What is the recommended starting dose for Novolog 70/30 (insulin aspart protamine/insulin aspart)?

NovoLog 70/30 Starting Dose Recommendations

For insulin-naïve patients with type 2 diabetes, the recommended starting dose of NovoLog 70/30 is 10 units or 0.1-0.2 units/kg body weight, administered twice daily, 30 minutes before breakfast and dinner. 1

Dosing Guidelines

• NovoLog 70/30 is a premixed insulin product containing 70% insulin aspart protamine suspension (intermediate-acting) and 30% insulin aspart solution (rapid-acting) 1
• For patients who have never used insulin before, start with 10 units or 0.1-0.2 units/kg body weight per day, divided into two equal doses 1, 2
• Administer NovoLog 70/30 twice daily, 30 minutes before breakfast and dinner 1
• For patients transitioning from other insulin regimens, dosing should be individualized based on previous insulin requirements and blood glucose levels 1

Dose Titration and Monitoring

• Adjust doses based on self-monitoring of blood glucose levels, targeting fasting blood glucose of 90-150 mg/dL 1
• Monitor for hypoglycemia, which is the most common adverse effect of insulin therapy 1
• Evaluate glycemic control every 2 weeks and adjust therapy as needed 1
• Equipping patients with an algorithm for self-titration of insulin doses based on self-monitoring of blood glucose improves glycemic control 2

Special Considerations

• People with type 2 diabetes generally require higher daily doses (≥1 unit/kg) than those with type 1 diabetes 1
• For patients at higher risk of hypoglycemia (older patients >65 years, those with renal failure, and those with poor oral intake), consider using lower starting doses 2
• Premixed insulin therapy has been associated with a higher rate of hypoglycemia compared to basal-bolus regimens, requiring careful monitoring 2
• When adding NovoLog 70/30 to patients already on oral antidiabetic agents, metformin therapy should typically be maintained while other oral agents may be discontinued to avoid unnecessarily complex regimens 2

Treatment Progression

• If glycemic targets are not achieved with twice-daily NovoLog 70/30, consider:
  • Advancing to thrice-daily premixed insulin 1
  • Switching to a basal-bolus regimen for more flexible glucose control 1
• Studies have shown that adding a third injection of biphasic insulin aspart 70/30 before lunch can improve glycemic control in patients not achieving goals with a twice-daily regimen 3

Common Pitfalls to Avoid

• Avoid using premixed insulin in patients with unpredictable eating patterns or those requiring more precise insulin dosing 2
• Do not use sliding scale insulin alone with premixed insulin products, as this approach may lead to unpredictable glucose control 2
• Recognize that comprehensive education regarding self-monitoring of blood glucose, diet, and the avoidance and treatment of hypoglycemia is critically important for any patient using insulin 2
• Be aware that the progressive nature of type 2 diabetes should be regularly explained to patients, and providers should avoid using insulin as a threat or describing it as a sign of personal failure 2