Usual Adult Dose for Diabetes Type 1

Individualize dose based on glucose treatment goals, metabolic needs, eating habits, and other lifestyle variables.

• Important Limitation of Premix Insulin Use: These insulins have a fixed proportion of rapid acting and long acting insulins which does not allow for basal versus prandial dose adjustments; this premix consists of 70% insulin aspart protamine (intermediate-acting insulin) and 30% insulin aspart (rapid-acting insulin).

Usual dose: Administer prescribed units subcutaneously within 15 minutes before meal initiation

• Typically dosed twice a day with each dose designed to cover 2 meals or 1 meal and 1 snack

Comments:

• Total daily insulin requirements are estimated to be between 0.5 and 1 unit/kg/day.
• Duration of action may vary according to the dose, injection site, blood flow, temperature, and level of physical activity.

Use: To improve glycemic control in patients with diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Individualize dose based on glucose treatment goals, metabolic needs, eating habits, and other lifestyle variables.

• Important Limitation of Premix Insulin Use: These insulins have a fixed proportion of rapid acting and long acting insulins which does not allow for basal versus prandial dose adjustments; this premix consists of 70% insulin aspart protamine (intermediate-acting insulin) and 30% insulin aspart (rapid-acting insulin).

Usual dose: Administer prescribed units subcutaneously within 15 minutes before or after meal initiation

• Typically dosed twice a day with each dose designed to cover 2 meals or 1 meal and 1 snack

Comments:

• Duration of action may vary according to the dose, injection site, blood flow, temperature, and level of physical activity.

Use: To improve glycemic control in patients with diabetes mellitus.

Renal Dose Adjustments

Use with caution; insulin requirements may be reduced in patients with renal impairment.

Liver Dose Adjustments

Use with caution; insulin requirements may be reduced in patients with hepatic impairment.

Dose Adjustments

Geriatric Use: Dose selection should be cautious, usually starting at the low end of the dosing range reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease, or other drug therapies.

• Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery
• Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Dosage adjustments may be required when the brand, type, or species of insulin is changed; oral antidiabetic treatment may need to be adjusted as well.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

v

Dialysis

Data not available

Other Comments

Administration advice:

• For subcutaneous administration; do not administer IV or via insulin pump
• This biphasic insulin suspension must be visually inspected and resuspended immediately before use; see preparation techniques below.
• Administer subcutaneously into the abdomen, buttocks, thigh, or upper arm within 15 minutes before a meal (type 1 diabetes) or within 15 minutes before or after initiation of a meal (type 2 diabetes).
• Rotate injection sites within same region to reduce the risk of lipodystrophy.
• Ensure patients have been educated as to proper injection technique.
• Never share an insulin pen between patients (even if the needle is changed) and do not reuse or share needles or syringes between patients when using vials as both present a risk for transmission of blood-borne pathogens.
• The prescription for NovoLog 70/30 should be written clearly in order to avoid confusion with other insulin products, for example, NovoLog or Novolin 70/30.

Preparation techniques:
Insulin Pens: Resuspension is easier when the insulin has reached room temperature

• Gently mix insulins by alternating rolling pen horizontally 10 times between palms and vertically moving pen up and down 10 times (the glass ball should move from 1 end to the cartridge to the other); continue with mixing steps until the liquid appears white and cloudy; administer immediately, if there is a delay, the insulin will need to be remixed.
• For subsequent injections, move pen up and down vertically at least 10 times until the liquid appears white and cloudy; a minimum of 12 units must be left in the cartridge to make sure the remaining insulin is evenly mixed; if there are less than 12 units left, use a new pen.
• Place disposable needle on the pen, give an air shot of 2 units before each injection.
• Dial in dose and then inject dose by pressing the push-button all the way in until the 0 lines up with the pointer; follow proper injection technique as demonstrated by health care provider.
• Consult manufacturer package labeling for additional instruction.

Insulin Vials: Resuspension is easier when the insulin has reached room temperature

• Roll the vial to resuspend suspension, do not shake; inspect suspension; it should be white and cloudy prior to administration.
• Follow proper injection technique as demonstrated by health care provider.
• Consult manufacturer package labeling for additional instruction.

Storage requirements:

• Store in-use insulin pen at room temperature for up to 14 days (up to 86F (30C); store without attached needle; keep away from excessive heat or sunlight
• Opened pens should be discarded after 14 days even if there is insulin left in them.
• In-use insulin vials may be stored at room temperature up to 86F (30C) or in the refrigerator 36F to 46F (2C to 8C); opened vials should be discarded after 28 days even if there is insulin left in them.
• Insulin pens/insulin vials not in use should be stored in the refrigerator at 36F to 46F (2C to 8C); unopened refrigerated pens/vials may be used until the expiration date printed on the label.

Monitoring:

• Blood glucose monitoring is essential for patients receiving insulin therapy.
• Glycosylated hemoglobin measurements are recommended every 3 months.

Patient advice:

• Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
• Patients must understand the necessity to resuspend insulin immediately prior to use.
• Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
• Patients should be instructed on how to handle situations which may affect their insulin requirements.
• Remind patients to check insulin labels before injection to avoid medication errors.
• Patients should check blood sugar prior to driving a car or operating machinery.
• Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.