Novolog 70/30 versus aspart

[medresident]

My attending and I had a discussion about prescribing Novolog 70/30 instead of aspart. What is the difference in the effect and side effects - in terms of level blood glucose levels and risk of hypoglycemia? How would the effect of 10 units of Novolog 70/30 compare with 10 units of aspart?

Has Novolog 70/30 ever been used tid in patients who have a history of noncompliance of episodes of uncontrolled DM? Is there any literature to support this?

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[angel80]

Novalog 70/30 combines NPH (a basal insulin) and Novalog (aspart). The problem with 70/30 is that it is a fixed dose given at a fixed time of the day. It is nothing like the physiologic pattern of insulin secretion. People don't eat the exact same foods at the exact same time everyday. If a person took, the full dose of insulin and then didn't eat very much, he or she would become hypoglycemic. If a person ate more that day, there wouldn't be enough insulin on board to cover it all. Plus, with 70/30, you have no lunch coverage. It's not an ideal way to give insulin, but if a patient is not very compliant, or does not want to check sugars and give injections four times a day, it's better than nothing.

I would never use aspart alone. Aspart is a rapid acting insulin and needs to be used in combination with a basal insulin (NPH, Lantus, Levemir). The basal insulin covers for 24 hours, and then boluses of rapid acting insulin are given with meals. This is similar to how the pancreas does it. If you eat a bigger meal, you take more insulin. If you eat a smaller meal, you take less insulin. This requires more effort on the part of the patient (checking sugars at least 4 times a day, and giving 4 injections a day), but does a better job.

 

[SOUNDMAN]

well said

 

[gutonc]

About the only reason to use 70/30 these days is for horribly non-compliant patients or people without insurance since 70/30 borders on free.

Aspart is ultra-rapid acting, fast-onset, short effect. The best thing about it is that, unlike regular insulin, you can take it when you start eating (rather than 30 min before) when you're doing mealtime supplemental insulin.