How can overlapping of Novolog (insulin aspart protamine/insulin aspart) 70/30 and Lantus (insulin glargine) be prevented?

Preventing Overlapping of Novolog 70/30 and Lantus

To prevent overlapping of Novolog 70/30 and Lantus, administer Lantus in the morning and Novolog 70/30 at breakfast and dinner, maintaining a consistent schedule and monitoring blood glucose levels closely. 1, 2

Understanding the Insulin Types

• Novolog 70/30 is a premixed insulin containing 70% insulin aspart protamine (intermediate-acting) and 30% insulin aspart (rapid-acting), providing both basal and prandial coverage 3
• Lantus (insulin glargine) is a long-acting basal insulin with a relatively constant release profile over 24 hours with no pronounced peak 4
• Using both insulins simultaneously creates risk of insulin stacking and hypoglycemia due to overlapping basal insulin components 1

Recommended Administration Schedule

• Change the timing of Lantus from bedtime to morning to minimize overlap with the intermediate-acting component of Novolog 70/30 3, 5
• Administer Novolog 70/30 before breakfast and dinner (typically 2/3 of daily dose before breakfast and 1/3 before dinner) 3, 1
• Maintain consistent timing between doses - ideally administer Lantus at least 12 hours apart from Novolog 70/30 evening dose 1, 2

Dose Adjustment Strategies

• When transitioning between insulin regimens, maintain the same total daily dose initially but adjust the distribution 1, 2
• For patients on Novolog 70/30 twice daily, use 70% of the total daily dose as Lantus in the morning 3, 1
• Titrate Lantus dose based on fasting glucose values over 1 week 3
• If fasting glucose values are consistently above target, increase Lantus by 2 units 3
• If experiencing hypoglycemia (glucose <80 mg/dL), decrease Lantus dose by 2 units 3

Monitoring Recommendations

• Check blood glucose more frequently during the transition period, focusing on both fasting and postprandial levels 3, 1
• Target fasting glucose values between 90-150 mg/dL 3
• Monitor for nocturnal hypoglycemia, which is less common with morning Lantus administration compared to evening dosing 5
• Use a simplified sliding scale temporarily during transition if needed 3

Common Pitfalls to Avoid

• Never administer Lantus at the same time as Novolog 70/30 1, 6
• Avoid using rapid-acting insulin at bedtime to prevent nocturnal hypoglycemia 3
• Don't convert insulin doses on a 1:1 basis without adjusting distribution between morning and evening doses 1, 2
• Never mix Lantus with any other insulin in the same syringe 6
• Don't neglect the importance of consistent meal timing, which is particularly critical with premixed insulin regimens 1, 6

Special Considerations

• For elderly patients or those at higher risk of hypoglycemia, consider using lower starting doses when transitioning 3, 6
• If wide glucose excursions are observed, consider simplifying the insulin regimen further 3
• For patients with cognitive or functional decline, a simpler regimen with fewer daily injections may be preferred 3