Can Novolog 70/30 (insulin aspart protamine/insulin aspart) be used for basal dosing?

Novolog 70/30 Should Not Be Used for Basal Insulin Dosing

Novolog 70/30 (insulin aspart protamine/insulin aspart) is not appropriate for use as a basal insulin and should not be used for basal-only dosing due to its pharmacokinetic profile and the risk of hypoglycemia.

Understanding Novolog 70/30 and Basal Insulin Requirements

What is Novolog 70/30?

• Novolog 70/30 is a premixed insulin product containing 70% protamine-bound insulin aspart (intermediate-acting) and 30% soluble insulin aspart (rapid-acting) 1, 2
• It is designed to address both basal and prandial insulin needs with a single injection, typically administered before breakfast and dinner 2

Appropriate Basal Insulin Options

• True basal insulins are designed to provide relatively constant insulin levels to restrain hepatic glucose production between meals and overnight 1
• Recommended basal insulins include:
  • Long-acting insulin analogs: glargine (U-100, U-300), detemir, degludec 1
  • Intermediate-acting: NPH insulin 1
  • These insulins have pharmacokinetic profiles specifically designed for basal coverage 3

Why Novolog 70/30 is Inappropriate for Basal-Only Dosing

Pharmacokinetic Limitations

• Novolog 70/30 contains 30% rapid-acting insulin aspart that causes pronounced insulin peaks shortly after injection 2, 4
• This rapid component creates a risk of hypoglycemia if used solely for basal coverage 4
• The intermediate-acting component (70% protamine-bound insulin aspart) does not provide the consistent 24-hour coverage that true basal insulins offer 2, 5

Clinical Guidelines Recommendations

• ADA Standards of Care specifically categorize premixed insulins like Novolog 70/30 as distinct from basal insulins 1
• Guidelines recommend premixed insulins as an option for combination therapy when both basal and prandial coverage are needed, not as basal-only therapy 1
• When basal-only insulin is needed, guidelines recommend starting with true basal insulin at 10 units or 0.1-0.2 units/kg/day 1

Appropriate Use of Novolog 70/30

When to Consider Novolog 70/30

• When both basal and prandial insulin coverage are needed but patient prefers fewer daily injections 1, 2
• As part of a twice-daily insulin regimen, typically before breakfast and dinner 2, 5
• When advancing from basal-only insulin therapy to more complex regimens in patients with inadequate glycemic control 1

Dosing Considerations

• Typically administered twice daily, before breakfast and dinner 2, 5
• May be considered when basal insulin has been titrated to acceptable fasting glucose but A1C remains above target 1
• Can be an alternative to basal-bolus regimens in patients who need simplified regimens 1

Potential Risks of Using Novolog 70/30 as Basal Insulin

Hypoglycemia Risk

• The rapid-acting component (30% insulin aspart) creates pronounced peaks that increase hypoglycemia risk if used for basal-only coverage 4
• Studies show hypoglycemia occurs in 43-57% of patients using BIAsp 30 (Novolog 70/30) 4
• Nocturnal hypoglycemia is a particular concern due to the pharmacokinetic profile 4

Inadequate 24-hour Coverage

• Unlike true basal insulins that provide consistent 24-hour coverage, the intermediate-acting component of Novolog 70/30 has a more limited duration of action 2, 3
• This can lead to inadequate overnight glucose control and morning hyperglycemia 5

Conclusion for Clinical Practice

• For patients requiring basal insulin only, use true basal insulins like glargine, detemir, degludec, or NPH 1
• Reserve Novolog 70/30 for patients who need both basal and prandial coverage with simplified injection regimens 1, 2
• When initiating insulin therapy, follow guidelines recommending basal insulin alone as the most convenient initial insulin regimen 1