Is 20 units of Novolog (insulin aspart) 70/30 twice a day an effective dosage for managing type 2 diabetes?

Novolog 70/30 Dosing for Type 2 Diabetes Management

20 units of Novolog 70/30 twice daily is an appropriate starting dose for many patients with type 2 diabetes, but requires individualized titration based on blood glucose monitoring to achieve target glycemic control.

Understanding Novolog 70/30

• Novolog 70/30 (insulin aspart) is a premixed insulin containing 70% protamine-crystallized insulin aspart (intermediate-acting) and 30% soluble insulin aspart (rapid-acting) 1
• This premixed formulation addresses both prandial and basal insulin needs with a single product, offering practical advantages for patients 1
• Compared to regular human insulin premixes, Novolog 70/30 provides improved postprandial glucose control with similar overall glycemic efficacy 2

Dosing Considerations

• Initial insulin dosing for type 2 diabetes typically starts at 0.1-0.2 units/kg/day based on body weight and degree of hyperglycemia, with individualized titration over days to weeks 3
• For a 70kg person, this would equate to approximately 7-14 units initially, making 20 units twice daily a moderate starting dose 3
• Premixed insulin regimens like Novolog 70/30 are typically administered before breakfast and dinner 3
• Dose titration should be based on self-monitoring of blood glucose, with adjustments of 2-4 units every 3-7 days until target glucose levels are achieved 4

Efficacy of Premixed Insulin

• Biphasic insulin aspart 30/70 (Novolog Mix 70/30) twice daily provides better postprandial glucose control compared to basal insulin alone or biphasic human insulin 1
• Studies show that Novolog 70/30 can be used to intensify insulin therapy and reach the glycemic target recommended by the American Diabetes Association (HbA1c <7.0%) 1
• Premixed insulin analogues are a valid tool to start and improve insulin treatment in type 2 diabetes 5

Monitoring and Adjustment Protocol

• During dose adjustment, daily self-monitoring of blood glucose is essential, checking both fasting and postprandial levels 4
• If 50% of fasting glucose values are above target (90-150 mg/dL), increase dose by 2 units 3
• If more than 2 fasting glucose values per week are below 80 mg/dL, decrease dose by 2 units 3
• Obtain HbA1c after 3 months to assess overall glycemic control 4

When to Consider Regimen Changes

• If basal insulin has been titrated to an acceptable fasting blood glucose level but HbA1c remains above target, combination injectable therapy should be considered 3
• When the total daily insulin dose exceeds 0.5 units/kg/day (especially as it approaches 1 unit/kg/day), consider adding prandial insulin coverage 3
• If blood glucose remains elevated despite reaching maximum doses or after 3-6 months of optimization, consider adding prandial insulin or changing regimens 4

Common Pitfalls to Avoid

• Delaying insulin intensification when blood glucose remains significantly elevated increases risk of complications 4
• Using sliding scale insulin alone is ineffective for persistent hyperglycemia 4
• Failure to consider patient-specific factors like renal function or risk of hypoglycemia when titrating insulin 4
• Continuing ineffective doses without appropriate adjustments can lead to prolonged hyperglycemia 4

Hypoglycemia Risk

• The incidence of hypoglycemia with Novolog 70/30 is similar to that of other insulin regimens 1
• Risk of severe hypoglycemia is not increased compared to other insulin regimens 1
• Minor hypoglycemic events occur with similar frequency to other premixed insulins 1