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

Novolog 70/30 and Lantus in Diabetes Management

Yes, Novolog 70/30 and Lantus can be used together for diabetes management, providing comprehensive 24-hour glucose coverage with Lantus delivering consistent basal insulin and Novolog 70/30 covering mealtime and post-meal glucose excursions. 1

Rationale for Combination Therapy

• The combination of basal insulin (Lantus) and premixed insulin (Novolog 70/30) addresses both fasting and postprandial glucose control needs, which is essential for comprehensive diabetes management 1
• This approach provides better postprandial glucose control compared to basal insulin alone while allowing more flexible meal planning than using premixed insulin as the sole therapy 1
• When basal insulin has been titrated to an acceptable fasting blood glucose level but A1C remains above target, advancing to combination injectable therapy is recommended 2

Administration Protocol

• Lantus (insulin glargine) should be administered once daily at the same time each day to provide consistent 24-hour basal insulin coverage 1
• Novolog 70/30 should be administered twice daily, 30 minutes before breakfast and dinner, to provide both immediate and extended glucose control throughout the day 1, 3
• Initial dosing recommendations:
  • Lantus: Start with 10 units or 0.1-0.2 units/kg of body weight 1
  • Novolog 70/30: Start with 10 units or 0.1-0.2 units/kg of body weight per day, divided into two equal doses 1, 3

Dose Titration and Monitoring

• Dose adjustments should be based on:
  • Fasting glucose readings for Lantus 1
  • Pre-meal and post-meal glucose readings for Novolog 70/30 1
• Regular monitoring of both fasting and postprandial glucose levels is essential, with HbA1c evaluated every 2-3 months 1
• The American Association of Clinical Endocrinologists suggests increasing the Novolog 70/30 dose by 2 units every 3 days if 50% of fasting glucose readings are above target 3
• In cases of hypoglycemia, the dose should be decreased by 10-20% 3

Clinical Benefits

• Lantus provides a relatively constant basal level of circulating insulin with no pronounced peak, which helps maintain stable glucose levels throughout the day 4
• Novolog 70/30 offers improved postprandial glucose control compared with regular human insulin, with a faster onset and shorter duration of action 5
• Studies have demonstrated that insulin glargine (Lantus) reduces the risk of severe hypoglycemia by 46% and severe nocturnal hypoglycemia by 59% compared to NPH insulin 6
• Insulin aspart (the rapid-acting component in Novolog 70/30) can be administered immediately before meals rather than 30 minutes prior, offering greater convenience 5

Potential Pitfalls and Considerations

• The risk of hypoglycemia may increase when using multiple insulin formulations, requiring careful monitoring and patient education 1
• Overlapping insulin action times may occur between the protamine component of Novolog 70/30 and Lantus, potentially requiring dose adjustments to prevent hypoglycemia 1
• When initiating combination injectable therapy, metformin therapy should be maintained, while sulfonylureas and DPP-4 inhibitors are typically discontinued 2, 1
• For patients with suboptimal blood glucose control requiring large insulin doses, adjunctive use of a thiazolidinedione or an SGLT2 inhibitor may help improve control and reduce the amount of insulin needed 2

Treatment Intensification

• If glycemic targets are not achieved with the current regimen, consider:
  • Adding a third dose of Novolog 70/30 for additional meal coverage 1
  • Switching to a more intensive basal-bolus regimen with multiple daily injections of rapid-acting insulin 2, 3
  • Adding a GLP-1 receptor agonist, which has potent glucose-lowering actions with less weight gain and hypoglycemia compared to intensified insulin regimens 2, 3