Defining Diabetes: Lantus Low

Summary

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Juicebox Podcast: Type 1 Diabetes - "Defining Diabetes: Lantus Low"

Host: Scott Benner
Guest: Jenny Smith
Date: January 24, 2026

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Episode Overview

In this episode of the Juicebox Podcast’s “Defining Diabetes” series, host Scott Benner and recurring guest Jenny Smith provide a practical, no-nonsense breakdown of insulin concentration terminology with a focus on U100, U200, and diluted insulin. Their aim is to demystify commonly misunderstood lingo around insulin dosing so listeners–new and experienced–can better manage type 1 diabetes and make informed decisions in partnership with their healthcare providers.

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Key Discussion Points & Insights

1. Understanding Insulin Concentration

[02:03 - 04:13]

• Insulin "U" Numbers:
  • U100 is the standard concentration—100 units of insulin per milliliter.
  • U200 means 200 units per milliliter; U500 means 500 units per milliliter.
• Unit Consistency:
  • For all standard insulins (Novolog, Humalog, Apidra), one unit = one effect, and dosing is straightforward.
  • Insulin vials typically contain 1,000 units in a 10 mL bottle.

2. The Purpose of Diluted Insulin

[02:51 - 04:19]

• Why Dilute?

  • Some individuals (e.g., very young children or those highly sensitive to insulin) require doses smaller than standard syringes can reliably deliver.
  • Diluting insulin allows accurate delivery of very small doses by increasing the volume while maintaining a manageable unit concentration.

  “If you dilute insulin… you make it dispersed almost more. Does that make sense? Right. And so if you dilute insulin… it gives you an easier way to dose a tiny amount in a volume that can be measured, especially in an insulin syringe.”
  — Jenny Smith [02:52]

3. Why Use More Concentrated Insulin (U200/U500)?

[04:53 - 06:02]

• Absorption & Practicality:

  • Patients needing larger daily doses may benefit from U200 or U500, reducing the volume of insulin injected or pumped–and thus improving absorption under the skin.
  • Using U200/U500 in pumps is off-label and requires careful calculation and professional oversight.

  "U200 means that one unit of volume is providing two units of effect."
  — Jenny Smith [05:26]

  "When you put it in a pump… you’d have to adjust all of your doses. Your basal dose, your insulin-to-carb ratio, your correction factor."
  — Jenny Smith [05:44]

4. Practical Example & Simple Math

[06:09 - 06:34]

• Scott demonstrates understanding:

  • U500: 1 unit of liquid acts like 5 units of insulin.

  “Yeah. So one unit of liquid now has the impact of five units of insulin.”
  — Scott Benner [06:27]

  • U500’s pharmacodynamics differ from U100 or U200; thus, dosing should be managed only by highly knowledgeable providers.

5. Why U100 is the Standard

[07:06 - 08:00]

• Simplicity and historic context:

  • U100 likely became standard due to its ease of understanding ("one equals one") and consistent action across most users.
  • Higher concentrations (U200/U500) introduce more complexity and require precise math.

  "One to one helps… that’s super easy for even basic math understanding from a kid level… you can’t really screw that up."
  — Jenny Smith [07:49]

6. Safe Diluting Practices

[08:18 - 08:49]

• Usually handled by a knowledgeable endocrinologist or trained pharmacist.

• Never dilute insulin with saline—only use manufacturer-provided diluents.

• Pharmacies may do the mixing, but some experienced families can take over under specific guidance.

  “Each of the insulin companies has a dilutant… This is not diluting with saline… very defined directions to diluting the insulin.”
  — Jenny Smith [08:26]

7. Basal Insulin Dilution?

[08:52 - 09:16]

• Diluting basal insulins is not generally done or recommended; this practice is almost exclusively for rapid-acting insulins.

