How to administer Insulin 70/30 (Novolin 70/30, NPH/Regular insulin)?

From the Guidelines

Novolin 70/30 insulin should be administered subcutaneously twice daily, typically 30 minutes before breakfast and dinner, with the standard starting dose being 0.5-1.0 units/kg/day divided between these two injections, as recommended by recent guidelines 1. To administer Insulin 70/30, first verify the insulin label to avoid injecting an incorrect insulin, and ensure the hands and injection site are clean 1. Before administration, gently roll the insulin pen or vial to mix the solution until it appears uniformly cloudy or milky. The injection sites include the abdomen, thighs, buttocks, or upper arms, and should be rotated to prevent lipohypertrophy, with rotation within one area recommended rather than rotating to a different area with each injection 1. Draw up the prescribed dose using an insulin syringe if using a vial, or dial the correct dose if using a pen device. Some key points to consider when administering Novolin 70/30 include:

• Store unopened insulin in the refrigerator (36-46°F), while in-use insulin can be kept at room temperature (below 86°F) for up to 28 days.
• Novolin 70/30 combines 70% intermediate-acting NPH insulin with 30% short-acting regular insulin, providing both basal and prandial coverage.
• The NPH component peaks 4-8 hours after injection and lasts 12-16 hours, while the regular insulin component begins working within 30 minutes, peaks at 2-3 hours, and lasts 5-8 hours, making this fixed combination suitable for patients who need coverage for both fasting and post-meal glucose levels. When adjusting the insulin dose, consider using a simplified sliding scale, and adjust the dose every 2 weeks based on finger-stick glucose testing performed before lunch and before dinner, with a goal of 90–150 mg/dL (5.0–8.3 mmol/L) before meals 1.

From the Research

Administration of Insulin 70/30

To administer Insulin 70/30 (Novolin 70/30, NPH/Regular insulin), follow these steps:

• Wash your hands with soap and water before handling the insulin vial or syringe.
• Choose an injection site, such as the abdomen, thigh, or arm, and rotate the site each time you inject to avoid lipodystrophy.
• Draw the insulin into the syringe, making sure to draw up the correct dose.
• Inject the insulin subcutaneously, at a 90-degree angle to the skin, using a smooth, steady motion.

Important Considerations

When administering Insulin 70/30, consider the following:

• The onset of action for Regular insulin is 30 minutes to 1 hour, while the onset of action for NPH insulin is 1.5 to 4 hours.
• The peak action for Regular insulin is 2 to 3 hours, while the peak action for NPH insulin is 4 to 12 hours.
• The duration of action for Regular insulin is 5 to 8 hours, while the duration of action for NPH insulin is 12 to 18 hours.

Studies on Insulin Administration

According to studies 2, 3, 4, the administration of insulin, including Insulin 70/30, should be individualized based on the patient's specific needs and medical history.

• A study published in 2017 2 found that intensive insulin therapy combined with metformin was associated with a reduction in both glucose variability and nocturnal hypoglycemia in patients with type 2 diabetes.
• Another study published in 2009 3 found that the relationship between HbA1c and hypoglycemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin was complex, and that the risk of hypoglycemia varied depending on the specific insulin regimen used.
• A more recent study published in 2024 4 found that treatment with insulin was associated with an increased risk of hypoglycemia, while treatment with metformin was associated with a reduced risk of hypoglycemia.

Note: There is no direct evidence in the provided studies on how to administer Insulin 70/30. The information provided is based on general knowledge of insulin administration and the studies provided, which discuss the use of insulin and metformin in the management of diabetes.