From the Guidelines
When switching from Lantus Solostar 15 units nightly to Novolin 70/30, the patient should start with 70% of their total daily dose as the morning dose of Novolin 70/30, which would be approximately 10.5 units, given the different pharmacokinetic profiles of these insulins 1. The recommended approach is based on the most recent guidelines for simplifying complex insulin therapy, which suggest using 70% of the total dose as basal only in the morning when switching from basal or prandial insulins to premixed insulin 1. Given that Lantus is a long-acting basal insulin and Novolin 70/30 is a premixed insulin, the dosing strategy needs to account for the different action profiles of these insulins. Key considerations include:
- The patient's current dose of Lantus Solostar is 15 units nightly, which needs to be adjusted for the switch to Novolin 70/30.
- The morning dose of Novolin 70/30 should be approximately 70% of the total daily dose, with the remainder given in the evening, typically before dinner.
- Blood glucose monitoring should be intensified during the transition period to guide dose adjustments, aiming for a fasting glucose goal of 90–150 mg/dL (5.0–8.3 mmol/L) 1.
- Adjustments to the dose should follow the guidelines, increasing the dose by 2 units if 50% of the fasting fingerstick glucose values are over the goal, and decreasing the dose by 2 units if more than 2 fasting fingerstick values per week are below 80 mg/dL (4.4 mmol/L) 1.
From the Research
Switching from Lantus Solostar to Novolin 70-30
When switching from Lantus Solostar (insulin glargine) to Novolin 70-30, several factors need to be considered:
- Dose adjustment: The dose of Novolin 70-30 may need to be adjusted to achieve the same level of glycemic control as Lantus Solostar. Studies have shown that insulin glargine can provide a smoother time-action profile compared to NPH insulin 2, 3.
- Pharmacokinetic profile: NPH insulin has a peak insulin activity 4-6 hours after administration, which can increase the risk of nocturnal hypoglycemia 2. In contrast, insulin glargine has a longer duration of action (up to 24 hours) and a smoother time-action profile.
- Glycemic control: Studies have shown that insulin glargine can improve glycemic control and reduce the frequency of hypoglycemic events compared to NPH insulin 3, 4, 5, 6.
- Administration schedule: Novolin 70-30 is typically administered twice daily, whereas Lantus Solostar is administered once daily. The administration schedule may need to be adjusted to accommodate the different pharmacokinetic profiles of the two insulins.
Key Considerations
- The patient's current dose of Lantus Solostar (15 units nightly) may need to be adjusted when switching to Novolin 70-30.
- The patient's glycemic control and hypoglycemic events should be closely monitored after switching to Novolin 70-30.
- The administration schedule of Novolin 70-30 may need to be adjusted to achieve optimal glycemic control.
- The patient's overall insulin regimen, including mealtime insulin and other medications, should be reviewed and adjusted as needed to ensure optimal glycemic control.