Back To Search Results

Aspart Insulin

Editor: Lindsey A. McIver Updated: 6/8/2024 8:16:50 AM


FDA-Approved Indications

Insulin aspart is a rapid-acting, human insulin analog that is FDA-approved to improve glycemic control for treating type 1 and type 2 diabetes in adults and children. Insulin aspart should be used in addition to a long-acting (basal) insulin for complete therapy unless already used in a continuous subcutaneous (insulin pump) or intravenous insulin infusion.[1] Rapid-acting insulin products aim to control post-meal blood glucose concentrations or reduce blood glucose in response to an elevated level, as in a correctional scale.[2] 

Insulin aspart is also available commercially with insulin degludec (long-acting insulin) or aspart protamine (intermediate-action insulin). Insulin degludec plus insulin aspart is administered once or twice daily with the main meal. Insulin-naive patients should start insulin degludec/aspart at 0.2 to 0.4 units/kg/d. Insulin aspart/insulin aspart protamine is 30% insulin aspart, 70% insulin aspart protamine. Dosing for the protamine product starts at 0.5 units/kg/d. The daily dose is divided into 2 doses before meals, with 70% of the daily dose before breakfast and 30% of the daily dose before dinner.[3] The fast-acting formulation of insulin aspart is also FDA-approved.[4][5] Faster-acting insulin aspart may help mitigate prandial excursions.[6] The 2023 Endocrine Society guidelines recommend using rapid-acting insulin analogs like insulin aspart instead of regular human insulin for patients on basal-bolus insulin therapy who are at high risk for hypoglycemia.[7]

Off-Label Uses

Insulin aspart may be used to treat diabetic ketoacidosis (DKA), though this is not an FDA-approved indication.[8]

Mechanism of Action

Register For Free And Read The Full Article
Get the answers you need instantly with the StatPearls Clinical Decision Support tool. StatPearls spent the last decade developing the largest and most updated Point-of Care resource ever developed. Earn CME/CE by searching and reading articles.
  • Dropdown arrow Search engine and full access to all medical articles
  • Dropdown arrow 10 free questions in your specialty
  • Dropdown arrow Free CME/CE Activities
  • Dropdown arrow Free daily question in your email
  • Dropdown arrow Save favorite articles to your dashboard
  • Dropdown arrow Emails offering discounts

Learn more about a Subscription to StatPearls Point-of-Care

Mechanism of Action

Insulin aspart regulates glucose metabolism by promoting storage and inhibiting the breakdown of glucose, fat, and amino acids. Insulin reduces blood glucose levels by increasing peripheral glucose uptake, particularly in skeletal muscle and fat. Insulin enhances the storage of fat (lipogenesis) and protein synthesis. Insulin aspart also inhibits gluconeogenesis (hepatic glucose production), lipolysis (breakdown of lipids to fatty acids), and proteolysis (breakdown of proteins into amino acids). Maximum glucose-reducing effects are observable within 1 to 3 hours and last for 3 to 5 hours. Insulin aspart is equipotent to regular insulin but has a faster onset and shorter duration of action. Thus, insulin aspart is preferred for mealtime insulin coverage as it can be administered every 4 hours.

The pancreas naturally produces endogenous insulin. Insulin apart is manufactured through recombinant DNA techniques using the Saccharomyces cerevisiae expression system. Insulin aspart differs from endogenous insulin as it has an aspartic acid residue at position B28 instead of proline. Insulins can be categorized as rapid, short, intermediate, and long-acting depending on their pharmacologic effects (eg, onset, peak, and duration). Rapid-acting insulin aspart has a quicker onset of action than insulin aspart or short-acting (regular) insulin. The formulation of insulin aspart includes 2 excipients: niacinamide and L-arginine. Niacinamide has a faster initial absorption following subcutaneous administration, while L-arginine is a stabilizing agent.[9]


Absorption: Insulin aspart's onset of action occurs within 0.3 hours, with peak glucose-reducing effects occurring between 1 and 3 hours following subcutaneous injection. Rapid-acting insulin aspart may be dosed at 0.1, 0.2, or 0.4 units/kg and has an earlier onset of action, ranging from 16 to 20 minutes. Pharmacokinetic analysis demonstrated an onset of action difference of approximately 5 minutes between rapid-acting insulin aspart and insulin aspart.[10] Factors influencing absorption include injection site, physical activity, injection site blood flow, and body temperature.

