What is the management plan for Novolin 70/30 (insulin aspart and insulin novolog mix 70/30)?

Management Plan for Novolin 70/30 Insulin

Novolin 70/30 is a premixed insulin regimen containing 70% NPH (intermediate-acting) and 30% regular (short-acting) insulin that should be administered twice daily, typically before breakfast and dinner, with dose titration based on blood glucose monitoring to achieve target glycemic control while minimizing hypoglycemia risk. 1

Initiation and Dosing

• For insulin-naïve patients, start with 10 units or 0.1-0.2 units/kg of body weight, typically divided into two daily doses 1
• Administer Novolin 70/30 twice daily, 30 minutes before breakfast and dinner 1
• When transitioning from self-mixed insulin regimens to premixed 70/30, the transfer can often be made on a dose-for-dose basis 2
• Continue metformin when initiating Novolin 70/30 if not contraindicated, as this combination is cost-effective and provides good glycemic control 3

Dose Titration

• Adjust doses based on self-monitoring of blood glucose (SMBG) levels 1
• Target fasting blood glucose of 90-150 mg/dL (5.0-8.3 mmol/L) for most patients, with adjustments based on overall health and goals of care 1
• If 50% of fasting fingerstick glucose values are over target, increase dose by 2 units 1
• If more than 2 fasting fingerstick values per week are <80 mg/dL (4.4 mmol/L), decrease dose by 2 units 1

Advantages and Limitations

• Premixed insulin regimens like Novolin 70/30 provide both prandial and basal insulin coverage in a single product, which can improve treatment adherence 4
• Pharmacodynamic profiles of premixed insulins make them suboptimal for covering postprandial glucose excursions compared to basal-bolus regimens 1
• Novolin 70/30 is more cost-effective than triple oral therapy for patients failing two oral medications, with comparable efficacy in lowering A1C 3

Special Considerations for Older Adults

• For older adults with complex medical issues or cognitive impairment, simplification of insulin regimens may be necessary 1
• If a patient is on a complex insulin regimen and needs simplification, consider:
  • Changing to morning-only dosing of Novolin 70/30 (using 70% of total daily dose) 1
  • Discontinuing prandial insulin if ≤10 units/dose and adding a non-insulin agent 1
  • Reducing prandial insulin by 50% if >10 units/dose and adding a non-insulin agent 1

Monitoring and Safety

• Monitor for hypoglycemia, which is the most common adverse effect of insulin therapy 1
• Do not use rapid-acting insulin at bedtime to avoid nocturnal hypoglycemia 1
• While adjusting insulin doses, a simplified sliding scale may be temporarily used (e.g., for premeal glucose >250 mg/dL, give 2 units of short-acting insulin) 1
• Evaluate glycemic control every 2 weeks and adjust therapy as needed 1

Alternative Regimens to Consider

• If glycemic targets are not achieved with Novolin 70/30 twice daily, consider:
  • Advancing to thrice-daily premixed insulin 1
  • Switching to a basal-bolus regimen for better postprandial control 1
  • Adding a GLP-1 receptor agonist to basal insulin for patients not achieving targets 1

Common Pitfalls and Caveats

• Premixed insulins like Novolin 70/30 offer less flexibility in dose adjustment compared to separate basal and bolus insulins 1
• The fixed ratio (70/30) may not be optimal for all patients, particularly those with varying insulin requirements throughout the day 1
• Sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists are typically discontinued when using premixed insulin regimens to avoid unnecessarily complex or costly regimens 1
• Patients should be educated about the importance of consistent meal timing when using premixed insulin 4