Starting Premixed Analog Insulin

(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:
At Breakfast	Before Dinner	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.
At Dinner	Before Bed	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.
Before Breakfast	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

When Premixed Insulin is Taken:

When to Test Blood Sugar:

If the Blood Sugar Results Are:
Then You Should:

At Breakfast

Before Dinner

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.

At Dinner

Before Bed

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.

Before Breakfast

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

Starting Premixed Analog Insulin

How to Start Premixed Insulin

Become a Member