What is the recommended dose of 70/30 (Novolin, Humulin) insulin per kilogram body weight?

Recommended Dose of 70/30 Insulin per Kilogram Body Weight

The recommended starting total daily dose of 70/30 (Novolin, Humulin) insulin is typically 0.5 units/kg of body weight, with a range of 0.4-1.0 units/kg depending on individual patient factors. 1

Initial Dosing Guidelines

• Starting dose range: 0.4-1.0 units/kg/day 1
• Typical starting dose: 0.5 units/kg/day for metabolically stable patients 1
• Higher doses: May be needed for patients presenting with diabetic ketoacidosis 1
• Administration: Given as twice-daily injections 2

Dose Distribution

When using 70/30 premixed insulin:

• Administer twice daily 1, 2
• Typically given before breakfast and dinner
• The total daily dose is divided between these two injections, often in a 2:1 ratio (morning:evening) or equal amounts depending on meal patterns and glucose monitoring results

Safety Considerations

• Doses exceeding 0.6 units/kg/day are associated with significantly increased odds of hypoglycemia 3
• For doses between 0.6-0.8 units/kg/day, the odds ratio for hypoglycemia is 2.10 (95% CI 1.08-4.09) 3
• For doses >0.8 units/kg/day, the odds ratio increases to 2.95 (95% CI 1.54-5.65) 3
• Doses below 0.6 units/kg/day have relatively lower hypoglycemia risk 3

Special Populations

• Puberty: Higher insulin doses are often required during puberty 1
• Enteral nutrition: For patients on tube feeding, UK guidelines suggest giving 70/30 mixed insulin with half at the start of the feed and the rest halfway through the feed 1
• Type 1 diabetes: Typically requires higher doses than type 2 diabetes, with total daily doses often in the range of 0.5-1.0 units/kg/day 1

Dose Adjustment

• Adjust insulin doses based on blood glucose patterns 4
• Monitor both fasting and postprandial glucose values to guide dose adjustments 2
• For patients with established diabetes, titrate doses based on:
  • Fasting blood glucose levels for the morning dose
  • Pre-dinner and bedtime glucose levels for the evening dose

Practical Application

1. Calculate the initial total daily dose based on patient weight (e.g., 0.5 units/kg)
2. Divide the total daily dose into two injections (morning and evening)
3. Monitor blood glucose before meals and at bedtime
4. Adjust doses every 2-3 days based on glucose patterns
5. Target fasting glucose <5.3 mmol/L (<95 mg/dL) and 2-hour postprandial <6.7 mmol/L (<120 mg/dL) 4

Remember that 70/30 insulin provides both basal and prandial coverage but with less flexibility than basal-bolus regimens. The fixed ratio may not be optimal for all patients, particularly those with variable meal timing or carbohydrate content.