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Rapid-Acting Insulin Analogue (Bolus) Pregnancy: Compatible — NovoRapid licensed in pregnancy

Insulin Aspart

Brand names: NovoRapid, Fiasp (faster-acting)

Adult dose

Dose: Mealtime: 0.1 units/kg per meal (typical starting). NovoRapid: give 5–10 min before meal. Fiasp: give at start of or up to 2 min after meal. CSII (pump) use.
Route: Subcutaneous or IV (hospital only)
Frequency: With each meal (TDS) ± corrections
Max: Adjust to carbohydrate intake and blood glucose — no fixed maximum
Faster peak action than soluble insulin (onset 10–20 min vs 30–60 min). For use in insulin pumps (CSII). Fiasp has even faster onset (addition of niacinamide and arginine).

Paediatric dose

Dose: 0.05 units/kg
Route: Subcutaneous
Frequency: With each meal
Max: Adjusted to blood glucose and carbohydrate count
Concentration: 100 units/mL units/ml
Licensed in children ≥1 year. Carbohydrate counting and insulin:carbohydrate ratio (ICR) taught. Dose titrated to 2-hour post-meal glucose. (per meal)

Dose adjustments

Renal

Lower doses required in renal impairment — reduced clearance

Hepatic

Lower doses required — reduced gluconeogenesis

Paediatric weight-based calculator

Licensed in children ≥1 year. Carbohydrate counting and insulin:carbohydrate ratio (ICR) taught. Dose titrated to 2-hour post-meal glucose. (per meal)

Clinical pearls

  • Must eat within 15 min of injection — hypoglycaemia risk if meal delayed (unlike short-acting soluble insulin which is injected 30 min before meals)
  • Fiasp: designed for post-meal administration (up to 2 min after) — useful for unpredictable eating patterns
  • CSII (insulin pump) use: aspart is suitable for continuous subcutaneous infusion
  • Teach sick-day rules: never stop insulin in T1DM during illness; check ketones; increase monitoring

Contraindications

  • Hypoglycaemia

Side effects

  • Hypoglycaemia (more likely if meal delayed after injection)
  • Injection site reactions
  • Weight gain
  • Lipohypertrophy

Interactions

  • As for all insulins — alcohol, beta-blockers, corticosteroids, thiazides (reduce efficacy)

Monitoring

  • Pre-meal and 2-hour post-meal glucose
  • HbA1c (3-monthly)
  • Injection sites
  • Hypoglycaemia episodes (CGM preferred in T1DM)

Reference: BNFc; BNF; NICE NG17; ADA Diabetes Standards 2024; NovoRapid SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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