#1755 Defining Diabetes: Lantus Lows

Summary

Juicebox Podcast: Type 1 Diabetes

Episode #1755 – Defining Diabetes: Lantus Lows

Date: January 31, 2026
Host: Scott Benner
Guest: Jenny
Theme: Understanding the term “Lantus Low” and how long-acting basal insulin (specifically Lantus) can sometimes cause low blood sugar.

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Episode Overview

This episode of the ongoing "Defining Diabetes" series tackles the community-submitted term “Lantus Low.” Host Scott Benner and diabetes educator Jenny examine what people mean when they use this phrase, dig into the mechanics of how Lantus (a long-acting basal insulin) can sometimes cause hypoglycemia, and discuss strategies for avoiding these lows. The conversation includes real-world anecdotes, physiological explanations, and practical tips for identifying and handling potential Lantus-related lows.

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Key Discussion Points & Insights

1. What Does "Lantus Low" Mean?

• [01:37] Scott: “This is one of the things people want defined. So what do they mean? Are they talking about like their blood sugars just keep getting dragged down by basal?”
• [01:46] Jenny: Suggests that a "Lantus low" happens when Lantus (basal insulin) brings blood sugar down lower than intended, especially in the absence of bolus insulin or recent food intake.

Key Points:

• Lantus is a 24-hour, long-acting insulin, dosed usually once daily.
• Unlike intermediate insulins, Lantus has a flatter effect, reducing extreme peaks and drops.
• However, some users report blood sugar “lows” seemingly due solely to Lantus, particularly overnight.

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2. Evaluation of Basal Insulin and Lantus-Related Lows

• [02:16] Jenny: “Usually we would do basal evaluation to note whether the dose is right or not by looking at overnight... If it's pulling your blood sugar down… the dose would need to be adjusted because the basal's job isn’t to pull you down.”

Key Points:

• Basal evaluation typically occurs overnight, as other variables (food, activity, rapid-acting insulin) are minimal.
• If blood sugar falls overnight, this points to a possible “Lantus low”—i.e., an excessive basal dose.
• Basal insulin should hold blood sugar steady, not lower it beyond necessity.

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3. Individual Variability of Lantus Effect

• [03:33] Jenny: “For me, Lantus was my transition to a long acting basal coming off of that cloudy intermediate. And for me, I can say that had I not adjusted it and also always had a nighttime snack, I would have been consistently low during the overnight time.”

Key Points:

• The “plateau” of Lantus can differ by person.
• Some experience a stronger Lantus effect at certain times, or find that the insulin does not last the full 24 hours, running out sooner (about 20 hours for some).
• Individual factors like activity, food, and hormonal cycles (for women) affect Lantus’s impact.

[03:33] Jenny: “Is there a peaking time? Not like the intermediate insulins, but there could be a time period where it seems to really work heavier.”

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4. Contextual Factors That Can Lead to Lantus Lows

• [04:42] Scott: Offers a scenario: a person with a sedentary weekday job but high weekend activity, using the same Lantus dose every day, may encounter lows on their more active days.
• [05:01] Jenny: Notes menstrual cycle influences basal needs: “I had a dose for the time period after my period started and up until kind of mid cycle... Then I had a dose for that week before that was three units higher.”

Key Points:

• Activity and hormonal changes can lead to increased sensitivity and greater risk of basal-induced lows.
• Adjusting the dose for different life situations (e.g., exercise, menstrual cycle) is a practical strategy.

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5. Advice on Identifying and Avoiding Basal Lows

• [05:34] Scott: Encourages listeners, when encountering overnight lows, not to immediately blame Lantus but to “zoom out a little more and see the other things that are affecting them.”
• [05:57] Jenny: Agrees, highlighting that many variables beyond just basal insulin could contribute to lows.

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Notable Quotes & Memorable Moments

• [01:46] Jenny: “You can’t… Lantus being a long acting insulin, it’s dosed typically once a day. It’s supposed to be a 24-hour acting insulin.”
• [02:16] Jenny: “The basal’s job isn’t to pull you down.”
• [03:33] Jenny: “I would have been consistently low during the overnight time.”
• [04:42] Scott: “It would be easy for somebody to say my basal insulin is pulling me down, instead of thinking my activity is making me lower.”
• [05:34] Scott: “I would probably try to ask those people to maybe zoom out a little more and see the other things that are affecting them.”
• [05:57] Jenny: “You might find the variables that are creating [the low] are at hand.”

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Timeline of Important Segments

| Timestamp | Topic/Content | |-----------|--------------| | 01:37 | Initial definition and question: What is a "Lantus low"? | | 02:16 | Basal evaluation and how to diagnose a Lantus-induced low | | 03:14 | Variability in Lantus effects and anecdotal experiences | | 04:42 | Impact of activity and routines on basal insulin needs | | 05:01 | Hormonal impacts, especially for women (cycle-related dose adjustments) | | 05:34 | Encouragement to broaden perspective beyond just blaming basal insulin |

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Tone and Takeaways

The episode is conversational, supportive, and practical—reassuring listeners that “Lantus lows” can be nuanced and are rarely attributable to just one factor. Both Scott and Jenny advocate for individualized management, ongoing self-evaluation, and an open-minded approach to troubleshooting.