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Notable Quotes & Memorable Moments

• “How did you do that so simply? I haven’t understood this for years. I actually understand now. Thank you.”
  — Scott Benner [06:02]

• “I want to say I’d like to give you a lot of credit. As we started talking, I asked my overlord to explain U200 insulin for dummies to me and I didn’t need to look at it. So thank you.”
  — Scott Benner [09:28]

• “Did I sound like the dummy explanation that was there?”
  — Jenny Smith [09:43]

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Timestamps for Key Segments

• [02:03]—Jenny begins the core explanation of insulin concentration.
• [02:51]—Diluting insulin and practical reasons.
• [04:13]—Drawing and measuring diluted doses.
• [05:10]—Why use U200 and U500: Absorption and pump considerations.
• [05:44]—Necessity for dose adjustments with concentrated insulins.
• [06:27]—Scott’s math check: U500 explained.
• [07:49]—Simplicity of U100 and the ease of "one equals one."
• [08:26]—How families/pharmacies handle diluting insulin; importance of correct diluent.
• [08:56]—On the rarity of diluting basal (long-acting) insulins.

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Episode Tone & Approach

Scott Benner and Jenny Smith maintain an approachable, reassuring, and slightly humorous tone throughout, emphasizing clarity and safety. They carefully avoid giving specific medical advice, repeatedly reminding listeners to consult qualified healthcare providers before making changes to their regimen. Jenny’s expertise and Scott’s honest questioning make complex concepts highly accessible—even to “dummies,” as Scott jokingly says.

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This episode is an excellent reference for anyone seeking to finally untangle insulin concentration terms, whether you’re new to diabetes management or just need a practical refresher.

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Transcript

[A]

Hello, friends, and welcome back 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 you or a loved one is newly diagnosed with type 1 diabetes and you're seeking a clear, practical perspective, check out the Bold Beginnings series on the Juice Box Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type 1. Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate Life with Type 1. You can start your journey informed and empowered with the Juice Box Podcast. The Bold Beginnings series and all of the collections in the Juice Box Podcast are available in your audio app [e-mail] in the menu. 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. Jenny, we are doing some new defining diabetes topics and I have one here. I'm going to start today with something that I just want to say outright I don't understand, and even if you don't feel comfortable defining it, like, you let me know, okay? But I have insulin concentration, like specifically U200 insulin, diluted insulin. Is there a way to explain it well enough so that people understand it without going in too deep and to be able to define it for them at the same time?

[B]

I think so.

[A]

Okay.

[B]

I mean, if. If in general you understand the concentration of anything at 100%, right. This is the normal amount of something that you get in the set 100% dose. Okay. That's our normal and eons old U100 insulin. That's what we use today. Right. So any of your novolog, even our insulin, Novolog, Humalog, Apidra, they're all unit for unit. You get a unit of effect in one unit of volume, meaning how much you draw up into a syringe or dial up on an insulin pen, a unit gives you a unit of effect.

[A]

Okay.

[B]

When you talk about concentration, though, and you get more into what are either again, diluted insulin, which means that you take up the volume, you would need the volume in the number of units, but it's a smaller amount of insulin, because anytime you dilute something. Right. You make it kind of like dispersed almost more. Does that make sense? Right. And so if you dilute insulin, which is very common for little Littles or people who may be super ultra sensitive to insulin, diluting insulin gives you an easier way to dose a tiny amount in a volume that can be measured, especially in an insulin syringe.

[A]

Okay.

[B]

We dilute insulin. Let's say you have a whole unit of insulin, but you can't deliver 0.1 units with an insulin syringe. You could do it with a pump, but you can't do it with an insulin syringe. So we actually mix a dilutant, which you can get from the insulin companies, and you would mix that in a certain volume ratio along with the actual U100 insulin, so that you can get.

[A]

The impact that you desire.

[B]

An amount in a dose you can draw up.

[A]

In a dose that you can actually measure and draw up.

[B]

Yes.

[A]

Okay.

[B]

Correct.

[A]

So u 100 insulin is 100 units of insulin per milliliter. Is that right?

[B]

Your bottles of insulin, like vials, I think, are the easiest to describe a vial of insulin. And we measure, I mean, the majority of people call insulin units. Right. We take a unit of insulin for whatever effect. The whole entire vial of insulin has 1,000 units of insulin.

[A]

Okay. So it's a 10 milliliter vial. Got it. Okay. There's a thousand units of insulin in the vial.

[B]

Yes.

[A]

Okay. And the reason someone might want u200 insulin is because they're using more insulin and it doesn't literally fit into the pump or it's a ton of the bolus under the skin and it becomes difficult to absorb.

[B]

It's more of an under the skin absorptive issue for some people. Yes. And again, it would be entirely used off label if you're using it in a pump with U200. U200 means that one unit of volume is providing two units of effect.

