(Using Humalog Mix 75/25%® or Novolog Mix 70/30%® | For Patients Who Are Not On Basal Insulin)
How to Start Premixed Insulin
The first dose should be 10% of the patient’s weight in pounds (i.e. 220 lbs = 22 units) taken once daily at the largest meal.
When Premixed Insulin is Taken:
When to Test Blood Sugar:
If the Blood Sugar Results Are: Then You Should:
Under 80 Subtract 2 units every 3-5 days until blood sugar is 80 – 130 before dinner.
80 – 130 Do not adjust.
Over 130 Add 2 units every 3-5 days until blood sugar is 80 – 130 before dinner.
80 – 130 Eat a small snack
130 – 180 For most people on premixed insulin, this is a good blood sugar goal to have in order to avoid hypoglycemia during the night.
Under 80 Subtract 2 units every 3–5 days until blood sugar is 80 – 130 before breakfast
80 – 130 Do not adjust dose
Over 130 Add 2 units every 3–5 days until blood sugar is 80 – 130 before breakfast
If blood sugar is under 70, drink 1/2 cup of juice or soda or eat something that contains sugar. You can also take glucose tablets to bring your blood sugar into normal range. Let your physician/care team know that you had low blood sugar.
These recommendations are derived from expert opinion and are based on the review of the following literature:
i Inzucchi, et al. Management of Hyperglycaemia in Type 2 Diabetes: A Patient-Centered Approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-79
ii Nathan, et al. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy. Diabetes Care. 2006; 8: 1963-1972
iii Davidson, M. Raskin, P. Tanenberg, R. Vlajnic, A. Hollander, P. A Stepwise Approach to Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Basal Insulin Treatment Failure. Endocrine Practice. 2011; 17: 395-403
iv Pearson, J. and Powers, M. Systematically Initiating Insulin: The Staged Diabetes Management Approach. The Diabetes Educator. 2006. 32: 19S-28S.
v Bergenstal, et al. Adjust to Target in Type 2 Diabetes. Diabetes Care. 2008. 31(7) 1305-1310.
vi Hirsch, I. Bergenstal, R. Parkin, C. Wright, E. Buse, J. A Real-World Approach to Insulin Therapy in Primary Care Practice. Clinical Diabetes. 2005. 23(2): 78-86
vii A Step-Wise Approach — Indications and Usage. FlexPen®, NovoLog®, and Levemir®. Novo Nordisk. 2011