What is the equivalent Lantus (insulin glargine) dose for a patient with a basal insulin need of 20 units per day using an Omnipod (U200 insulin)

Converting U200 Omnipod Basal Insulin to Lantus

For a patient requiring 20 units per day of basal insulin in an Omnipod using U200 insulin, the equivalent Lantus dose is 20 units per day—there is no conversion factor needed between U200 and U100 insulin formulations, as units remain units regardless of concentration. 1

Understanding Insulin Concentration vs. Dosing

• The concentration of insulin (U100 vs U200) affects only the volume injected, not the number of units prescribed 1
• U200 insulin contains 200 units per mL, while U100 insulin (like Lantus) contains 100 units per mL 1
• If a patient needs 20 units of basal insulin daily, they receive 20 units whether using U200 or U100 formulation 1
• The only difference is that U200 requires half the injection volume (0.1 mL for 20 units) compared to U100 (0.2 mL for 20 units) 1

Practical Conversion Approach

• Maintain the same 20 units per day when switching from U200 Omnipod to Lantus (U100) 1, 2
• Administer Lantus as a single daily subcutaneous injection at the same time each day 1, 2
• The American Diabetes Association recommends this direct unit-to-unit conversion when changing insulin formulations or delivery methods 1

Monitoring After Conversion

• Monitor fasting blood glucose daily during the first week after switching 1, 3
• Target fasting plasma glucose of 80-130 mg/dL (4.4-7.2 mmol/L) 1
• If hypoglycemia occurs without clear cause, reduce the dose by 10-20% immediately 1, 2
• Assess adequacy of the basal insulin dose at every clinical visit 1, 2

Titration Guidelines Post-Conversion

• Increase the dose by 2 units every 3 days if fasting glucose is 140-179 mg/dL 1, 3
• Increase by 4 units every 3 days if fasting glucose is ≥180 mg/dL 1, 3
• Continue titration until fasting blood glucose reaches target range without hypoglycemia 1, 3

Critical Threshold to Recognize

• When basal insulin exceeds 0.5 units/kg/day and approaches 1.0 units/kg/day, consider adding prandial insulin rather than continuing to escalate basal insulin alone 1
• Clinical signals of overbasalization include basal dose >0.5 units/kg/day, bedtime-to-morning glucose differential ≥50 mg/dL, hypoglycemia, and high glucose variability 1

Common Pitfall to Avoid

• Do not attempt to "convert" units based on concentration—this is the most dangerous error when switching between U100 and U200 insulins 1
• The patient requires the same number of units; only the volume changes 1
• Lantus should not be diluted or mixed with any other insulin or solution due to its low pH 1