NovoMix 30 Dosage/Direction for Use

NovoMix 30 dosing is individual and determined in accordance with the needs of the patient. Blood glucose monitoring and insulin dose adjustments are recommended to achieve optimal glycaemic control.
In patients with type 2 diabetes, NovoMix 30 can be given as monotherapy. NovoMix 30 can also be given in combination with oral antidiabetic drugs and/or GLP-1 receptor agonists.
How to start: Insulin naive patients: For patients with type 2 diabetes, the recommended starting dose of NovoMix 30 is 6 U at breakfast and 6 U at dinner (evening meal). However, it can also be initiated once daily with 12 U at dinner (evening meal).
How to switch: When transferring a patient from biphasic human insulin to NovoMix 30, start with the same dose and regimen. Then titrate according to individual needs (see Table 1 as follows). As with all insulin products, close glucose monitoring is recommended during the transfer and in the initial weeks thereafter (see Transfer from other insulin products).
How to intensify: NovoMix 30 can be intensified from once daily to twice daily. When using NovoMix 30 once daily, it is generally recommended to move to twice daily when reaching 30 units by splitting the dose into equal breakfast and dinner doses (50:50).
From NovoMix 30 twice daily to thrice daily: the morning dose can be split into morning and lunchtime doses (thrice daily dosing).
How to adjust the dose: Adjust the dose of NovoMix 30 on the basis of the lowest pre-meal blood glucose level from the three previous days.
Always change the mealtime dose preceding the measurement.
Dose adjustment can be made once a week until target HbA_1c is reached.
The dose should not be increased if hypoglycaemia occurred within these days.
Adjustment of dosage may be necessary if patients undertake increased physical activity, change their usual diet or during concomitant illness.
The following titration guideline is recommended for dose adjustments: (See Table 1.)

Click on icon to see table/diagram/image

In patients with type 2 diabetes, a dose reduction of 20% is recommended for patients with an HbA_1c less than 8% when a GLP-1 receptor agonist is added to NovoMix 30, to minimise the risk of hypoglycaemia. For patients with an HbA_1c higher than 8% a dose reduction should be considered. Subsequently, dosage should be adjusted individually
Special populations: As with all insulin products, in special populations, glucose monitoring should be intensified and the insulin aspart dosage adjusted on an individual basis.
Elderly: NovoMix 30 can be used in elderly patients; however there is limited experience with the use of NovoMix 30 in combination with OADs in patients older than 75 years.
Renal and hepatic impairment: Renal or hepatic impairment may reduce the patient's insulin requirements.
Paediatric population: NovoMix 30 can be used in children and adolescents aged 10 years and above when premixed insulin is preferred. Limited clinical data exist for children aged 6 to 9 years (see Pharmacology: Pharmacodynamics under Actions).
No data are available for NovoMix 30 in children below 6 years of age.
Method of administration: NovoMix 30 is for subcutaneous administration only. NovoMix 30 must not be administered intravenously as it may result in severe hypoglycaemia. Intramuscular administration should be avoided. NovoMix 30 is not to be used in insulin infusion pumps.
NovoMix 30 is administered subcutaneously by injection in the thigh or in the abdominal wall. If convenient, the gluteal or deltoid region may be used. Injection sites should always be rotated within the same region in order to reduce the risk of lipodystrophy and cutaneous amyloidosis (see Precautions and Adverse Reactions). As with all insulin products, the duration of action will vary according to the dose, injection site, blood flow, temperature and level of physical activity.
NovoMix 30 has a faster onset of action than biphasic human insulin and should generally be given immediately before a meal. When necessary, NovoMix 30 can be given soon after a meal.