What is the recommended morning and evening dose of 70/30 (Novolin 70/30 or Humulin 70/30) insulin?

Recommended Dosing for 70/30 Insulin

For patients on 70/30 premixed insulin (Novolin 70/30 or Humulin 70/30), the recommended dosing is to use the usual morning dose at the evening meal (sunset/Iftar) and half the usual evening dose at the morning meal (predawn/Suhur). 1

Standard Dosing Approach

When initiating 70/30 premixed insulin in a twice-daily regimen:

• Morning dose: Typically 2/3 of the total daily insulin dose
• Evening dose: Typically 1/3 of the total daily insulin dose 2

Titration Guidelines

1. Target glucose range: 90-150 mg/dL fasting 1, 2
2. Dose adjustments:
   • If 50% of fasting fingerstick values are above target: Increase dose by 2 units
   • If >2 fasting fingerstick values/week are <80 mg/dL: Decrease dose by 2 units 1

Specific Dosing Examples

For a patient on a typical twice-daily 70/30 insulin regimen (e.g., 30 units in morning and 20 units in evening):

• Morning dose: 10 units (half of usual evening dose)
• Evening dose: 30 units (usual morning dose) 1

Special Considerations

Timing of Administration

• 70/30 NPH/regular insulin: Administer 30 minutes before meals
• 70/30 aspart mix or 75/25 lispro mix: Administer 0-15 minutes before meals 2

Dose Distribution

Research indicates that a higher morning-to-evening dose ratio (55:45 to 60:40) may be more effective than an equal split (50:50) 3. This aligns with the guideline recommendation of using 2/3 of the total dose in the morning and 1/3 in the evening.

Inadequate Control on Twice-Daily Regimen

If glycemic targets are not achieved with twice-daily dosing:

1. Consider adding a third dose of 70/30 insulin before lunch
2. Start with 3-6 units and titrate based on 2-hour post-lunch glucose values 4, 5

Simplification for Older Adults

For older adults requiring insulin regimen simplification:

• If on premixed insulin: Use 70% of total daily dose as basal-only insulin in the morning
• Adjust based on fasting glucose values using the same titration algorithm (increase/decrease by 2 units) 1

Common Pitfalls to Avoid

1. Overbasalization: Watch for elevated bedtime-to-morning glucose differentials
2. Hypoglycemia risk: Particularly with twice-daily premixed insulin in older adults
3. Meal timing inconsistency: Premixed insulin works best with consistent meal schedules
4. Inadequate monitoring: Regular glucose monitoring is essential when using premixed insulin

Remember that while these are standard recommendations, the ultimate goal is to achieve target glucose levels while minimizing hypoglycemia risk, which may require individualized adjustments based on glucose patterns.