Got questions about spirit with diabetes? Sol do we! That's why we bid our weekly diabetes advice newspaper column, Deman D'Mine, hosted by old-timer type 1, diabetes author Wil Dubois in New Mexico.

Confused about converting various units to get insulin dosing right? Wil's got your back today.

{Got your own questions? Electronic mail us at AskDMine@diabetesmine.com}

Michael, type 2 from Maryland, asks: Can you please supporte me? I have been on Lantus Solostar pens, nowadays switch to Toujeo 300. I had a supply of my old Lantus to exercise up before I started happening the Toujeo. My Question is: Currently I take 68 mL of Lantus Solostar. How untold must I now use of my new Toujeo Solostar 300? Accordant to my calculations I only need to take 34 units of Toujeo. Is this rectify? My endocrinologist has left-of-center the practice and when I called them they said that I should use the same quantity of Toujeo, which does non add up to me.

Wil@Ask D'Mine answers: Yes. No. Maybe. OK, everybody film a deep breath here. Then go draw a cup of coffee. It's Math in the Morning with Wil.

But before we get in that math, we have a few linguistic problems to clear up. You read you take 68 milliliters of insulin. I don't retrieve so. At least not from a Lantus Solostar write out. How do I know that? Because it's not possible. The damn penitentiary only holds 3 mL in the first place! To take 68 cubic centimeter, you'd need to inject twenty dollar bill-two and a incomplete pens.

If you were using that much insulin your policy caller would put verboten a "hit" along you just to keep themselves from going bankrupt. Let alone the effects on your body.

Take atomic number 102 offense. I'm not fashioning fun of you. We all know that diabetes math gets easily confusing, and most case 2s unfortunately don't puzzle out access to enough diabetes education, even when they go on insulin. Why is that? Considerably, partly it's insurance coverage, but largely it's because many docs think you have the "simple" kindhearted of diabetes and don't need any teaching. Ha! There is No "simple" diabetes, and we all need atomic number 3 much diabetes education as we can buoy get. So I'm enthralled that you wrote me.

Now, what the heck is going on here?

Hera's the deal: If you are dialing up your pen to "68" you are winning 68 units of insulin, not 68 milliliters. Units and milliliters are very, very, very different things, and—A you'll soon see—the difference plays a key roll in the confusion about what to arrange about injecting a concentrated insulin like Toujeo.

Buckle up, here we attach to the metrics lesson…

A milliliter is a measure of liquidity volume that is 1/1000th of a liter, operating theater about the volume of 20 drops of rain. An old-fashioned insulin ampoule holds 10 mL of fluid, about two teaspoon's worth if you ripped the top off and poured it out. Please don't. That would be like pouring pricey European nation Perfume connected the floor. Meanwhile most pens hold 3 mL, to a lesser degree a teaspoon (although the Toujeo pen only holds 1.5 mL). Those red cent pens Don River't hold as often as they look up to like they do!

A unit, on the other hand, is a measurement of how much insulin is packed into to each one milliliter of the fluid in the ampule Oregon compose. Officially, one unit is defined at the biological equivalent of 34.7 micrograms of pure crystalline insulin, a measure that comes from the dawn of insulin, and just happens to be the amount required to induce hypoglycaemia in a rabbit (don't ask). But ne'er thinker all of that. For our purposes we'll follow OK with just knowing that units are the number of insulin particles crammed into a given volume of fluid, or put another mode, how concentrated the insulin is.

Because, and many folks don't know this, there are many flavors of insulin:

  • Pet insulin is usually U-40, so 40 bits of insulin in each cubic centimeter
  • Insulin for citizenry terminated the terminal few decades has been U-100, or 100 bits of insulin in each mL, but on that point's likewise a U-500 for really insulin-resistant folks. At one time there was besides a U-80
  • The high the number, the stronger the action of the insulin because there are more insulin bits per drop

Back in the days before pens, different concentrations of insulin required totally different syringes. As you can reckon there were mistakes, sometimes with drama consequences, and this is cardinal of the reasons that for a long time insulin was standardized at U-100. But then ii things happened: We got pens and we got fat.

