Biphasic (Premixed) Insulin Analogue Pregnancy: Not recommended in pregnancy — separate basal and prandial insulins preferred for flexible dosing.

Biphasic Insulin Aspart

Brand names: NovoMix 30

Adult dose

Dose: Type 2 DM (starting with twice-daily premix): 6–12 units BD with morning and evening meals; adjust by 2–4 units every 3 days to achieve targets. Type 1 DM: generally avoided — basal-bolus preferred.

Route: Subcutaneous injection

Frequency: Twice daily (with meals) — can be given TDS with meals

Max: Individualised per glycaemic target

MHRA safety requirement: prescribe by brand name (NovoMix 30). Cloudy suspension — resuspend by rolling/inverting 10 times. Contains 30% rapid-acting insulin aspart + 70% intermediate-acting aspart. Onset 10–20 min, duration 14–24h.

Paediatric dose

Route: Subcutaneous injection

Frequency: Twice daily

Max: Individualised

Not routinely used in paediatric Type 1 DM — basal-bolus preferred. Seek specialist paediatric endocrinology opinion.

Dose adjustments

Renal

Monitor closely — insulin requirements may decrease. Dose reduction likely needed in moderate-severe renal impairment.

Hepatic

Hepatic failure reduces glucose production — risk of hypoglycaemia; monitor closely.

Clinical pearls

Premixed insulins reduce injection burden but offer less flexibility than basal-bolus regimens — suitable for Type 2 DM with regular meal patterns
NICE NG28: premixed analogues acceptable option in Type 2 DM when twice-daily injections preferred
Antidote for hypoglycaemia: oral glucose if conscious; IM glucagon 1mg or IV dextrose 10% if unconscious
Must be given within 15 minutes of a meal — missed meal after injection causes significant hypoglycaemia risk

Contraindications

Hypoglycaemia
Hypersensitivity to insulin aspart or protamine

Side effects

Hypoglycaemia
Weight gain
Injection site reactions
Oedema at initiation

Interactions

Beta-blockers — mask hypoglycaemia symptoms
Corticosteroids, thiazides — antagonise effect
Alcohol, ACE inhibitors — potentiate hypoglycaemia

Monitoring

Pre-meal glucose
Fasting glucose (4–7 mmol/L)
HbA1c 3 monthly
Hypoglycaemia frequency

Reference: BNFc; BNF 90; NICE NG28 (Type 2 DM); MHRA Insulin Safety Alert. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways