Insulin Therapy for Type 2 Diabetes

Dosing Guidelines

The American Diabetes Association recommends starting insulin-naïve patients with type 2 diabetes on 10 units or 0.1-0.2 units/kg body weight of NovoLog 70/30 per day, divided into two equal doses, administered twice daily, 30 minutes before breakfast and dinner 1, 2
For patients transitioning from other insulin regimens, dosing should be individualized based on previous insulin requirements and blood glucose levels 1

The American Association of Clinical Endocrinologists suggests adjusting doses based on self-monitoring of blood glucose levels, targeting fasting blood glucose of 90-150 mg/dL 1
Equipping patients with an algorithm for self-titration of insulin doses based on self-monitoring of blood glucose improves glycemic control 2

People with type 2 diabetes generally require higher daily doses (≥1 unit/kg) than those with type 1 diabetes 1
For patients at higher risk of hypoglycemia (older patients >65 years, those with renal failure, and those with poor oral intake), consider using lower starting doses 3
The Endocrine Society recommends that when adding NovoLog 70/30 to patients already on oral antidiabetic agents, metformin therapy should typically be maintained while other oral agents may be discontinued to avoid unnecessarily complex regimens 2

If glycemic targets are not achieved with twice-daily NovoLog 70/30, consider advancing to thrice-daily premixed insulin or switching to a basal-bolus regimen for more flexible glucose control 1

The European Association for the Study of Diabetes advises against using premixed insulin in patients with unpredictable eating patterns or those requiring more precise insulin dosing 3
Comprehensive education regarding self-monitoring of blood glucose, diet, and the avoidance and treatment of hypoglycemia is critically important for any patient using insulin 2