Is Novolim 70/30 (insulin aspart (Novolog)) an intermediate-acting insulin?

Novolim 70/30 is an Intermediate-Acting Insulin

Novolim 70/30 (insulin aspart) is a premixed insulin formulation containing 70% intermediate-acting protamine insulin aspart and 30% rapid-acting insulin aspart, making it primarily an intermediate-acting insulin with a rapid-acting component.

Composition and Classification

• Novolim 70/30 (also known as Novomix 30) contains 30% rapid-acting insulin aspart and 70% intermediate-acting protaminated insulin aspart in a single formulation 1
• It belongs to the category of premixed insulin analogues that combine both rapid and intermediate-acting components to provide coverage for both prandial (mealtime) and basal insulin needs 1, 2
• The intermediate-acting component (70% protaminated insulin aspart) provides the extended duration of action similar to NPH insulin 1, 3

Pharmacokinetic Profile

• The rapid-acting component (30% soluble insulin aspart) has a faster onset of action compared to regular human insulin, providing immediate postprandial coverage 4
• The intermediate-acting protamine component (70%) extends the duration of action to provide basal insulin coverage between meals 3
• Peak insulin levels with premixed insulin analogues like Novolim 70/30 are twice as high and reached in half the time compared to premixed human insulin formulations 2

Clinical Applications

• Novolim 70/30 is typically administered twice daily, usually before breakfast and dinner 2, 3
• It provides an alternative to basal-bolus regimens for patients who require both prandial and basal insulin coverage but prefer fewer daily injections 1
• It can be used for insulin initiation in type 2 diabetes when a single insulin formulation covering both basal and prandial needs is desired 3
• It may also be used when transitioning from self-mixed insulin regimens to a more convenient premixed formulation 5

Comparison to Other Insulin Types

• Unlike purely long-acting insulins (glargine, detemir, degludec) that only provide basal coverage, Novolim 70/30 provides both basal and prandial coverage 1
• Unlike purely rapid-acting insulins (lispro, aspart, glulisine) that only provide prandial coverage, Novolim 70/30 provides extended coverage between meals 1, 4
• The pharmacodynamic profile of premixed insulins like Novolim 70/30 makes them suboptimal for precise postprandial glucose control compared to separate basal-bolus regimens 1

Administration Considerations

• Novolim 70/30 is typically administered twice daily, immediately before breakfast and dinner 2, 6
• Some studies suggest that postprandial administration (15-20 minutes after meal onset) may be an acceptable alternative for elderly patients who have difficulty with timing preprandial doses 6
• The insulin should be visually inspected before use - it should appear uniformly cloudy due to the protamine suspension component 1

Common Pitfalls and Caveats

• Premixed insulins like Novolim 70/30 offer less flexibility in dose adjustment compared to separate basal and bolus insulin regimens 1, 3
• The fixed ratio (70/30) may not be optimal for all patients, as individual insulin requirements can vary throughout the day 2
• Patients switching from other insulin regimens to Novolim 70/30 should do so under medical supervision, with appropriate blood glucose monitoring 1
• Storage requirements must be followed - unused vials should be refrigerated, while vials in use may be kept at room temperature to limit local injection site irritation 1