Distribution: Insulin aspart binds weakly to plasma protein (<10%).

Metabolism: Insulin aspart metabolism occurs primarily in hepatic, renal, and adipose tissues.

Excretion: The clearance of insulin aspart is approximately 1.2 L/h/kg. Insulin aspart demonstrates an elimination half-life of approximately 81 minutes. Faster-acting insulin aspart has a half-life of roughly 66 minutes.


Available Dosage Forms and Strengths

Insulin aspart is available as an injectable solution containing 100 units/mL and a prefilled syringe containing 100 units/mL. Insulin aspart protamine and insulin aspart are available together as an injectable suspension containing 100 units/mL (U-100), constituting 70% insulin aspart protamine and 30% insulin aspart. This formulation is available in a 10 mL multiple-dose vial and a 3 mL prefilled pen. Insulin aspart should be administered subcutaneously (SC) 5 to 10 minutes before a meal, for 1 to 4 meals daily. To avoid lipodystrophy, injection sites should rotate between the top of the thighs, back of the upper arms, buttocks, and abdomen. Injecting within 2 inches of the naval should be avoided. Insulin aspart may also be administered using a continuous subcutaneous infusion through an insulin pump or intravenously (IV) as a diluted solution. Intravenous administration requires close monitoring of blood glucose and serum potassium levels. Insulin aspart can be mixed with NPH insulin but may only be administered subcutaneously once mixed.

Adult Dosage

Type 1 Diabetes

Insulin aspart, or any rapid or short-acting insulin, is a mainstay of therapy for type 1 diabetes. According to the 2023 American Diabetes Association (ADA) guidelines, total daily insulin doses range from 0.4 to 1 units/kg/d, divided into long-acting and rapid-acting insulin, such as aspart. An initial breakdown of 50% basal insulin and 50% rapid-acting insulin is the initial therapy for most patients with type 1 diabetes and is adjusted based on blood glucose levels. Doses are patient-specific.

Type 2 Diabetes

Patients with type 2 diabetes are often prescribed basal insulin rather than bolus insulin.[11] Insulin aspart may be added for further glycemic control in addition to oral medications or long-acting insulin. The recommended initial dose for patients with type 2 diabetes is 4 units per meal, 0.1 units/kg per meal, or 10% of the basal dose. If HgbA1c is less than 8%, the basal insulin dose should be reduced when insulin is added for meals.[12]

Specific Patient Populations

Hepatic impairment: Patients with hepatic dysfunction are more likely to experience dysglycemia; it is recommended to use insulin aspart cautiously in these cases.

Renal impairment: Changes in insulin aspart doses may be necessary for individuals with renal or during acute illness to minimize the risk of hypoglycemia or hyperglycemia.

Pregnancy considerations: Per the 2023 ADA guidelines, insulin is recommended as the primary medication for managing hyperglycemia in gestational diabetes mellitus. Glyburide and metformin are not recommended as initial treatment options due to their potential to pass through the placenta to the fetus. For patients using insulin pumps and basal-bolus therapy, it is recommended to test pre-meal insulin dosage and monitor post-meal to improve glycemic outcomes and reduce the risk of preeclampsia.[13]

Breastfeeding considerations: Breastfeeding should be encouraged for all mothers, including those with diabetes, as it is nutritionally and immunologically beneficial for infants. Breastfeeding may also provide long-term metabolic advantages for mother and child, including a reduced risk of type 2 diabetes in mothers with gestational diabetes. However, lactation can increase the risk of overnight hypoglycemia, necessitating insulin dosage adjustments. Exogenous insulin, including insulin analogs like aspart, is excreted into breast milk. Insulin is a natural component of breast milk and may lower the risk of type 1 diabetes in breastfed infants.[14] According to the manufacturer label, breastfeeding benefits and the use of maternal insulin aspart require a thorough risk-benefit analysis, including potential adverse effects on the infant.

