Can Lantus (insulin glargine) and Novolog 70/30 (insulin aspart 70/30) be used together for diabetes management?

Lantus and Novolog 70/30 for Diabetes Management

Yes, Lantus (insulin glargine) and Novolog 70/30 (insulin aspart 70/30) can be used together effectively for diabetes management as part of a basal-bolus insulin regimen to optimize glycemic control and reduce morbidity and mortality. This combination provides complementary coverage of both basal and prandial insulin needs.

Pharmacological Rationale

• Lantus (insulin glargine) is a long-acting basal insulin that provides relatively constant basal insulin levels over 24 hours without pronounced peaks, making it ideal for controlling fasting blood glucose 1
• Novolog 70/30 is a premixed insulin containing 30% rapid-acting insulin aspart and 70% intermediate-acting protamine-crystallized insulin aspart, providing both immediate and extended glucose control 2
• This combination addresses both basal (Lantus) and prandial/post-prandial (Novolog 70/30) glucose control needs 3

Clinical Application

Recommended Regimen Structure

• Lantus should be administered once daily at bedtime as the basal component 4
• Novolog 70/30 should be administered twice daily, 30 minutes before breakfast and dinner 5
• This regimen provides comprehensive 24-hour coverage with:
  • Lantus providing consistent background insulin
  • Novolog 70/30 covering mealtime and post-meal glucose excursions 3

Dosing Considerations

• When initiating this combination:
  • Lantus can be started at 10 units or 0.1-0.2 units/kg of body weight 3
  • Novolog 70/30 can be initiated at 10 units or 0.1-0.2 units/kg of body weight per day, divided into two equal doses 5
• Dose titration should be based on self-monitored blood glucose (SMBG) readings 3
• For Lantus: adjust based on fasting glucose readings 3
• For Novolog 70/30: adjust based on pre-meal and post-meal glucose readings 5

Evidence-Based Benefits

• This combination provides better postprandial glucose control compared to basal insulin alone 3
• Lantus has been shown to reduce the risk of hypoglycemia, particularly nocturnal episodes, compared to NPH insulin 6
• The combination allows for more flexible meal planning than using premixed insulin alone 3
• Studies have demonstrated that adding prandial coverage to basal insulin improves overall glycemic control when basal insulin alone is insufficient 3

Monitoring and Adjustment

• Regular monitoring of both fasting and postprandial glucose levels is essential 3
• HbA1c should be evaluated every 2-3 months to assess overall glycemic control 5
• If glycemic targets are not achieved:
  • Adjust Lantus dose based on fasting glucose readings 3
  • Adjust Novolog 70/30 dose based on pre-meal and post-meal glucose readings 5
  • Consider adding a third dose of Novolog 70/30 if needed for additional meal coverage 3

Potential Pitfalls and Considerations

• Risk of hypoglycemia may increase when using multiple insulin formulations; careful monitoring is required 3
• Timing of Novolog 70/30 administration is important (30 minutes before meals) to match its pharmacokinetic profile with meal absorption 5
• Overlapping insulin action times may occur between the protamine component of Novolog 70/30 and Lantus; dose adjustments may be needed to prevent hypoglycemia 3
• Metformin therapy should be continued when possible, but sulfonylureas and DPP-4 inhibitors are typically discontinued when using this combination insulin regimen 3

Alternative Approaches

• If this combination is not achieving targets, consider:
  • Switching to a basal-bolus regimen with Lantus plus rapid-acting insulin at each meal 3
  • Switching to thrice-daily premixed insulin if adherence to multiple daily injections is an issue 3
  • Adding a GLP-1 receptor agonist to the regimen for additional glycemic control 3

This combination of Lantus and Novolog 70/30 represents a practical approach to insulin therapy that addresses both basal and prandial insulin needs, potentially improving overall glycemic control and reducing diabetes-related morbidity and mortality.