Management of Premixed Insulin Regimens

Initiation and Dosing

The American College of Physicians recommends initiating insulin-naïve patients with 10 units or 0.1-0.2 units/kg of body weight of Novolin 70/30, typically divided into two daily doses 1
Administer Novolin 70/30 twice daily, 30 minutes before breakfast and dinner, as recommended by the American Diabetes Association 2, 3

Adjust doses based on self-monitoring of blood glucose levels, with a target fasting blood glucose of 90-150 mg/dL for most patients, as recommended by the American Association of Clinical Endocrinologists 1, 4, 5
If 50% of fasting fingerstick glucose values are over target, increase dose by 2 units, as suggested by the American Diabetes Association 4
If more than 2 fasting fingerstick values per week are below target, decrease dose by 2 units, as recommended by the American Association of Clinical Endocrinologists 4, 5

Monitor for hypoglycemia, which is the most common adverse effect of insulin therapy, as warned by the American College of Physicians 1, 2
Do not use rapid-acting insulin at bedtime to avoid nocturnal hypoglycemia, as advised by the American Diabetes Association 4, 5
Evaluate glycemic control every 2 weeks and adjust therapy as needed, as recommended by the American Association of Clinical Endocrinologists 5

If glycemic targets are not achieved with Novolin 70/30 twice daily, consider advancing to thrice-daily premixed insulin or switching to a basal-bolus regimen, as suggested by the American Diabetes Association 2, 6
Adding a GLP-1 receptor agonist to basal insulin may be considered for patients not achieving targets, as recommended by the American Association of Clinical Endocrinologists 6

Premixed insulins like Novolin 70/30 offer less flexibility in dose adjustment compared to separate basal and bolus insulins, as noted by the American College of Physicians 2
The fixed ratio (70/30) may not be optimal for all patients, particularly those with varying insulin requirements throughout the day, as warned by the American Diabetes Association 1, 2

The American Diabetes Association recommends checking blood glucose at least 4 times per day, before breakfast, before dinner, at bedtime, and when suspecting low blood sugar, for individuals taking 70/30 insulin 7
Checking blood glucose before breakfast, before dinner, and at bedtime is crucial to assess overnight glucose control, evaluate daytime glucose control, and prevent nocturnal hypoglycemia, respectively, for individuals taking 70/30 insulin 7, 8
Testing blood glucose when suspecting low blood sugar is essential for individuals taking premixed insulins like 70/30, which carry a significant hypoglycemia risk 7

The American Diabetes Association recommends testing blood glucose after treating low blood sugar until glucose normalizes, for individuals taking 70/30 insulin 7
Testing blood glucose before exercise is necessary to prevent exercise-induced hypoglycemia, for individuals taking 70/30 insulin 7
Testing blood glucose before critical tasks like driving is necessary to ensure safety, for individuals taking 70/30 insulin 7

The American Diabetes Association recommends a fasting glucose goal of 90-130 mg/dL for individuals taking 70/30 insulin 9
The American Diabetes Association recommends a peak postprandial glucose target of <180 mg/dL for individuals taking 70/30 insulin 9

The American Diabetes Association emphasizes the importance of never skipping bedtime testing to prevent nocturnal hypoglycemia, particularly common with 70/30 insulin due to the NPH component's overnight action 7
Testing blood glucose more frequently than 4 times daily is recommended during dose adjustments or regimen changes, or when experiencing frequent hypoglycemia or unstable glucose control, for individuals taking 70/30 insulin 7, 8