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June 6, 2006

Insulin

Question from Wichita, Kansas, USA:

My daughter is on a lot of insulin, 40 units of Lantus and approximately 13 to 17 units of fast-acting insulin. What are the long-term effects of using that much insulin? Is it dangerous?

Answer:

Please be aware that I am talking a bit tongue-in-cheek here, trying to lighten the day:

Frankly, I am still somewhat surprised when someone asks about the “dangers” of insulin, as if it were some artificial, alien science. It’s insulin! You make it; you’re supposed to. The LACK of insulin, as in your daughter with type 1 diabetes, is what is dangerous! Indeed, not taking insulin will lead to an ugly death through diabetic ketoacidosis (DKA).

True, Lantus (and now every other insulin available in the U.S., except Human Regular) is produced biosynthetically and does not look exactly like Mother Nature’s insulin.

So, as to the dangers:

Unopposed insulin, without calories or without balance with meal and exercise planning will lead to hypoglycemia. But, you knew that already.

Is 40 units a lot of insulin? Maybe. But, you need what you need, as long as you are balancing meals and exercise. You did not indicate your daughter’s weight and you did not indicate the type of the other insulin that she takes at meals (accounting for the 13 to 17 units, but I presume that is either Regular or Humalog or NovoLog.) In very broad terms, people typically require about one-half to one and a half units of insulin for every kilogram that they weigh. This is a rough estimate as some require more and some less, depending on how long they’ve had diabetes, other medications, pubertal status, other health issues, and AGAIN, how well they genuinely and accurately follow a meal and exercise plan. Indeed, the Lantus dose typically provides 40 to 60% of a total daily insulin need.

So, if your daughter weighs 100 pounds (45.5 kg), then I’d say she is on more insulin than I would expect. I would look for things that might make her more resistant to the effects of insulin, but I would really suspect other issues related to meal planning, etc.

But, if her A1c values are satisfactory, then I would not pursue matters too vigorously.

I will point out that in some laboratory animal studies sometime back, there were concerns of whether Lantus might be harmful in young animals (such as rats). This is part of the reason why Lantus is not yet FDA-approved for use in children under age six years, but many clinicians do, in fact, prescribe it.

DS