yeah i was having issues finding things too, this was the only thing i found. Hope this helps/gets you on the right track.
Intensifying Premix Regimens
One of the most informative studies about the intensification of a premixed regimen is the 1-2-3 Study S Study ( Figure 2).[24] Patients began with a single daily injection of BIAsp 30 and if after 16 weeks HbA1c was not at the target level of 6.5%, a second injection of 6 U was added before breakfast and the dose titrated based on predinner glycemia. Within the next 16 weeks, HbA1c goal attainment of 7.0% increased from 41% to 70% of patients. Interestingly, this is a very similar target achievement rate to that reported in the ACTION trial[47] (described above). For patients still not achieving glycemic goals on 2 daily injections of the premix analogue in the 1-2-3 Study,[24] a third injection was started before lunch at a very low dose of 3 U and titrated based on postlunch blood glucose. This led to an increase in the percentage of patients (from 70% to 77%) achieving HbA1c levels <7.0%. In a more complete analysis, the final goal achievement rate was 88%a very high rate considering that only 1 type of insulin was being used.
In my experience 2 injections of a premix may not reach glycemic targets, either because of the dose limitations of pen devices (60 U) or because of hypoglycemia. In the former case, 16 U of BIAsp 30 can be added at lunchtime and titrated based on predinner glucose values. In the latter case, both doses of insulin are decreased by 10% and the amount subtracted is added back in at lunchtime. Again, titration is based on predinner glucose values. In a personal retrospective analysis of 12 patients in my practice, HbA1c decreased from 8.4% to 7.2%, hypoglycemia abated, and weight decreased by 2.2 lb (0.99 kg).[49]
Initiating and Intensifying Insulin Therapy in Type 2 Diabetes Mellitus
Joseph Tibaldi, MD
The American Journal of Medicine - Volume 121, Issue 6 Suppl (June 2008)
