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July 29, 2019

Daily Care, Insulin

Question from New York:

I’m a 24-year-old male in great shape, 5’9” and about 150 pounds. I’ve been able to manage my type 1 diabetes without mealtime insulin (excellent blood sugars and never high ketones, so I don’t want to hear the speech about how this is dangerous. I’ve researched it and I monitor my blood sugar and other tests, such as ketones, frequently) by going on a beef, eggs, water, and Himalayan pink salt diet. However, I still need to use Lantus (generally about 4 to 8 units) to cover gluconeogenesis, glycolysis, and other endogenous or hepatic glucose production. Is this what Lantus is generally used for, to cover hepatic and endogenous glucose release only? I’ve read conflicting things that some doctors and people believe that Lantus is supposed to lower blood sugar but from my studies I’ve concluded that it has little to do with food or lowering blood sugar, rather aims to keep it stable aligning with your hepatic endogenous glucose production. An in-depth explanation of basal insulin would be much appreciated.


From: George Grunberger, MD, FACP, MACE

Briefly, a human being needs about 50% of insulin to cover “basal” needs; i.e., to be able to live, walk, talk, breathe, simply to exist; the other half comes from the need to cover meals. In a person who does not make his/her own insulin, these need to come from the outside: basal insulin (i.e., Levemir, Lantus, Basaglar, Tresiba, etc.) indeed suppresses the endogenous (mostly hepatic) glucose production while prandial insulin (i.e. Humalog, Novolog, Fiasp, Apidra, etc.) covers the mealtime glucose excursions.


Editor's Comments:

You may wish to discuss this in more detail with your own endocrinologist. You may also benefit from Basal Insulin: The Foundation of Good Control by Gary Scheiner, a CDE who has had type 1 for many years.