#1746 Defining Diabetes: Insulin Concentration
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Scott and Jenny define "Insulin Concentration" in this Defining Diabetes episode.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner (0:0) Hello, friends, and welcome back to another episode of the Juice Box podcast. (0:14) Managing diabetes is difficult, but trying to do it when you don't understand the lingo, that's almost impossible. (0:21) The defining diabetes series began in 2019, and today we're adding to it. (0:26) 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. (0:36) If your loved one is newly diagnosed with type one diabetes and you're seeking a clear practical perspective, check out the Bold Beginnings series on the Juice Box podcast.
Scott Benner (0:45) It's hosted by myself and Jenny Smith, an experienced diabetes educator with over thirty five years of personal insight into type one. (0:53) Our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. (0:59) You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one. (1:06) You can start your journey informed and empowered with the Juice Box podcast. (1:10) The bold beginning series and all of the collections in the Juice Box podcast are available in your audio app and at juiceboxpodcast.com in the menu.
Scott Benner (1:19) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (1:23) Always consult a physician before making any changes to your health care plan. (1:29) Jenny, we are doing some new defining diabetes topics. (1:34) Hey. (1:35) And I have one here.
Scott Benner (1:37) I'm gonna start today with something that I just wanna say outright. (1:41) I don't understand. (1:42) And even if you don't feel comfortable defining it, like, you let me know.
Jenny Smith (1:46) Okay.
Scott Benner (1:46) But I have insulin concentration, like, u 200 insulin, diluted insulin. (1:53) 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?
Jenny Smith (2:03) I think so.
Scott Benner (2:04) Okay.
Jenny Smith (2:04) I mean, if if in general, understand the concentration of anything at a 100%.
Scott Benner (2:13) Mhmm.
Jenny Smith (2:13) Right? (2:14) This is the normal amount of something that you get in the set one hundred percent dose. (2:20) Okay? (2:21) That's our normal and eons old u one hundred insulin. (2:27) That's what we use today.
Jenny Smith (2:29) Right? (2:29) So any of your NovoLog, even our insulin, NovoLog, Humalog, Apidra, they're all unit for unit. (2:38) 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. (2:48) A unit gives you a unit of effect.
Scott Benner (2:51) Okay.
Jenny Smith (2:52) 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
Scott Benner (3:16) Okay.
Jenny Smith (3:16) Almost more. (3:17) Does that make sense?
Scott Benner (3:18) It does.
Jenny Smith (3:18) Right? (3:19) 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.
Scott Benner (3:40) Okay.
Jenny Smith (3:40) We dilute insulin. (3:41) Let's say you have, you know, a whole unit of insulin, but you can't deliver point one units with an insulin syringe. (3:52) You could do it with a pump, but you can't do it with an insulin syringe. (3:56) So we actually mix of the diluent, which you can get from the insulin companies. (4:02) Mhmm.
Jenny Smith (4:03) And you would mix that in a certain volume ratio along with the actual u one hundred insulin.
Scott Benner (4:13) So that you can get the impact that you desire and amount
Jenny Smith (4:16) A dose you can draw up.
Scott Benner (4:17) A dose that you can actually measure and draw up.
Jenny Smith (4:19) Yes.
Scott Benner (4:20) Okay.
Jenny Smith (4:20) Correct.
Scott Benner (4:21) So u one hundred insulin is a hundred units of insulin per milliliter. (4:26) Is that right?
Jenny Smith (4:27) Your bottles of insulin, like vials, I think, are the easiest to describe. (4:31) A vial of insulin and we measure I mean, the majority of people call insulin units. (4:37) Right? (4:37) We take a unit of insulin for whatever effect. (4:41) The whole entire vial of insulin has one thousand units of insulin.
Scott Benner (4:46) Okay. (4:47) So it's a 10 vial? (4:49) Got it. (4:50) Okay. (4:51) There's a thousand units of insulin in the vial.
Jenny Smith (4:53) Yes.
Scott Benner (4:55) Okay. (4:55) And the reason someone might want you two hundred 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?
Jenny Smith (5:10) It's more of an under the skin absorptive issue. (5:13) For some people, yes. (5:14) And, again, it would be entirely used off label if you're using it in a pump with u 200. (5:19) U 200 means that one unit of volume Mhmm. (5:23) Is providing two units of effect.
Scott Benner (5:27) Okay.
Jenny Smith (5:28) Right?
Scott Benner (5:28) Yep.
Jenny Smith (5:29) When you put it in a pump, we have to, again, off label. (5:33) This is not directions for people to do it.
Scott Benner (5:35) Yes. (5:35) Nothing. (5:36) You here on the Juice Box podcast should be considered advice, medical or otherwise. (5:39) Always consult a physician before making any changes to your health care plan. (5:42) There you go, Jenny.
Scott Benner (5:42) Keep going.