Pediatric patients: Insulin aspart has received FDA approval for pediatric patients with diabetes. One study demonstrated that insulin pumps in pediatric patients that contain faster insulin aspart result in sustained improvements in glycemic control.[15]

Older patients: The practice of using sliding-scale insulin (SSI) to address hyperglycemia in hospitalized patients, including older individuals, remains prevalent. However, relying solely on an SSI regimen often fails to manage glucose fluctuations adequately. Multiple studies have demonstrated that a basal-bolus regimen demonstrates superior glycemic control and reduced rates of perioperative complications compared to sliding-scale insulin therapy.[16]

Adverse Effects

The most common adverse effect of insulin aspart is hypoglycemia, defined as a blood glucose level below 70 mg/dL. Signs and symptoms of hypoglycemia include dizziness, light-headedness, sweating, confusion, headache, blurred vision, slurred speech, tremors, tachycardia, irritability, or hunger.[17] Severe cases of hypoglycemia (blood glucose level lower than 30 mg/dL) may lead to seizures or death. Hypoglycemia is dose-dependent and can be avoided by reducing doses of insulin.[18] After a hypoglycemic event, insulin dosages and glucose intake should be evaluated and adjusted to prevent future hypoglycemic episodes.[19]

Additional adverse reactions include allergic reactions (which may occur locally at injection sites), lipodystrophy, rash, pruritus, and hypokalemia. Hypokalemia is dose-dependent, though the other additional adverse reactions are not.

Drug-Drug Interactions

  • Antidiabetic agents, ACE inhibitors, fluoxetine, fibrates, monoamine oxidase inhibitors, salicylates, and octreotide can increase the risk of hypoglycemia. When using insulin aspart in conjunction with these medications, increasing the frequency of glucose monitoring is advised.
  • Drugs that may reduce the blood glucose-lowering effect of insulin aspart include corticosteroids, diuretics, estrogens, niacin, oral contraceptives, protease inhibitors, thyroid hormone, albuterol, epinephrine, and atypical antipsychotics (eg, olanzapine, clozapine).[20] Dose adjustment of insulin and more frequent glucose monitoring may be required.
  • Pentamidine may increase or decrease the blood glucose-reducing effect of insulin aspart. When insulin aspart is concomitantly administered with pentamidine, dose adjustments may be necessary.
  • Beta-blockers and clonidine may mask the signs and symptoms of hypoglycemia and should be used with caution.[21][22]


Insulin aspart is contraindicated for patients with documented hypersensitivity to the drug or a component of the formulation. Insulin aspart is also contraindicated during episodes of hypoglycemia, though it may be resumed at lower doses once hypoglycemia resolves. Patients with hypersensitivity to other insulin products may try insulin aspart with appropriate measures available in case of an adverse reaction (antihistamine and epinephrine as needed).

Warnings and Precautions

  • Risk for pathogen transmission: Insulin aspart protamine and insulin aspart (Aspart 70/30) should not be shared between patients due to the risk of transmitting blood-borne pathogens, and patients using vials should not share needles or syringes.
  • Modifying regimen: Changes to insulin therapy, including changing dose, manufacturer, injection site, or method of administration, can affect glycemic control and increase the risk of hypoglycemia or hyperglycemia. Modifications to an insulin regimen should only be made under medical supervision. Dosage adjustments of simultaneous anti-diabetic medications may be required.
  • Medication errors: Instances of unintentional interchanging of insulin products have been documented. Patients should verify the insulin label before each injection to reduce medication errors involving insulin aspart and other insulins.
  • Hypokalemia: Insulin aspart protamine/insulin aspart may cause hypokalemia by shifting extracellular potassium into the cell. Untreated hypokalemia can cause severe complications, such as ventricular arrhythmia.[23][24] Potassium levels should be monitored when taking medications that affect the serum potassium concentration.
  • Fluid retention and heart failure: Concomitant use of thiazolidinediones, like pioglitazone (a PPAR-γ agonist), may result in dose-dependent fluid retention, particularly when co-administered with insulin aspart. This fluid retention can exacerbate heart failure and requires vigilant monitoring of patients receiving insulin aspart and PPAR-γ agonists. If heart failure develops, discontinuation or dose reduction of the PPAR-γ agonist should be considered.[25][26]