Final message: Understanding the real causes of overnight or unexplained lows with Lantus is less about blaming the insulin and more about seeing the bigger picture—including dose timing, lifestyle, hormonal shifts, and activity patterns. Awareness and small adjustments can go a long way in staying safe and achieving steady blood sugars.

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For more definitions: Check out the full "Defining Diabetes" series at juiceboxpodcast.com.

Transcript

[A]

Welcome back, friends, to another episode of the Juice Box Podcast. Managing diabetes is difficult, but trying to do it when you don't understand the lingo, that's almost impossible. The Defining Diabetes series began in 2019 and today we're adding to it. Go to juiceboxpodcast.com up in the menu, click on Defining Diabetes and you'll see a complete list of all the terms that we've defined so far. If this is your first time listening to the Juice Box Podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all, look for the Juice Box Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management? Go to juiceboxpodcast.com up in the menu and look for Bold Beginnings, the Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. While you're listening, please remember that nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Jenny is the term Lantus low a common thing that you hear?

[B]

Lantus low, Lantis low?

[A]

This is one of the things people want defined. So what do they mean? Are they talking about like their blood sugars just kept getting keep getting dragged down by basal?

[B]

That's what I would expect would be the definition because you can't, you know, Lantus being a long acting insulin, it's dosed typically once a day. It's supposed to be a 24 hour acting insulin. Of the previous types of intermediate acting insulins, Lantus was huge because it had a much more plateaued effect for 24 hours compared to the cloudy intermediates which had a peak and a drop.

[A]

Right.

[B]

But a Lantus low I would expect could come from two places. Usually we would do basal evaluation to note whether the dose is right or not by looking at overnight. Okay, so regardless of whether you dose your basal lantus in the morning or the evening, we would evaluate the overnight to determine if the dose is too heavy, if it's pulling your blood sugar down Ailantis low in an environment where there's no iob from rapid insulin or food intake or whatever, then the dose would need to be adjusted because the basal's job isn't to pull you down Right. Daytime too, if you ever skipped a meal or whatever on mdi, having basil as dialed in with Lantus or any of the Basal injectables is beneficial because sure, it could drop your blood sugar if the dose is not right, but Lantis low. That's interesting. I guess I've never heard it put together as a term.

[A]

Yeah, I haven't either. But it was brought up by enough people that it made it on the list. And I saw some examples of like, I went low overnight for my Basil. Somebody said Lantus is peaking. Does it maybe burn a little brighter sometimes or do they think it's stronger in the beginning than at the end? Maybe. Is that maybe how they're thinking of it?

[B]

Yes, in terms of it's supposed to be a plateau type of basal insulin. But again, person to person, we all know things work a little bit differently. For me, I mean, I. Lantus was my transition to a long acting basal coming off of that cloudy intermediate. And for me, I can say that had I not adjusted it and also always had a nighttime snack, I would have been consistently low during the overnight time. So is there a peaking time? Not like the intermediate insulins, but there could be a time period where it seems to really work heavier. I do know that another piece to Lantus is that While being a 24 hour acting insulin, for some people, it peters out at the very end hours. It only lasts really about 20 hours, not truly 24 hours, which isn't a low issue, but could be where you might adjust and then you end up having lows to beat the end.

[A]

I don't know. What if you had a very sedentary job and you were active on the weekends, but you shot the same amount every day? Maybe that would feel like. And I guess it would be true. Right. During the activity you'd be like, oh, the Basils. It would be easy for somebody to say my basal insulin is pulling me down, instead of thinking my activity is making me lower. Like you could see, you know what I mean? Yeah.

[B]

And for women during cycle time, I know when I was on Lantus, I had two doses. I had a dose for the time period after my period started and up until kind of mid cycle or until like that week before my next cycle was expected to start, I had a dose that in general worked as well as it could. Right. And then I had a dose for that week before that was three units higher.

[A]

Okay.

[B]

I still remember the doses because it's kind of funny how you remember those.

[A]

Things in my mind. So, okay, I guess if you're seeing somebody use this online, this is one of the things they're trying to convey. They had a low overnight they think it's basal related. I would probably try to ask those people to maybe zoom out a little more and see the other things that are affecting them. I think it's possible if you don't find yourself blaming the basal insulin, you might find the.

[B]

The variables that are creating that are at hand. Yes.

[A]

Anyway. Well, there's one I never heard before, so thanks.

[B]

Me neither. Thank you.

[A]

I don't know if we defined it, but I think we tried to figure it out. Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app. Go to YouTube and follow me. Or Instagram TikTok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't want to miss any. Please do not know about the private group. You have to join the private group. As of this recording, it has 74,000 members. They're active. Talking about diabetes. Whatever you need to know. There's a conversation happening in there right now and I'm there all the time. Tag me. I'll say hi. If you've ever heard a diabetes term and thought, okay, but what does that actually mean? You need the Defining Diabetes series from the Juice Box podcast. Defining Diabetes takes all of those phrases and terms that you don't understand and makes them clear quick and easy episodes. Find out what bolus means, basal insulin sensitivity, and all of the rest. There has to be over 60 episodes of defining Diabetes. Check it out now in your audio player or go to juiceboxpodcast.com and go up into the menu. Have a podcast. Want it to sound fantastic? Wrongwayrecording.com.