From the Guidelines
For a 90-year-old male transitioning from Tresiba to Novolin 70/30 for nighttime coverage while continuing Novolog 6 units before breakfast, I recommend starting with Novolin 70/30 at 10 units once daily at bedtime, as this approach is supported by the most recent guidelines for diabetes management 1. This provides both intermediate-acting insulin (NPH) for overnight coverage and some short-acting regular insulin.
- The goal is to maintain fasting glucose between 100-180 mg/dL for this age group, and to achieve this, morning fasting blood glucose should be monitored closely for 3-5 days.
- Adjustments to the insulin dose can be made by 1-2 units every 3 days if needed, based on the patient's response and to minimize the risk of hypoglycemia.
- It is crucial to instruct the patient or caregiver to administer the insulin at the same time each night, ideally around 9-10 PM, and to mix the insulin thoroughly by gently rolling (not shaking) the pen or vial.
- Signs of nighttime hypoglycemia such as night sweats, morning headaches, or restless sleep should be watched for, and the patient or caregiver should be educated on how to recognize and manage these symptoms. The 70/30 mix contains 70% NPH (intermediate-acting) and 30% regular insulin, making it suitable for providing overnight basal coverage, and its use is supported by recent guidelines that emphasize the importance of cost-effective management options, especially for patients with type 2 diabetes who may have relaxed A1C goals or cost concerns 1.
From the Research
Converting Novolog to Novolin 70/30 for a 90-year-old Male
To convert Novolog to Novolin 70/30 for a 90-year-old male, consider the following:
- Novolog is a rapid-acting insulin analog, while Novolin 70/30 is a premixed insulin containing 70% NPH (intermediate-acting) and 30% regular (short-acting) insulin.
- The patient is currently taking 6 units of Novolog before breakfast, and needs coverage for nighttime only once his insurance will cover Novolin 70/30.
Key Considerations
- When switching from a rapid-acting insulin to a premixed insulin, the dosage and timing may need to be adjusted to avoid hypoglycemia or hyperglycemia.
- Studies have shown that premixed insulins like Novolin 70/30 can provide effective glycemic control with a lower risk of hypoglycemia compared to traditional human insulins 2, 3.
- However, the patient's age and potential comorbidities should be taken into account when adjusting the insulin regimen.
Potential Conversion Strategy
- Start by reducing the total daily dose of insulin by 10-20% to account for the change in insulin type and to minimize the risk of hypoglycemia.
- Consider administering the Novolin 70/30 at bedtime, as the NPH component will provide coverage throughout the night.
- Monitor the patient's blood glucose levels closely and adjust the dose and timing of the Novolin 70/30 as needed to achieve optimal glycemic control.
- Be aware that the patient may experience a higher risk of hypoglycemia with the premixed insulin, especially if they have renal or hepatic impairment 4, 5.
- Educate the patient and their caregivers on the proper use and administration of the new insulin regimen, as well as the signs and symptoms of hypoglycemia and hyperglycemia.