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Is 22 units dosage of Lantus once daily sufficient for a type 1 diabetic?

William Lee Dubois
Endocrinology Diabetes & Metabolism
If you are a Type-1 Diabetic and just take Lantus, you will likely die, or at least be very, very ill. T-1 is an autoimmune disease where the body turns on the beta cells, mistaking them for an infection, and wipes them out. T-1s have no native insulin in our bodies and to survive we must import all the insulin we need from outside. Like folks living on rocky islands, we depend on the supply ships.

There are a number of different kinds of insulin in the world, and a number of different delivery devices too. Lantus, the one you asked about, is what we call a basal insulin. Think of it like a time-release medication. It is designed to provide for over-night and between meal coverage for our bodies; but it’s not up to the task of helping us with the huge rush of sugar that comes with any meal.

For this we need fast-acting insulin. T-1s use a therapy called MDI, for Multiple Daily Injection (or insulin pumps, which are a high tech way of accomplishing the same thing). You might get away with just one Lantus shot. Some folks need two. But you will still need fast acting insulin before every meal.

As to how much insulin you need, just like cars, your mileage may vary. No two people are the same. In general, smaller frame lighter people need less, while heavy people need more. There is no maximum amount of insulin. You take what you need to take to get the job done.

For what it’s worth, the starting point for calculating total insulin needs for T-1s is 0.55 units per kilo of body weight. About half that dose would be basal and half fast-acting. So reverse engineering your 22 units and converting kilos back to pounds I get that 22 units of Lantus would be the typical amount of basal insulin that a 180 pound Type-1 would need. But that same person would still need another 22 units of fast-acting spread out throughout the day.

But please be alert to the fact that this formula is only a starting point. Some of us are more insulin sensitive and some of us are more insulin resistant. Some Type-2s are so resistant to insulin that we have them use a special super-sized insulin called U-500 that is five times stronger than the typical insulin used here in the states.

Lantus was originally designed to be dosed once daily.  It releases steadily over a 24-hour period.  As resistance develops, more insulin is required and is broken into more injections each day. The severity of diabetes varies from person to person. Your body may still make some insulin, or more insulin than the next person. Also, your response to the insulin may be better than someone whose diabetes is more advanced. If diabetes is left uncontrolled, insulin resistance can develop. If you have kept your A1C and daily blood sugar numbers well-controlled, your body has a better opportunity to respond to your medication.

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