Can Novolog (insulin aspart) 70/30 be taken before morning and evening meals in a patient with a current medication regimen of Novolog 70/30?

Novolog 70/30 Timing: Before Morning and Evening Meals

Yes, Novolog 70/30 should be taken before morning and evening meals—specifically within 5-15 minutes before breakfast and dinner—as this premixed insulin regimen requires consistent meal timing to match its fixed insulin profile. 1

Administration Timing Requirements

Novolog 70/30 must be administered 5-15 minutes before meals (not 30 minutes like older human insulin formulations), as the rapid-acting insulin aspart component begins working within 10-20 minutes. 2, 3

Standard Dosing Schedule:

• Morning dose: 5-15 minutes before breakfast 1
• Evening dose: 5-15 minutes before dinner 1
• Critical requirement: Meals must be consumed at similar times every day 1

Essential Patient Requirements for Premixed Insulin

Patients on premixed insulin plans must adhere to strict meal timing and carbohydrate consistency to prevent dangerous hypoglycemia. 1

Non-negotiable requirements:

• Insulin doses taken at consistent times every day 1
• Meals consumed at similar times every day 1
• Do not skip meals to reduce hypoglycemia risk 1
• Eat similar amounts of carbohydrates each day to match the set insulin doses 1
• Always carry quick-acting carbohydrates as physical activity may cause low blood glucose 1

Alternative Timing: Postprandial Dosing

For elderly patients or those with unpredictable meal intake, postprandial dosing (15-20 minutes after meal onset) is an acceptable alternative, though it produces slightly higher postprandial glucose excursions. 2

• A randomized crossover study in elderly type 2 diabetes patients (≥65 years) showed postprandial Novolog Mix 70/30 dosing achieved similar overall glycemic control to preprandial dosing 2
• Mean blood glucose increment was 16.3 mg/dL higher with postprandial versus preprandial dosing (p<0.05) 2
• No increase in hypoglycemia risk with postprandial dosing (113 vs 125 episodes) 2
• This approach allows dose adjustment based on actual food consumed, improving safety in patients with variable appetite 2

Critical Safety Warnings

Premixed insulin regimens carry substantially higher hypoglycemia risk compared to basal-bolus therapy and should be avoided in hospital settings. 1, 4

High-risk situations requiring dose reduction:

• Elderly patients (>65 years) 5, 4
• Renal impairment 5, 4
• Poor or unpredictable oral intake 5, 4
• Unpredictable eating patterns 4

For these patients, use lower starting doses (0.1 units/kg/day) and consider basal-bolus regimens instead. 5, 4

When Premixed Insulin Is Inappropriate

Premixed insulin should NOT be used in patients requiring flexible dosing or those with irregular meal patterns, as the fixed 70/30 ratio cannot be adjusted independently. 4

Consider switching to basal-bolus therapy when:

• Patient has unpredictable eating patterns 4
• More precise insulin dosing control is needed 4
• A1C remains above target despite dose escalation 4
• Basal insulin component exceeds 0.5 units/kg/day 5, 4

Randomized trials demonstrate that basal-bolus therapy provides superior glycemic control with reduced hospital complications compared to premixed insulin regimens, which show significantly increased hypoglycemia rates. 1, 4

Monitoring and Dose Adjustment

Adjust doses every 2 weeks based on self-monitoring of fasting blood glucose, targeting 90-150 mg/dL. 5

Titration algorithm:

• If ≥50% of fasting values exceed goal: increase dose by 2 units 5
• If >2 fasting values/week are <80 mg/dL: decrease dose by 2 units 5

Common Pitfalls to Avoid

Never continue escalating Novolog 70/30 indefinitely if A1C remains above target—this represents therapeutic inertia and increases hypoglycemia risk without proportional benefit. 5, 4

Do not use premixed insulin in hospitalized patients—inpatient studies show unacceptably high rates of iatrogenic hypoglycemia compared to scheduled basal-bolus regimens. 1

Maintain metformin when using Novolog 70/30 (unless contraindicated), but discontinue sulfonylureas and DPP-4 inhibitors to reduce hypoglycemia risk. 5

When basal insulin requirements exceed 0.5 units/kg/day, consider adding a GLP-1 receptor agonist or converting to basal-bolus therapy rather than continuing to increase premixed insulin doses. 5, 4