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

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

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.

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.

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]

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.

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.

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.