Critically ill patients receiving insulin aspart should have their blood glucose level tested every 1 to 2 hours. Non-critically ill patients on insulin aspart should routinely monitor their blood glucose concentration at home or in the hospital to assess the efficacy of the insulin dose. This testing ideally occurs before or 2 hours after a meal. Insulin dose adjustments should be based on testing results, typically 10% to 20% adjustments in either direction. All patients on insulin therapy should have their HgbA1c tested every 6 months and electrolyte levels tested annually. Hemoglobin A1c should be monitored quarterly in patients who do not meet treatment goals or after changes in therapy.

According to the American Diabetes Association, monitoring goals include a fasting blood glucose level of 80 to 130 mg/dL, a peak postprandial (1 to 2 hours post-meal) blood glucose level of less than 180 mg/dL, and a HgbA1c level less than 7.0% for non-pregnant adult patients. These goals may change for individual patients based on age, duration of diabetes, comorbid conditions, hypoglycemia unawareness, risk of a hypoglycemic event, and other considerations. Patients with more comorbid conditions or a higher risk of harm during a hypoglycemic event have less stringent goals.

According to the Endocrine Society guidelines, patients with type 1 diabetes who receive multiple daily injections should receive continuous glucose monitoring (CGM) instead of self-monitoring via fingerstick. CGM should be initiated in the inpatient setting for patients who are at high risk for hypoglycemia.[7]


Signs and Symptoms of Overdose

An overdose of insulin aspart presents with hypoglycemia. In more severe cases, individuals may experience seizures, coma, or neurological impairment. A systematic review on insulin overdose identified complications, including electrolyte disturbances (eg, hypokalemia, QTc prolongation, cardiac arrhythmia), prolonged cerebellar ataxia, and acute pulmonary edema.[27]

Management of Overdose

Toxic effects of insulin aspart include hypoglycemia, which is treated by administering glucose, dextrose, or oral carbohydrates to increase blood glucose levels. During a hypoglycemic episode, patients who can eat should consume 15 grams of carbohydrates (eg, glucose gel, tablets, or glucose-containing food). Fifteen minutes should pass before rechecking blood glucose, and the treatment should be repeated if the patient is still hypoglycemic. Once the glucose level returns to normal, the patient should eat a meal within an hour to prevent the recurrence of hypoglycemia.[28] If the patient is unable or unwilling to consume oral glucose, intramuscular (IM) glucagon is used for ambulatory patients. Intravenous dextrose can be administered to conscious or unconscious patients with hypoglycemia; each dose contains 10 to 25 g. Blood glucose levels should be tested 15 minutes after receiving dextrose, and repeat doses of IV dextrose or IM glucagon may be necessary until blood glucose returns to normal. Additionally, insulin doses should be evaluated and adjusted after hypoglycemic events to prevent additional hypoglycemia.[29] Correction of electrolyte imbalances such as hypokalemia typically requires potassium supplementation.

Enhancing Healthcare Team Outcomes

All healthcare professionals administering insulin aspart should know its uses and adverse effects. Insulin aspart is a rapid-acting, human insulin analog that is FDA-approved for treating type 1 and type 2 diabetes by improving glycemic control in adults and children. Insulin aspart may also be used off-label to treat diabetic ketoacidosis (DKA). Insulin aspart should be used in addition to a long-acting (basal) insulin for comprehensive therapy unless used in a continuous subcutaneous (insulin pump) or intravenous insulin infusion. An endocrinologist should be consulted for optimal glycemic control. Pharmacists should verify the order and perform medication reconciliation. All interprofessional healthcare team members must educate the patient regarding proper dosing and usage of insulin aspart and any potential dosing adjustments to prevent hypoglycemia. Emergency medicine physicians should rapidly stabilize patients with severe hypoglycemia. Patients with diabetic ketoacidosis should be admitted to the MICU under the supervision of critical care physicians.

