Novolog Mix 70/30 Dosing
For insulin-naïve patients with type 2 diabetes, start Novolog Mix 70/30 at 10 units or 0.1-0.2 units/kg body weight per day, divided into two equal doses administered twice daily, 30 minutes before breakfast and dinner. 1
Starting Dose Framework
The recommended initial dose is 10 units or 0.1-0.2 units/kg body weight per day, split into two equal doses given before breakfast and dinner. 2, 1
Patients with type 2 diabetes commonly require ≥1 unit/kg/day or higher once titrated to goal, which is substantially higher than type 1 diabetes requirements. 1
For patients with a history of hypoglycemia, use lower starting doses (closer to 0.1 units/kg/day or even less) as these patients face substantially higher hypoglycemia risk and require more conservative titration. 1
Timing of Administration
Administer Novolog Mix 70/30 within 0-5 minutes before meals (breakfast and dinner for twice-daily dosing). 3, 4
Postprandial injection (15-20 minutes after meal onset) may be an acceptable alternative for some elderly patients, though it results in slightly higher postprandial glucose excursions compared to preprandial dosing. 4
Dose Titration Strategy
Adjust doses every 2 weeks based on self-monitoring of blood glucose, targeting fasting blood glucose of 90-150 mg/dL. 2, 1
If ≥50% of fasting values exceed goal over 2 weeks, increase dose by 2 units. 5, 1
If >2 fasting values per week are <80 mg/dL, decrease dose by 2 units. 5, 1
Critical Dosing Thresholds
When basal insulin exceeds 0.5 units/kg/day and glycemic goals are not met, consider combination injectable therapy or regimen intensification rather than continuing to escalate premixed insulin alone. 1, 3
If prandial insulin component is >10 units per dose, consider decreasing dose by 50% and adding a non-insulin agent (such as GLP-1 receptor agonist or SGLT-2 inhibitor) to reduce hypoglycemia risk. 5
Medication Management During Initiation
Maintain metformin when starting or intensifying Novolog Mix 70/30. 2, 1, 3
Discontinue sulfonylureas and DPP-4 inhibitors to avoid unnecessarily complex regimens and reduce hypoglycemia risk. 2, 1, 3
Common Pitfalls to Avoid
Do not use premixed insulin in patients with unpredictable eating patterns or those requiring more precise insulin dosing, as the fixed 70/30 ratio limits flexibility. 1
Do not continue escalating Novolog Mix 70/30 indefinitely if HbA1c remains above target—this represents therapeutic inertia and increases hypoglycemia risk without proportional benefit. 1
Avoid using rapid-acting insulin at bedtime in older adults. 5
For premeal glucose >250 mg/dL, consider adding 2 units of rapid-acting insulin as a simplified sliding scale; for >350 mg/dL, give 4 units. 5
Special Population Considerations
In older adults (≥65 years), use more conservative glycemic goals (90-150 mg/dL fasting) and lower starting doses to minimize hypoglycemia risk. 5, 1
For older adults on premixed insulin who need simplification, use 70% of the total daily dose as basal insulin only in the morning and discontinue the prandial component. 5