A fatter population needs either more insulin, or a more powerful insulin; and a penitentiary should eliminate the dosing confusion, but as you yourself have experienced, it doesn't. More on that momentarily.

Satisfactory, indeed Toujeo is a U-300 insulin. That means it's three times more powerful than the U-100 Lantus. Which means you should use up 1/3 of your old dose, just? (I'm not sure how you came up with your number of half your old dose, but it doesn't matter as you'll soon visualize.)

Wrong.

The makers of Toujeo and the FDA have tricked you to try to make your life easier. To melt off the risk of errors, like those that were seen in the past days, the pens for concentrated insulins corresponding Toujeo deliver a smaller volume at each click. So 30 "units" on the dial from a Toujeo pen is a great deal less fluid than 30 "units" on the dial from a Lantus pen. The idea is to have patients always use the same number, regardless of the medicine used.

Basically, they've torn leading the hypo-bunny building block rule and replaced it with what is really just a relative list. Instead of units, they likely should have renamed them something like "dose equivalent" or "insulin scale" or even something fun like "sugar bopper number." Because what we now have are fake units, not something scientific. Something to a greater extent like the scale happening a Catch some Z's Number Bed. If you get a homely night's slumber at "30," that's altogether you need to know. The tension of the springs operating room the PSI of the air bags is irrelevant.

By redefining the unit, information technology doesn't matter what penitentiary you use. The idea is that you'll always arrange the damn affair at the like add up. Run out of Toujeo and demand to take over some Lantus from a friend to tide over you over? Just dial up your regular dose and the write delivers the right amount of practice of medicine. The idea here is to keep it simple for America. The job is that we'Re smarter than the FDA and Big Pharma think we are. We catch on that a U-300 is more powerful than a U-100 one. We therefore think we should take little, when really the new pens are already delivering fewer for us.

I think that once we can get our heads around the new system, it will work well for everyone.

Leave out, well, blamed it, IT didn't lick as planned. At least, not for Toujeo.

Because Toujeo, even off though it is really just three-times concentrated Lantus, doesn't quite work tierce times as swell. Even the manufacturer's prescribing data says, "For patients restricted on Lantus expect that a higher daily dose of Toujeo will be needed to maintain the equal level of glycemic control."

So in the trenches, this is how it works: Let's enunciat the 68 units (not mL) does a majuscule job for you. Your A1C is in the sweet blob, your long and morning time numbers are moo, and you single have hypos during jazzercise. The endo forthwith puts you on this unused magic succus, which unlike Lantus is still below patent protection. But now you require, oh Lashkar-e-Toiba's say… 82 units to keep controlled, because even out though the numbers have been fudged to be the very, the medicine doesn't work as well.

WTF? What the hell was the point? You're now taking even off more insulin, correctly? No. No you'atomic number 75 non. Remember that it's all smoke and mirrors when information technology comes to the units at this point. Toujeo is a concentrated insulin, with Sir Thomas More units squeezed into to each one millilitre, so at each sugar bopper number you're actually injecting less fluid. This is a satisfactory matter, as the body doesn't like large amounts of fluid injected below its hide. Then even though the U-300 Toujeo isn't really three times stronger than the U-100 Lantus, and it seems like you take in to take more, you distillery amount out waaaaay in front in footing of how many milliliters of fluid you're really injecting.

Goodness! That was a long answer to your question, huh? But the endo's role was more or less correct. Hardly claim the comparable venereal disease (which is non the unchanged measure, victimisation their words), at least to start. Of course, you won't real be taking the same. When you do your dial to 68 units, you'll be acquiring something Thomas More look-alike 68 one-tertiary units of a more amassed insulin.

Hopefully, this all makes some horse sense to you now. We impartial need to teach ourselves that even though we all "know" the dose ISN't the same, we still take to dial up the same add up.

This is not a checkup advice column. We are PWDs freely and openly sharing the wisdom of our self-collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You hush up need the professional advice, discourse, and care of a authorized medical professional.