Rapid-acting insulin products aim to control post-prandial blood glucose concentrations or reduce blood glucose to counter an elevated level, as in a correctional scale. Healthcare professionals must monitor glucose concentrations closely when administering insulin aspart as it can induce hypoglycemia. Having some glucose-containing fluid or a meal ready is essential in case hypoglycemia develops.[30] An interprofessional team approach and open communication between clinicians (MDs, DOs, NPs, PAs), pharmacists, dieticians, nurses, and endocrinologists are necessary to optimize outcomes for patients on insulin aspart therapy.



Wen WL, Tsai KB, Lin YH, Hwang SJ, Hsiao PJ, Shin SJ, Hung WW. Successful management of type IV hypersensitivity reactions to human insulin analogue with injecting mixtures of biphasic insulin aspart and dexamethasone. Journal of the Formosan Medical Association = Taiwan yi zhi. 2019 Apr:118(4):843-848. doi: 10.1016/j.jfma.2019.01.004. Epub 2019 Jan 28     [PubMed PMID: 30704815]


You W, Yang J, Liu Y, Wang W, Zhu L, Wang W, Yang J, Chen F. Fulminant type 1 diabetes mellitus: Two case reports. Medicine. 2019 Feb:98(5):e14319. doi: 10.1097/MD.0000000000014319. Epub     [PubMed PMID: 30702611]

Level 3 (low-level) evidence


Misra S, Mathieu C. Are newer insulin analogues better for people with Type 1 diabetes? Diabetic medicine : a journal of the British Diabetic Association. 2020 Apr:37(4):522-531. doi: 10.1111/dme.13891. Epub 2019 Jan 21     [PubMed PMID: 30585663]


Dutta D, Mohindra R, Mahajan K, Sharma M. Performance of Fast-Acting Aspart Insulin as Compared to Aspart Insulin in Insulin Pump for Managing Type 1 Diabetes Mellitus: A Meta-Analysis. Diabetes & metabolism journal. 2023 Jan:47(1):72-81. doi: 10.4093/dmj.2022.0035. Epub 2022 Jun 24     [PubMed PMID: 35746893]

Level 1 (high-level) evidence


Haahr H, Heise T. Fast-Acting Insulin Aspart: A Review of its Pharmacokinetic and Pharmacodynamic Properties and the Clinical Consequences. Clinical pharmacokinetics. 2020 Feb:59(2):155-172. doi: 10.1007/s40262-019-00834-5. Epub     [PubMed PMID: 31667789]


ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2023. Diabetes care. 2023 Jan 1:46(Suppl 1):S140-S157. doi: 10.2337/dc23-S009. Epub     [PubMed PMID: 36507650]


McCall AL, Lieb DC, Gianchandani R, MacMaster H, Maynard GA, Murad MH, Seaquist E, Wolfsdorf JI, Wright RF, Wiercioch W. Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism. 2023 Feb 15:108(3):529-562. doi: 10.1210/clinem/dgac596. Epub     [PubMed PMID: 36477488]

Level 1 (high-level) evidence


Kildegaard J, Buckley ST, Nielsen RH, Povlsen GK, Seested T, Ribel U, Olsen HB, Ludvigsen S, Jeppesen CB, Refsgaard HHF, Bendtsen KM, Kristensen NR, Hostrup S, Sturis J. Elucidating the Mechanism of Absorption of Fast-Acting Insulin Aspart: The Role of Niacinamide. Pharmaceutical research. 2019 Feb 11:36(3):49. doi: 10.1007/s11095-019-2578-7. Epub 2019 Feb 11     [PubMed PMID: 30746556]


Hsu L, Buckingham B, Basina M, Ekhlaspour L, von Eyben R, Wang J, Lal RA. Fast-Acting Insulin Aspart Use with the MiniMed(TM) 670G System. Diabetes technology & therapeutics. 2021 Jan:23(1):1-7. doi: 10.1089/dia.2020.0083. Epub     [PubMed PMID: 32520594]


