Preventing Overlapping of Insulin Regimens

Understanding the Insulin Types

• Novolog 70/30 is a premixed insulin containing 70% insulin aspart protamine and 30% insulin aspart, providing both basal and prandial coverage 3
• Using both insulins simultaneously creates risk of insulin stacking and hypoglycemia due to overlapping basal insulin components 1

Recommended Administration Schedule

• Change the timing of Lantus from bedtime to morning to minimize overlap with the intermediate-acting component of Novolog 70/30 4
• Administer Novolog 70/30 before breakfast and dinner, typically 2/3 of daily dose before breakfast and 1/3 before dinner 5, 1
• Maintain consistent timing between doses, ideally administer Lantus at least 12 hours apart from Novolog 70/30 evening dose 1, 2

Dose Adjustment Strategies

• When transitioning between insulin regimens, maintain the same total daily dose initially but adjust the distribution 1, 2
• For patients on Novolog 70/30 twice daily, use 70% of the total daily dose as Lantus in the morning 4, 1
• Titrate Lantus dose based on fasting glucose values over 1 week 4
• If fasting glucose values are consistently above target, increase Lantus by 2 units 4
• If experiencing hypoglycemia, decrease Lantus dose by 2 units 4

Monitoring Recommendations

• Check blood glucose more frequently during the transition period, focusing on both fasting and postprandial levels 4, 1
• Target fasting glucose values between 90-150 mg/dL 4
• Use a simplified sliding scale temporarily during transition if needed 4

Common Pitfalls to Avoid

• Never administer Lantus at the same time as Novolog 70/30 1, 6
• Avoid using rapid-acting insulin at bedtime to prevent nocturnal hypoglycemia 4
• Don't convert insulin doses on a 1:1 basis without adjusting distribution between morning and evening doses 1, 2
• Never mix Lantus with any other insulin in the same syringe 6
• Don't neglect the importance of consistent meal timing, which is particularly critical with premixed insulin regimens 1, 6

Special Considerations

• For elderly patients or those at higher risk of hypoglycemia, consider using lower starting doses when transitioning 4, 6
• If wide glucose excursions are observed, consider simplifying the insulin regimen further 7, 4
• For patients with cognitive or functional decline, a simpler regimen with fewer daily injections may be preferred 7