The neonatogists and pediatric cardiologists decided against the use of this agent as it can not be used for prophylaxis of intraventricular hemorrhage.

Below is the package insert dosing recommendations.

·        NovoLog Mix 70/30 will be used in place of Humalog Mix 75/25 and Novolin 70/30. 

·        Humalog Mix 75/25 and NovoLog Mix 70/30 (rapid acting mixes) produce similar blood sugar control and may be therapeutically interchanged.

·        Pharmacy will automatically substitute the most cost-effective, rapid-acting biphasic mix.

·        This conversion is recommended during hospitalization only.

NovNovoLog Mix 70/30 will be used in place of Humalog Mix 75/25 and Novolin 70/30. 

·        Humalog Mix 75/25 and NovoLog Mix 70/30 (rapid acting mixes) produce similar blood sugar control and may be therapeutically interchanged.

·        Pharmacy will automatically substitute the most cost-effective, rapid-acting biphasic mix.

·        This conversion is recommended during hospitalization only.

·        Novolog (insulin aspart) will be auto-substituted for Humalog (Lispro) as the onset and duration are similar and Novolog is less expensive. 

NovNovLog Mix 70/30 (aspart protamine /aspart) will be used in place of Humalog Mix 75/25 and Novolin 70/30. 

·        Humalog Mix 75/25 and NovoLog Mix 70/30 (rapid acting mixes) produce similar blood sugar control and may be therapeutically interchanged.

·        Pharmacy will automatically substitute the most cost-effective, rapid-acting biphasic mix.

·        This conversion is recommended during hospitalization only.

• Patients using detemir at home will be asked to continue their own supply
• Physicians will be asked to use NPH twice daily or Lantus daily for patients being initiated on Detemir as
  • Detemir’s duration of action is dose dependent, doses less than 0.4 units/kg do not allow for once daily dosing (see graphic below).  Determination of the proper once daily dose requires that the patient be started on twice daily dosing with dosage titration to an effective dose. The total daily dose can then be converted to once daily. The dose response curve for once daily dosing is not flat and is not comparable to glargine, which may cause higher rates of hypoglycemia (see graphic below).
    • There is only one published study comparing detemir to glargine [Pieber 2005 Diabetologia 2005;48(suppl1):A92]

Plank  J, Diabetes Care 2005;28(5):1107-1112

• Exubera is not recommended for addition to formulary

• Patients using Exubera at home may continue to use their own supply in the hospital if they are capable of self administration.
• Patients using Exubera at home who can not self administer will be converted to an equivalent dose of regular insulin at the same dosage frequency. (see chart below)

The insulin AUC is 40% higher when three 1 mg blisters are administered.