Heise T, Pieber TR, Danne T, Erichsen L, Haahr H. A Pooled Analysis of Clinical Pharmacology Trials Investigating the Pharmacokinetic and Pharmacodynamic Characteristics of Fast-Acting Insulin Aspart in Adults with Type 1 Diabetes. Clinical pharmacokinetics. 2017 May:56(5):551-559. doi: 10.1007/s40262-017-0514-8. Epub     [PubMed PMID: 28205039]


Siebel S, Galderisi A, Patel NS, Carria LR, Tamborlane WV, Sherr JL. Reversal of Ketosis in Type 1 Diabetes Is Not Adversely Affected by SGLT2 Inhibitor Therapy. Diabetes technology & therapeutics. 2019 Mar:21(3):101-104. doi: 10.1089/dia.2018.0356. Epub 2019 Jan 28     [PubMed PMID: 30688521]


Melo KFS, Bahia LR, Pasinato B, Porfirio GJM, Martimbianco AL, Riera R, Calliari LEP, Minicucci WJ, Turatti LAA, Pedrosa HC, Schaan BD. Short-acting insulin analogues versus regular human insulin on postprandial glucose and hypoglycemia in type 1 diabetes mellitus: a systematic review and meta-analysis. Diabetology & metabolic syndrome. 2019:11():2. doi: 10.1186/s13098-018-0397-3. Epub 2019 Jan 3     [PubMed PMID: 30622653]

Level 1 (high-level) evidence


ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Jeffrie Seley J, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes care. 2023 Jan 1:46(Suppl 1):S254-S266. doi: 10.2337/dc23-S015. Epub     [PubMed PMID: 36507645]


. Insulin. Drugs and Lactation Database (LactMed®). 2006:():     [PubMed PMID: 30000050]


Stamati A, Sotiriou G, Dimitriadou M, Christoforidis A. Efficacy and safety of faster aspart in insulin pumps in children and adolescents with type 1 diabetes mellitus: A single-center study with real-world data. Journal of diabetes and its complications. 2023 Sep:37(9):108587. doi: 10.1016/j.jdiacomp.2023.108587. Epub 2023 Aug 15     [PubMed PMID: 37597378]


Umpierrez GE, Pasquel FJ. Management of Inpatient Hyperglycemia and Diabetes in Older Adults. Diabetes care. 2017 Apr:40(4):509-517. doi: 10.2337/dc16-0989. Epub     [PubMed PMID: 28325798]


Fullerton B, Siebenhofer A, Jeitler K, Horvath K, Semlitsch T, Berghold A, Gerlach FM. Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus. The Cochrane database of systematic reviews. 2018 Dec 17:12(12):CD013228. doi: 10.1002/14651858.CD013228. Epub 2018 Dec 17     [PubMed PMID: 30556900]

Level 1 (high-level) evidence


Shi C, Sun L, Bai R, Wang H, Liu D, Du J. Comparison of a twice daily injection of insulin aspart 50 with insulin aspart 30 in patients with poorly controlled type 2 diabetes. Current medical research and opinion. 2019 Jun:35(6):1091-1096. doi: 10.1080/03007995.2018.1558853. Epub 2019 Jan 14     [PubMed PMID: 30550344]

Level 3 (low-level) evidence


Nunez Lopez YO, Retnakaran R, Zinman B, Pratley RE, Seyhan AA. Predicting and understanding the response to short-term intensive insulin therapy in people with early type 2 diabetes. Molecular metabolism. 2019 Feb:20():63-78. doi: 10.1016/j.molmet.2018.11.003. Epub 2018 Nov 16     [PubMed PMID: 30503831]

Level 3 (low-level) evidence


Carli M, Kolachalam S, Longoni B, Pintaudi A, Baldini M, Aringhieri S, Fasciani I, Annibale P, Maggio R, Scarselli M. Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences. Pharmaceuticals (Basel, Switzerland). 2021 Mar 8:14(3):. doi: 10.3390/ph14030238. Epub 2021 Mar 8     [PubMed PMID: 33800403]


