Role of Novomix (Biphasic Insulin Aspart) in Diabetes Management
Novomix 30 (biphasic insulin aspart) is recommended as an alternative insulin regimen for patients who may struggle with multiple daily injections, particularly in steroid-induced hyperglycemia or type 2 diabetes requiring insulin therapy. 1
Overview of Biphasic Insulin Aspart
Biphasic insulin aspart (NovoMix) is a premixed insulin preparation containing:
- 30% rapid-acting insulin aspart (NovoMix 30)
- 70% intermediate protamine-bound insulin aspart
This formulation provides both immediate glucose-lowering effects and extended coverage between meals from a single injection.
Clinical Applications
Type 2 Diabetes Management
- Primary indication: Patients who need insulin therapy but may struggle with multiple daily injections
- Dosing strategy: Typically administered twice daily (before breakfast and dinner)
- Starting dose: When switching from basal insulin, calculate 80% of current total daily basal dose and divide into two injections:
- 2/3 before breakfast
- 1/3 before dinner 2
Steroid-Induced Hyperglycemia
- Particularly useful for patients on corticosteroids who develop hyperglycemia
- Provides coverage for both fasting and postprandial glucose elevations 1
Advantages Over Traditional Regimens
- Fewer daily injections compared to basal-bolus regimens
- Better postprandial glucose control than regular human insulin mixtures 3
- Greater patient satisfaction reported compared to regular human insulin regimens 3
Efficacy and Comparative Studies
Biphasic insulin aspart has demonstrated:
- Similar long-term glycemic control to biphasic human insulin after 2 years in type 2 diabetes 3
- Significantly better postprandial glucose control than similar mixtures of biphasic regular human insulin 3
- Potential for lower rates of nocturnal hypoglycemia compared to regular human insulin 4
Dosing and Administration
- Timing: Administer 0-15 minutes before meals (unlike regular human insulin which requires 30-minute lead time) 2
- Dose adjustment: Increase by 2 units if 50% of fasting fingerstick values are above target; decrease by 2 units if more than 2 fasting values per week are below 80 mg/dL 2
- Monitoring: Regular blood glucose monitoring is crucial, especially when initiating therapy or changing doses 2
Important Considerations and Limitations
- Patient selection: Best suited for patients with consistent meal timing and content
- Not recommended for:
- Patients with highly variable meal schedules
- Inpatient use (due to higher risk of iatrogenic hypoglycemia) 2
- Concomitant medications:
- Continue metformin when initiating NovoMix
- Consider discontinuing sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists 2
Alternative Formulations
Other biphasic insulin aspart formulations include:
- NovoMix 50 (50% rapid-acting/50% intermediate-acting)
- NovoMix 70 (70% rapid-acting/30% intermediate-acting)
These higher proportions of rapid-acting insulin may provide better control of postprandial hyperglycemia when needed 5.
When to Consider Treatment Intensification
If twice-daily NovoMix fails to achieve glycemic targets:
- Consider adding a non-insulin agent
- Consider transitioning to a more intensive insulin regimen (basal-bolus)
- Consider thrice-daily premixed insulin analogs (before each main meal) 2
Biphasic insulin aspart represents an important option in the diabetes management toolkit, balancing simplicity of administration with effective glycemic control for selected patients.