Jenny Smith (5:42) Thank you, Scott. (5:43) You're welcome. (5:44) You would have to essentially adjust all of your doses. (5:48) Right? (5:48) Mhmm.
Jenny Smith (5:48) Your basal dose, your insulin to carb ratio, your correction factor. (5:52) They would all all have to be dose adjusted because now you're getting two units of effect in one volume unit.
Scott Benner (6:02) Okay. (6:03) Well, that's
Jenny Smith (6:04) Okay.
Scott Benner (6:04) How did you do that so simply? (6:06) I haven't understood this for years. (6:07) I actually understand now. (6:08) Thank you.
Jenny Smith (6:09) Yes. (6:10) Well and then there's even one even more concentrated. (6:13) It's u five hundred.
Scott Benner (6:14) 500.
Jenny Smith (6:15) Yes. (6:16) So what would that mean?
Scott Benner (6:18) Oh oh gosh. (6:20) Now I said I understood it. (6:21) Now you're testing me. (6:22) It's okay.
Jenny Smith (6:23) Use the u two hundred. (6:25) It's essentially the same thing, just even more concentrated.
Scott Benner (6:28) Yeah. (6:28) So one unit of liquid now has the impact of five units of insulin.
Jenny Smith (6:34) Correct. (6:34) U five hundred. (6:35) Five hundred is a really interest I mean, it's it's action that way that the insulin goes in, gets distributed, and decays. (6:44) It is very different, and you really would need to work with a provider who is very knowledgeable in u five hundred dosing Mhmm. (6:53) Because it's even more different than using u two hundred.
Scott Benner (6:56) You just, I think covered the the only real follow-up question I had, which is why do why is u 100 the standard? (7:04) Like, why you know mean? (7:05) Like, is but the way
Jenny Smith (7:06) That's a good question. (7:07) 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 nineteen twenties, and they're like, hey. (7:17) We solved this problem.
Scott Benner (7:18) This seems to work. (7:19) Good luck, everybody.
Jenny Smith (7:20) To work. (7:21) Yeah.
Scott Benner (7:22) Well, I mean, my expectation is based on what you said. (7:25) Now, obviously, I'm making this up, but what jumped in my mind was if the u 500 works differently, then that means the u 200 works differently. (7:33) Maybe at u 100, 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.
Jenny Smith (7:45) I could be wrong. (7:46) The math of it. (7:47) Right? (7:47) One equals one helps. (7:49) Yeah.
Jenny Smith (7:49) 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.
Scott Benner (8:00) Yeah.
Jenny Smith (8:00) Right?
Scott Benner (8:01) Yeah. (8:01) That makes sense.
Jenny Smith (8:02) There's a lot more math to diluting or using more concentrated insulin, and you really have to pay attention 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.
Scott Benner (8:18) 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. (8:24) Do they let the families dilute it eventually?
Jenny Smith (8:28) You can. (8:28) Yeah. (8:29) Sometimes, pharmacy will do the diluting for you, but each of the pump each of the, insulin companies has a dilutant, essentially to be able to utilize. (8:38) This is not diluting with saline. (8:41) This is not what you end up doing, and there are very defined directions to diluting the insulin.
Scott Benner (8:47) Can't get it from Amazon, you're telling me?
Jenny Smith (8:49) No. (8:49) Please don't.
Scott Benner (8:52) What about do people dilute basal insulins, or does that not end up being a need?
Jenny Smith (8:56) You know, that is not something that I've ever heard done. (9:00) Now, again, I me being the end of not as many people as there are with diabetes and insulin using, Maybe somebody has done that. (9:10) I've it's mostly rapid acting insulins that you would dilute. (9:14) I've never heard of a basal diluting.
Scott Benner (9:16) Okay. (9:17) Did we cover this? (9:18) I feel like we did.
Jenny Smith (9:19) Yeah. (9:19) As a baseline direction? (9:21) Yes. (9:22) Yeah. (9:22) Could we have a much more in-depth discussion?
Jenny Smith (9:24) A 100% we could. (9:26) It's just a defining. (9:27) It's just a defining. (9:27) I
Scott Benner (9:28) wanna say, I'd like to give you a lot of credit. (9:31) As we started talking, I asked my overlord to, explain you two hundred insulin for dummies to me, and I didn't need to look at it. (9:40) So thank you. (9:40) You did a really good job making it Great. (9:42) Making it accessible to me.
Jenny Smith (9:44) Did I sound like the dummy explanation was there?
Scott Benner (9:46) I don't know about that, but this dummy understood you. (9:49) So I think we did a good job.
Jenny Smith (9:50) Good. (9:50) Thank you. (9:51) Yay. (9:52) Sure.
Scott Benner (9:58) Okay. (9:59) Well, here we are at the end of the episode. (10:00) You're still with me? (10:01) Thank you. (10:02) I really do appreciate that.
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