Amna S, Øhlenschlaeger T, Saedder EA, Sigaard JV, Bergmann TK. Review of clinical pharmacokinetics and pharmacodynamics of clonidine as an adjunct to opioids in palliative care. Basic & clinical pharmacology & toxicology. 2024 Apr:134(4):485-497. doi: 10.1111/bcpt.13979. Epub 2024 Jan 26     [PubMed PMID: 38275186]


Mancia G, Kjeldsen SE, Kreutz R, Pathak A, Grassi G, Esler M. Individualized Beta-Blocker Treatment for High Blood Pressure Dictated by Medical Comorbidities: Indications Beyond the 2018 European Society of Cardiology/European Society of Hypertension Guidelines. Hypertension (Dallas, Tex. : 1979). 2022 Jun:79(6):1153-1166. doi: 10.1161/HYPERTENSIONAHA.122.19020. Epub 2022 Apr 5     [PubMed PMID: 35378981]


Thu Kyaw M, Maung ZM. Hypokalemia-Induced Arrhythmia: A Case Series and Literature Review. Cureus. 2022 Mar:14(3):e22940. doi: 10.7759/cureus.22940. Epub 2022 Mar 7     [PubMed PMID: 35411269]

Level 2 (mid-level) evidence


Khiatah B, Frugoli A, Carlson D. The Clinical Caveat for Treating Persistent Hypokalemia in Diabetic Ketoacidosis. Cureus. 2023 Jul:15(7):e42272. doi: 10.7759/cureus.42272. Epub 2023 Jul 21     [PubMed PMID: 37605707]


Hong F, Xu P, Zhai Y. The Opportunities and Challenges of Peroxisome Proliferator-Activated Receptors Ligands in Clinical Drug Discovery and Development. International journal of molecular sciences. 2018 Jul 27:19(8):. doi: 10.3390/ijms19082189. Epub 2018 Jul 27     [PubMed PMID: 30060458]


Sheikh IM, Hassan OA, Adam SM, Ali AI, Ogedegbe OJ, Tabowei G, Barbarawi A, Yussuf FM, Nor MA. Association of Pioglitazone With Major Adverse Cardiovascular Events, All-Cause Mortality, and Heart Failure Hospitalizations: A Systematic Review. Cureus. 2023 Oct:15(10):e46911. doi: 10.7759/cureus.46911. Epub 2023 Oct 12     [PubMed PMID: 37954768]

Level 1 (high-level) evidence


Johansen NJ, Christensen MB. A Systematic Review on Insulin Overdose Cases: Clinical Course, Complications and Treatment Options. Basic & clinical pharmacology & toxicology. 2018 Jun:122(6):650-659. doi: 10.1111/bcpt.12957. Epub 2018 Feb 23     [PubMed PMID: 29316226]

Level 1 (high-level) evidence


Dall V. Preclinical safety pharmacology studies on the rapid-acting insulin analogue insulin aspart. Arzneimittel-Forschung. 1999 May:49(5):463-70     [PubMed PMID: 10367110]

Level 3 (low-level) evidence


Gallagher A, Butler TJ, Home PD. The effect of the optimal use of rapid-acting insulin analogues on insulin secretion in Type 2 diabetes. Diabetes research and clinical practice. 2007 Jun:76(3):327-34     [PubMed PMID: 17092597]

Level 1 (high-level) evidence


Buse JB, Carlson AL, Komatsu M, Mosenzon O, Rose L, Liang B, Buchholtz K, Horio H, Kadowaki T. Fast-acting insulin aspart versus insulin aspart in the setting of insulin degludec-treated type 1 diabetes: Efficacy and safety from a randomized double-blind trial. Diabetes, obesity & metabolism. 2018 Dec:20(12):2885-2893. doi: 10.1111/dom.13545. Epub 2018 Oct 10     [PubMed PMID: 30259644]

Level 1 (high-level) evidence