From the Guidelines
Switching from Lantus to NovoMix should be done under medical supervision, with the initial dose of NovoMix calculated as approximately 60% of the total daily Lantus dose given before breakfast and 40% before dinner, and adjustments made based on blood glucose readings. When making this switch, it's essential to consider the different action profiles of these insulins, as Lantus is a long-acting basal insulin and NovoMix is a biphasic insulin that combines rapid and intermediate-acting components 1.
Key Considerations for Switching
- The total daily insulin dose on Lantus should be calculated to determine the initial dose of NovoMix.
- NovoMix is typically administered twice daily, with approximately 60% of the total daily dose given before breakfast and 40% before dinner.
- For example, if a patient was taking 30 units of Lantus daily, they might start with 18 units of NovoMix before breakfast and 12 units before dinner.
- NovoMix should be injected 10-15 minutes before meals since it contains a rapid-acting component.
- Blood glucose monitoring should be increased during the transition period, checking levels before meals and at bedtime.
Adjusting the Dosage
- The dosage of NovoMix may need adjustment based on blood glucose readings, with changes typically made in 10-15% increments every 2-3 days until target glucose levels are achieved.
- According to the 2023 standards of care in diabetes, if 50% of premeal fingerstick values over 2 weeks are above goal, the dose or add another agent should be increased, and if more than 2 premeal fingerstick values/week are below 90 mg/dL, the dose of medication should be decreased 1.
- The goal is to achieve premeal glucose levels between 90–150 mg/dL, which may be adjusted based on overall health and goals of care.
Importance of Medical Supervision
- Switching from Lantus to NovoMix requires medical supervision due to the different action profiles of these insulins and the need for individualized dose adjustments.
- Medical supervision ensures that the transition is made safely and effectively, minimizing the risk of hypoglycemia or hyperglycemia.
From the Research
Switching from Lantus to Novomix
To switch from Lantus (insulin glargine) to Novomix (biphasic insulin aspart), several factors should be considered:
- The dosage of Lantus should be evaluated, as it is typically administered once daily, whereas Novomix is administered twice daily, typically before breakfast and dinner 2.
- The patient's current glucose control and insulin regimen should be assessed to determine the appropriate starting dose of Novomix 3.
- The patient should be educated on the proper administration and timing of Novomix injections, as well as how to monitor and adjust their glucose levels 2.
Key Considerations
- Novomix has a faster onset of action compared to Lantus, which may require adjustments to the patient's meal plan and glucose monitoring schedule 4.
- The patient's risk of hypoglycemia may increase with the switch to Novomix, particularly if they are not accustomed to administering insulin twice daily 3.
- Regular follow-up appointments should be scheduled to monitor the patient's glucose control and adjust the Novomix dosage as needed 2.
Clinical Evidence
- Studies have shown that biphasic insulin aspart (Novomix) can be an effective alternative to insulin glargine (Lantus) in patients with type 2 diabetes, with improved postprandial glucose control and reduced risk of hypoglycemia 4, 3, 5.
- However, the optimal dosage and administration schedule for Novomix may vary depending on the individual patient's needs and glucose control goals 2, 6.