What is a good starting dose for a 70/30 Novolog (insulin aspart) pen?

Starting Dose for 70/30 NovoLog Pen

For patients starting on a 70/30 NovoLog (insulin aspart) pen, the recommended starting dose is 0.1 to 0.2 units/kg of body weight per day, typically administered as a twice-daily regimen before breakfast and dinner.

Dosing Algorithm for 70/30 NovoLog Pen

Initial Dosing Approach

• Calculate total daily dose: 0.1-0.2 units/kg body weight
• For a 70 kg person, this would be approximately 7-14 units total daily dose
• Divide the total daily dose into two equal injections:
  • First dose before breakfast
  • Second dose before dinner

Titration Process

After starting therapy, adjust the dose based on blood glucose monitoring:

• Monitor fasting glucose levels for 1 week
• Target fasting glucose: 90-150 mg/dL (5.0-8.3 mmol/L)
• If 50% of fasting glucose values are above target: increase dose by 2 units
• If >2 fasting glucose values/week are <80 mg/dL: decrease dose by 2 units

Special Considerations for Older Adults

For older adults, the guidelines recommend a simplified approach 1:

• If transitioning from a more complex insulin regimen to 70/30 premixed insulin, use 70% of the total previous daily insulin dose
• Administer as twice-daily injections (before breakfast and dinner)
• Adjust based on blood glucose monitoring as described above

Practical Administration Tips

• 70/30 NovoLog contains 30% rapid-acting insulin aspart and 70% intermediate-acting insulin aspart protamine
• Administer within 15 minutes before meals
• Ensure proper pen technique:
  • Prime pen with 2 units before first use
  • Inject into abdomen, thigh, or upper arm
  • Rotate injection sites to prevent lipohypertrophy

Common Pitfalls to Avoid

1. Inappropriate timing: Unlike regular insulin that requires 30-minute pre-meal administration, NovoLog 70/30 should be given immediately before meals (within 15 minutes)

2. Inadequate monitoring: Failure to monitor both fasting and post-meal glucose can lead to suboptimal dose adjustments

3. Overlooking hypoglycemia risk: Pay special attention to signs of hypoglycemia, especially in older adults or those with impaired awareness

4. Inappropriate storage: Store unused pens in refrigerator (36-46°F); in-use pens can be kept at room temperature (<86°F) for up to 28 days

5. Using at bedtime: Guidelines specifically recommend against using rapid-acting insulin components at bedtime 1

For patients who require smaller, more precise doses, there are now half-unit pens available that allow for more granular dose adjustments 2, though standard 70/30 NovoLog pens typically allow for 1-unit increments.

Human factors studies have shown that most patients find insulin pens easier to use than vials and syringes, with the FlexPen (used for NovoLog products) receiving particularly high usability scores 3, 4.