Novolog 70/30 Starting Dose for Type 2 Diabetes
The recommended starting dose of Novolog 70/30 (insulin aspart protamine/insulin aspart) for adults with type 2 diabetes is 10 units or 0.1-0.2 units/kg of body weight, typically administered before breakfast and/or dinner. 1
Initial Dosing Approach
- For insulin-naïve patients with type 2 diabetes, start with 10 units or 0.1-0.2 units/kg of body weight of Novolog 70/30 1
- Premixed insulin like Novolog 70/30 (containing 70% insulin aspart protamine and 30% insulin aspart) is typically administered twice daily, before breakfast and dinner 2
- When switching from oral agents to insulin therapy, Novolog 70/30 can be initiated at 12 units before dinner, with subsequent dose adjustments based on blood glucose monitoring 3
- For patients already on basal insulin, consider using 70% of the total daily basal insulin dose as the starting dose of Novolog 70/30 1
Dose Titration and Adjustment
- Titrate the dose of Novolog 70/30 based on blood glucose monitoring with a target fasting blood glucose of 90-150 mg/dL (5.0-8.3 mmol/L) 1
- If 50% of fasting blood glucose values are above target over a week, increase the dose by 2 units 1
- If more than 2 fasting blood glucose values per week are below 80 mg/dL (4.4 mmol/L), decrease the dose by 2 units 1
- For elderly patients, consider higher glycemic targets to minimize hypoglycemia risk 1
Administration Timing
- Novolog 70/30 should be administered within 15 minutes before meals 4
- For some patients, particularly elderly individuals who may have unpredictable eating patterns, postprandial dosing (15-20 minutes after starting a meal) may be an acceptable alternative 4
Combination with Other Medications
- When initiating Novolog 70/30, metformin therapy should generally be continued 5
- Consider discontinuing sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists when starting premixed insulin regimens to avoid unnecessarily complex medication plans 1
- Thiazolidinediones or SGLT2 inhibitors may be continued to improve glucose control and potentially reduce total daily insulin dose 1
Intensification of Therapy
- If glycemic targets are not achieved with twice-daily Novolog 70/30, consider adding a third dose before lunch 6
- In a stepwise approach, once-daily Novolog 70/30 achieved HbA1c ≤6.5% in 21% of patients, twice-daily in 52% of patients, and thrice-daily in 60% of patients 6
Potential Pitfalls and Considerations
- Premixed insulins like Novolog 70/30 may be suboptimal for covering postprandial glucose excursions compared to basal-bolus regimens 1
- In elderly patients, adding once-daily basal insulin to oral agents may provide better glycemic control with less hypoglycemia than twice-daily premixed insulin alone 7
- Regular monitoring of blood glucose is essential for appropriate dose adjustments 5
- Watch for signs of hypoglycemia, which may occur more frequently with premixed insulin compared to basal insulin alone 7
By following these dosing recommendations and monitoring protocols, most patients with type 2 diabetes can achieve appropriate glycemic control with Novolog 70/30.