Management of Premixed Insulin in Type 2 Diabetes

Insulin Formulation and Initiation

Novolin 75-25 is a premixed insulin containing 75% intermediate-acting NPH insulin and 25% regular insulin, designed to provide both basal and prandial coverage 1
Initial dosing of Novolin 75-25 can be estimated based on body weight and degree of hyperglycemia, with individualized titration over days to weeks 1

The American Academy of Pediatrics recommends that all patients on Novolin 75-25 perform finger-stick blood glucose monitoring before meals and at bedtime until reasonable metabolic control is achieved 2
Twice-daily blood glucose monitoring is recommended for patients on premixed insulin like Novolin 75-25, as long as HbA1c and blood glucose concentrations remain at goal 2
More frequent monitoring should be advised during illness or if symptoms of hyperglycemia or hypoglycemia develop 2

Most patients can be taught to uptitrate their own insulin dose using algorithms that involve adding 1–2 units once or twice weekly if fasting glucose levels remain above target 3
As glycemic targets are approached, dosage adjustments should become more modest and less frequent 3
Downward adjustment is necessary if any hypoglycemia occurs 3

If fasting glucose is at target but HbA1c remains above goal after 3–6 months of insulin titration, consider adding additional prandial insulin coverage 3
Practitioners should be aware that the need for additional prandial insulin therapy becomes more likely when the daily dose exceeds 0.5 U/kg/day 4

Hypoglycemia can be reversed with administration of 15-20g of rapid-acting glucose, with blood glucose reversal confirmed after 15 minutes 5
Severe or frequent hypoglycemia is an absolute indication for modification of treatment regimens 5

Thiazolidinediones should be reduced in dose or discontinued when using insulin to avoid edema and excessive weight gain, though they may be helpful in certain individuals with severe insulin resistance 4

Proper education regarding glucose monitoring techniques, insulin injection technique, and recognition/treatment of hypoglycemia is crucial for successful insulin therapy 7