[A]

Okay. Right. Yep.

[B]

When you put it in a pump, we have to again, off label. This is not directions for people to do it.

[A]

Yes. 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. There you go, Jenny. Keep going.

[B]

Thank you, Scott.

[A]

You're welcome.

[B]

You would have to essentially adjust all of your doses. Right. Your basal dose, your insulin to carb ratio, your correction factor. They would all. All have to be dose adjusted because now you're getting two units of effect in One volume unit?

[A]

Yes. Okay. How did you do that so simply? I haven't understood this for years. I actually understand now. Thank you.

[B]

Yes, well, and then there's even one even more concentrated. It's U500.

[A]

500?

[B]

Yes. So what would that mean?

[A]

Well. Oh gosh, now I said I understood it. Now you're testing me.

[B]

Use the U200. It's essentially the same thing, just even more concentrated.

[A]

Yeah. So one unit of liquid now has the impact of five units of insulin.

[B]

Correct. And U500 is a really interesting, I mean it's, it's action that way that the insulin goes in, gets distributed and decays. It is very different. And you really would need to work with a provider to, who is very knowledgeable in U500 dosing because it's even more different than using U200.

[A]

You just, I think covered the, the only real follow up question I had, which is why do, why is U100 the standard, like why, you know what I mean? Like is. But the way.

[B]

That's a good question, honestly, I don't even know the, I mean the answer to that. I, I would expect goes way back to like what, how they formulated in the 1920s when they're like, hey, we solved this problem, this seems to work.

[A]

Good luck everybody. Yeah, well, I mean my expectation is based on what you said. Now obviously I'm making this up, but what jumped in my mind was if the U500 works differently, then that means the U200 works differently. Maybe at U100 this is the most uniformed, trackable way they could formulate it so that it was doing what they expected most throughout, you know, a greater number of people.

[B]

But I could be wrong about the math of it. Right. One equals one.

[A]

One to one helps.

[B]

Yeah, like that's super easy for even basic math understanding from a kid level and under sixth grade sort of reading one to one that you can't really screw that up. Yeah, right.

[A]

Yeah, that makes sense.

[B]

There's a lot more math to diluting or using more concentrated insulin. And you really have to pay attention and, and have somebody who's knowledgeable, who can give you the right dosing plan in the way that you're measuring insulin. Again, whether it's with a pump or with a syringe.

[A]

So when people are doing this with kids, you have to find an endo who's comfortable with it. Right. To explain to you how to dilute it. Do they let the families dilute it?

[B]

Eventually you can. Sometimes pharmacy will do the diluting for you. But Each of the insulin companies has a dilutant essentially to be able to utilize. This is not diluting with saline. It's not what you end up doing. And there are very defined directions to diluting the insulin.

[A]

Can't get it from Amazon. You're telling me.

[B]

No, please don't.

[A]

What about do people dilute basal insulins or does that not end up being a need?

[B]

You know, that is not something that I've ever heard done. Now again, me being the N of not as many people as there are with diabetes and insulin using. Maybe somebody has done that. It's mostly rapid acting insulins that you would dilute. I've never heard of a basal diluting.

[A]

Okay. Did we cover this? I feel like we did, yeah.

[B]

As a baseline direction, yes. Could we have a much more in depth discussion? 100% we could.

[A]

This is just a defining.

[B]

Just a defining.

[A]

I want to say I'd like to give you a lot of credit. As we started talking, I asked my overlord to explain U200 insulin for dummies to me and I didn't need to look at it. So thank you. You did a really good job making it, making it accessible to the.

[B]

Did I. Did I sound like the dummy explanation that was there?

[A]

I don't know about that, but this dummy understood you. So I think we did a good job.

[B]

Good.

[A]

Very good. Yay.

[B]

Sure.

[A]

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, please. Do you 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. I created the Diabetes Variables series because I know that in type 1 diabetes management, the little things aren't that little and they really add up. In this series, we'll break down everyday factors like stress, sleep, exercise, and those other variables that impact your day more than you might think. Jenny Smith and I are going to get straight to the point with practical advice that you can trust. So check out the Diabetes Variable series in your podcast player or at juiceboxpodcast. Com. Have a podcast? Want it to sound fantastic? Wrongwayrecording. Com.