Is Novolog (insulin aspart) 70/30 the same as Glargine (insulin glargine)?

NovoLog 70/30 and Insulin Glargine Are Different Insulin Products with Distinct Pharmacological Properties

NovoLog 70/30 (insulin aspart protamine/insulin aspart) is not the same as insulin glargine (Lantus, Basaglar, etc.) - they are fundamentally different insulin formulations with distinct pharmacokinetic profiles, durations of action, and clinical applications. 1, 2

Key Differences Between NovoLog 70/30 and Insulin Glargine

Composition and Classification

• NovoLog 70/30:

  • A premixed insulin containing 70% intermediate-acting insulin aspart protamine and 30% rapid-acting insulin aspart
  • Provides both basal and prandial coverage in a single injection
  • Classified as a biphasic insulin analog 2

• Insulin Glargine:

  • A long-acting basal insulin analog
  • Contains 100% insulin glargine with no rapid-acting component
  • Designed specifically for basal insulin needs 1

Pharmacokinetics and Timing

• NovoLog 70/30:

  • Onset: Rapid component begins working within 10-20 minutes
  • Peak: Dual peaks (one from rapid component, one from intermediate component)
  • Duration: Approximately 24 hours but with variable coverage
  • Administration: Typically given twice daily, 0-15 minutes before meals 2

• Insulin Glargine:

  • Onset: 1-2 hours
  • Peak: Relatively peakless (flat action profile)
  • Duration: 24+ hours with consistent effect
  • Administration: Once daily at same time each day 1

Clinical Applications and Considerations

When to Use NovoLog 70/30

• Patients who benefit from simplified regimens with fewer daily injections
• Those with consistent meal timing and carbohydrate content
• Patients who need both basal and prandial coverage but prefer fewer injections
• May be more cost-effective for some patients compared to separate basal-bolus insulins 2

When to Use Insulin Glargine

• Patients requiring only basal insulin coverage
• Those needing a more flexible meal schedule
• As part of a basal-bolus regimen with separate rapid-acting insulin
• Patients at higher risk of nocturnal hypoglycemia 1

Efficacy and Safety Considerations

Glycemic Control

• NovoLog 70/30 may provide better postprandial glucose control than glargine alone due to its rapid-acting component 3, 4
• Insulin glargine provides more consistent fasting glucose control with less variability 1
• Studies comparing biphasic insulin aspart 70/30 with insulin glargine show that the biphasic formulation may achieve greater HbA1c reductions in some patients, but with higher risk of hypoglycemia 3, 4

Hypoglycemia Risk

• NovoLog 70/30 typically has a higher risk of hypoglycemia compared to glargine alone due to its rapid-acting component 3, 4
• Insulin glargine has a lower risk of nocturnal hypoglycemia compared to older basal insulins like NPH 1

Common Pitfalls and Caveats

1. Incorrect Substitution: Never substitute one for the other as they have fundamentally different action profiles and dosing requirements

2. Timing Confusion: NovoLog 70/30 should be administered 0-15 minutes before meals, while glargine is typically given at the same time each day regardless of meals 2

3. Dose Conversion: When switching between these insulins, dose adjustments are necessary - typically starting with 80% of the previous total daily dose when converting to premixed insulin 2

4. Flexibility Limitations: NovoLog 70/30 requires more consistent meal timing and content compared to a basal-bolus regimen with glargine 2

5. Overbasalization Risk: Using high doses of glargine without addressing postprandial needs may lead to overbasalization, which NovoLog 70/30 might help avoid in some patients 1

In conclusion, these are distinct insulin products with different compositions, action profiles, and clinical applications that cannot be used interchangeably.