietary intake, concomitant medications and exercise may all alter the risk of hypoglycemia. Use NovoLog Mix 70/30 with caution in patients who may be predisposed to hypoglycemia, such as patients who have erratic intake or who are fasting, or with patients with hypoglycemia unawareness.
Hypoglycemia may result in the decrease in the patient’s ability to concentrate and react. This may result in serious risk in in some situations, typically in situations where these abilities are especially important, like during driving.
Also, rapid changes in serum glucose levels may induce symptoms of hypoglycemia in diabetes patients, regardless of the glucose level.
Early symptoms of hypoglycemia may be less severe or different under certain conditions, like prolong duration of diabetes, use of medications like beta-blockers, intensified diabetes control, or diabetic nerve disease.
Pharmacological and clinical studies with NovoLog Mix 70/30 in diabetes patients with different levels of severity of renal impairment have not been documented. However, the needs for NovoLog Mix 70/30 may be reduced in diabetes patients with a history of renal impairment.
NovoLog Mix 70/30, as well as other insulin products causes a shift in potassium, possibly resulting in low potassium level. If the low potassium level (hypokalemia) is left untreated or unattended to, it may lead to ventricular arrhythmia, respiratory paralysis, and possibly death. The use of NovoLog Mix 70/30 with caution in diabetes patients who may be at risk for hypokalemia is inevitable. This also includes the set of patients taking medications that are sensitive to potassium concentration or patients using potassium lowering medications.
Pharmacological and clinical studies with NovoLog Mix 70/30 in diabetes patients with different degrees of hepatic impairment have not been documented. The needs for NovoLog Mix 70/30 may be reduced in diabetes patients with a history of hepatic impairment.
Fluid Retention and Heart Failure
The peroxisome proliferator-activated receptor (PPAR)-gamma agonist, also known as Thiazolidinediones (TZDs) may cause dose related fluid retention, especially when used in combination with insulin. Fluid retention often leads to or exacerbates heart failure. Diabetes patients treated with insulin, including NovoLog Mix 70/30, and PPAR-gamma agonist should be observed for signs and symptoms of heart failure. If any sign of heart failure develops, it should be treated according to current standards of care, and discontinuation of NovoLog Mix 70/30 or PPAR-gamma agonist dose reduction must be considered.
A disclaimer: NovoLog Mix 70/30 FlexPen is a safe form of insulin, however; patients should always seek medical advice in case of any doubts, especially with the dosage selection, uses of NovoLog Mix 70/30 FlexPen, and side effects of NovoLog Mix 70/30 FlexPen.