What is the maximum amount I can increase my 70/30 (Novolin or Humulin) insulin dose by?

Maximum Dose Increase for 70/30 Insulin

Increase your 70/30 insulin by 2 units when 50% or more of your fasting blood glucose values exceed your target goal of 90-150 mg/dL over a one-week period. 1

Standard Titration Protocol

The American Diabetes Association provides clear guidance for adjusting premixed 70/30 insulin:

• Assess fasting glucose values over 1 week to determine if adjustment is needed 2, 1
• Increase by 2 units if ≥50% of fasting fingerstick values are above goal (90-150 mg/dL) 2, 1
• Decrease by 2 units if >2 fasting values per week are <80 mg/dL to prevent hypoglycemia 2, 1
• Reassess every 2 weeks and repeat the adjustment process based on glucose patterns 1, 3

Critical Safety Thresholds

When your total daily dose of 70/30 insulin exceeds 0.5 units/kg/day, you should consider switching to a different insulin regimen rather than continuing to escalate the dose. 3 This threshold represents a point where:

• Further dose increases carry substantially higher hypoglycemia risk without proportional benefit 3
• Alternative strategies (adding other medications or switching to basal-bolus insulin) become more appropriate 3
• The fixed ratio of 70/30 may no longer provide optimal glucose control 3

Practical Dosing Context

For patients with type 2 diabetes on 70/30 insulin:

• Total daily requirements commonly reach ≥1 unit/kg/day or higher, which is substantially more than type 1 diabetes requirements 3
• Each dose adjustment should be 2 units - not more, not less - to maintain safety while achieving glycemic targets 2, 1
• Never adjust more frequently than weekly to allow adequate time to assess the effect of the change 2, 1

When to Stop Escalating and Consider Alternatives

Do not continue indefinitely increasing your 70/30 dose if your A1C remains above target. 3 This represents therapeutic inertia and increases complications. Instead, consider:

• Adding an SGLT-2 inhibitor or GLP-1 receptor agonist to improve control while reducing insulin requirements 3
• Transitioning to basal insulin plus GLP-1 receptor agonist, which provides potent glucose-lowering with less weight gain and hypoglycemia 3
• Converting to basal-bolus regimen for patients needing more precise dosing control 3

Common Pitfalls to Avoid

• Never increase by more than 2 units at a time - larger adjustments increase hypoglycemia risk without evidence of benefit 2, 1
• Do not adjust based on a single glucose reading - you need patterns over at least one week 2, 1
• Avoid skipping meals when on 70/30 insulin, as the fixed insulin action profile requires consistent meal timing to prevent hypoglycemia 1
• Always carry quick-acting carbohydrates as physical activity may cause hypoglycemia depending on timing 1

Hypoglycemia Management

If hypoglycemia occurs:

• Determine the cause (missed meal, increased activity, incorrect dose) 1
• If no clear reason exists, lower the corresponding dose by 10-20% immediately 1
• Reassess your overall regimen if hypoglycemia becomes recurrent 1