What are the substitutes for Novolog (insulin aspart) 70/30?

Substitutes for NovoLog 70/30 Insulin

The most appropriate substitutes for NovoLog 70/30 (insulin aspart 70/30) are Humalog Mix 75/25 (insulin lispro protamine/insulin lispro) or Humulin 70/30 (human insulin 70/30), with Humalog Mix 75/25 being the closest analog insulin alternative. 1, 2

Understanding NovoLog 70/30

NovoLog 70/30 is a premixed insulin containing:

• 70% intermediate-acting protamine-bound insulin aspart
• 30% rapid-acting insulin aspart

Available Substitutes

Analog Insulin Alternatives

1. Humalog Mix 75/25 (insulin lispro protamine/insulin lispro)

   • Contains 75% insulin lispro protamine suspension and 25% insulin lispro injection
   • Similar pharmacokinetic profile to NovoLog 70/30
   • Can be administered within 15 minutes before meals
   • Provides both immediate and extended glucose coverage 2

2. Humalog Mix 50/50 (insulin lispro protamine/insulin lispro)

   • Contains 50% insulin lispro protamine suspension and 50% insulin lispro
   • Higher proportion of rapid-acting component
   • May be suitable for patients needing more postprandial coverage 1, 3

Human Insulin Alternatives

1. Humulin 70/30

   • Contains 70% NPH insulin and 30% regular human insulin
   • Less expensive option
   • Should be administered 30-60 minutes before meals
   • Slower onset and longer duration than analog premixes 4, 1

2. Humulin 50/50

   • Contains 50% NPH insulin and 50% regular human insulin
   • Higher proportion of short-acting component for greater postprandial coverage 1

Key Differences Between Premixed Insulin Types

Pharmacokinetic Differences

• Analog premixes (NovoLog 70/30, Humalog mixes):

  • More rapid onset (0-15 minutes before meals)
  • Earlier peak action
  • More physiological insulin profile 1, 5

• Human premixes (Humulin 70/30):

  • Slower onset (administer 30-60 minutes before meals)
  • Later peak action
  • Less physiological profile 4, 1

Clinical Considerations

Administration Timing

• NovoLog 70/30: 0-15 minutes before meals
• Humalog Mix 75/25: 0-15 minutes before meals
• Humulin 70/30: 30-60 minutes before meals 1

Efficacy Comparison

• Glycemic control is comparable between NovoLog 70/30 and Humalog Mix 75/25 6
• Analog premixes provide better postprandial glycemic control than human premixes 5
• HbA1c reductions with analog premixes range from -1.23% to -2.89% 7

Hypoglycemia Risk

• Similar hypoglycemia profiles between NovoLog 70/30 and Humalog Mix 75/25 6
• Analog premixes may have lower risk of nocturnal hypoglycemia compared to human premixes 1

Special Populations

Elderly Patients

• Premixed insulin regimens may be appropriate for older adults with consistent meal patterns
• Consider simplifying insulin regimens in elderly patients to reduce hypoglycemia risk 4, 1

Type 2 Diabetes

• Premixed insulins are often used in type 2 diabetes when basal insulin alone is insufficient
• Provide both basal and prandial coverage with fewer daily injections than basal-bolus regimens 7

Practical Switching Guidelines

When switching between premixed insulins:

1. Calculate 80% of the current total daily NovoLog 70/30 dose
2. Divide into two injections: 2/3 before breakfast and 1/3 before dinner
3. Monitor blood glucose closely and adjust as needed 1

Important Cautions

• Do not interchange insulin types without medical supervision
• Premixed insulins are not recommended for inpatient use due to higher risk of iatrogenic hypoglycemia
• Patients with highly variable meal schedules may not be ideal candidates for premixed insulins 4, 1

Remember that while these products are substitutes, they have different pharmacokinetic profiles, and dose adjustments may be necessary when switching between them. Close monitoring of blood glucose is essential during any insulin transition.