When should Novolog (insulin aspart protamine/insulin aspart) be taken when a patient is also on Lantus (insulin glargine) at bedtime?

Timing of Novolog 70/30 Administration When Used with Bedtime Lantus

Novolog 70/30 should be administered before breakfast and before dinner when a patient is also on Lantus at bedtime. 1

Understanding the Insulin Regimen Components

• Novolog 70/30 is a premixed insulin containing 70% insulin aspart protamine (intermediate-acting) and 30% insulin aspart (rapid-acting) 1
• Lantus (insulin glargine) is a long-acting basal insulin that provides relatively constant insulin levels over 24 hours 1
• This combination represents a regimen that provides both basal coverage (Lantus) and prandial/postprandial coverage (Novolog 70/30) 1

Optimal Administration Schedule

Novolog 70/30 Timing

• Administer twice daily, typically before breakfast and before dinner 1
• The premixed formulation provides both immediate postprandial coverage (from the rapid-acting component) and extended coverage between meals (from the intermediate-acting component) 1
• This twice-daily administration helps control glucose levels throughout the day and evening 1

Lantus Timing

• Administer Lantus at bedtime as prescribed 1
• Bedtime administration of Lantus helps provide consistent basal insulin coverage overnight and throughout the day 1, 2
• This timing helps minimize nocturnal hypoglycemia while maintaining fasting glucose control 2

Dosage Considerations

• The total daily insulin dose should be distributed appropriately between the premixed insulin and basal insulin 1
• When using both premixed insulin and basal insulin, careful dose adjustment is needed to avoid insulin stacking and hypoglycemia 1
• Consider reducing the Lantus dose if adding Novolog 70/30 to an existing Lantus regimen to prevent overbasalization 1

Monitoring and Adjustment

• Monitor blood glucose before meals and at bedtime to assess the effectiveness of the regimen 1
• Adjust the morning dose of Novolog 70/30 based on pre-dinner glucose readings 1
• Adjust the evening dose of Novolog 70/30 based on bedtime and fasting glucose readings 1
• Adjust the Lantus dose based on fasting glucose levels 1

Potential Pitfalls and Considerations

• Risk of hypoglycemia is increased with multiple insulin formulations, particularly during the night 1
• Overlapping insulin action times between the intermediate component of Novolog 70/30 and Lantus may increase hypoglycemia risk 1
• Fixed-ratio premixed insulins like Novolog 70/30 offer less flexibility in dose adjustment compared to basal-bolus regimens 1
• Patients must maintain consistent meal timing and carbohydrate content when using premixed insulins 1

Alternative Approaches

• If glycemic targets are not achieved with this regimen, consider transitioning to a full basal-bolus regimen with Lantus plus rapid-acting insulin at each meal 1
• For patients struggling with multiple daily injections, consider once-daily fixed-ratio combination products containing basal insulin plus a GLP-1 receptor agonist 1
• For patients with significant postprandial hyperglycemia despite premixed insulin, consider adding a GLP-1 receptor agonist or switching to a basal-bolus regimen 1

Remember that consistent timing of insulin administration is crucial for optimal glycemic control, and patients should be educated about the importance of adhering to their prescribed insulin schedule.