Basal-bolus ratios

[DeusXM]

Just was having a think today. Compared to my bolus intake, my basal insulin is pretty low. I'm on 22u of Lantus once a day - any more and I tend to either drop overnight or between meals. Meanwhile, my actual bolus requirements are a lot higher. I don't carb count in any meaningful sense but lunch can be anything from 8-15u Novorapid, evening meals 10-17u, and breakfast is usually from 3-6u. So some days I'll be having over 30u of Novorapid a day, in comparison with the 22u Lantus.

So far it's working for me, so is there any reason for me to be concerned about the discrepancy between the two?

[sofaraway]

I was thinking about this too, except I'm the other way around I use 15-16 units of lantus, and my bolus total is normally around 6-10 units of novorapid.

I've heard that Total daily should be 50% basal 50% bolus.

[xMenace]

Just was having a think today. Compared to my bolus intake, my basal insulin is pretty low. I'm on 22u of Lantus once a day - any more and I tend to either drop overnight or between meals. Meanwhile, my actual bolus requirements are a lot higher. I don't carb count in any meaningful sense but lunch can be anything from 8-15u Novorapid, evening meals 10-17u, and breakfast is usually from 3-6u. So some days I'll be having over 30u of Novorapid a day, in comparison with the 22u Lantus.

So far it's working for me, so is there any reason for me to be concerned about the discrepancy between the two?


Nope. i've been like this my whole career.

It's my belief that there is a class of male like us - athletic, ripped, good looking, sexy, etc -- that need much higher boluses.

I've been pondering my own patterns for some time, and so far I have no explanation. I am forming a theory though. Morning Madness - Those Darn Phenomenons! Complied by Barb Chafe (http://www.insulin-pumpers.ca/darnphenomenons.html) says

The Break-Fast Phenomenon
A common occurrence is a steep incline in blood sugars following the first meal
of the day. This phenomenon persists at all meals eaten after a stretch of
fasting; this can mean an early breakfast, a midday brunch, or supper following
a Yom Kippur fast. Many people find that they cannot properly deal with the
sudden ingestion of carbohydrates if the regular insulin dose is administered.

One would have to experiment with higher insulin-to-carb ratios at the first
meal eaten every day. Or, if the high blood sugars appear only after a high
carb meal is eaten, then the amount of carbohydrates in your breakfast may need
to be reduced. (See our "Breakfast Smarts" article below for more breakfast
tips.)



--------------------------------------------------------------------------------

The Motor Start Phenomenon
An interesting trend that some people experience has been informally dubbed the
"Motor Start Phenomenon". This is when blood sugars spike sharply following
breakfast, no matter how many or how few carbs are consumed. This phenomenon
tends to be inconsistent, surfacing and then disappearing in the same
individual. Its causes are unclear, but it may be stress and hormone related.
It differs from the dawn phenomenon in that it appears only after food is
eaten. Many people also find that it does not kick in when they sleep in longer
than usual, maybe because they are more relaxed on those days.

To test for the "Motor Start" Phenomenon: Go to sleep and wake up at your usual
time, but skip breakfast. Test consistently to get a fasting morning BG
profile. On another typical day, eat a protein-only breakfast and test BGs
constantly. On a third morning, eat a lower carb breakfast and record your
blood glucose readings. Finally, eat a high carbohydrate breakfast and log your
blood sugars. If you are experiencing the Motor Start phenomenon, you will
likely have high blood sugars on all mornings that you ate any food, except on
the day you fasted.

The best method we have found for dealing with this blood sugar rise is to
administer an extra fixed amount of insulin, usually about 1.5 to 2 units, upon
awakening or before eating breakfast. (It may be necessary to take this insulin
some time before eating to give the insulin a chance to begin working before
breakfast is eaten.) Just remember that as soon as your body's tendency
changes, this extra insulin must be eliminated. Otherwise, it can cause serious
low blood sugars.

I suspect our body releases sugars whenever we eat foods. You and I release more than normal with very little fasting required. I have a strong survival instinct, I faint easily, and I have extremely good reflexes (I routinely take out the teenagers in Halo despite my ancientness), and I have a very strong DP. I think my liver follows this mold.

[xMenace]

I was thinking about this too, except I'm the other way around I use 15-16 units of lantus, and my bolus total is normally around 6-10 units of novorapid.

I've heard that Total daily should be 50% basal 50% bolus.

These are numbers derived by statisticians. They have zero medical basis.

[duck]

These are numbers derived by statisticians. They have zero medical basis.

I completely agree...I don't want to be rude, but everytime this comes up my brain literally asks "Who gives a ****?" I am open to input, but why would anyone care or try to limit their TDD to what their basal is, or base their TDD on their basal?

:confused:

[belyro]

I take 5u of basal a day and usually about 24u of bolus. That's nowhere near 50/50, but it works for me.

[tanyatype1]

[QUOTE=xMenace;222777]

It's my belief that there is a class of male like us - athletic, ripped, good looking, sexy, etc -- that need much higher boluses.

:hahaha: That's funny!

[Gangrel]

[QUOTE=xMenace;222777]

It's my belief that there is a class of male like us - athletic, ripped, good looking, sexy, etc -- that need much higher boluses.

:hahaha: That's funny!


You know, for many years i've been looking for someone with the same problems, and now I have finally found men with the same, dreaded, curse as myself! I can finally belong!!!!!

PS: I'm typing this with my ab muscles.........


Oh, and to actually say something usefull, I'm on 35u a day of basal, and i average about 28u of bolus according to my metre.

[shabbie6247]

I was thinking about this too, except I'm the other way around I use 15-16 units of lantus, and my bolus total is normally around 6-10 units of novorapid.

I've heard that Total daily should be 50% basal 50% bolus.

my copy of using insulin says that basal dosage should be between 45% to 65% of your total daily dosage.

mine is more like 30% ??!!

[SueM]

16 basal for me and 23 bolus. I don't don't normally need as much but have an infection so dosage increased for a few days.

[grace girl]

I think it's another one of those areas where they are trying to put everyone into a box, and it just doesn't work. If you're basals are set correctly, and you're not really using bolus to compensate all the time, then what does it really matter?

I personally think that good, reliable control is the goal, not to fit properly into someone's percentage box.

[xMenace]

[QUOTE=tanyatype1;222808]

PS: I'm typing this with my ab muscles.........


Ya, well I'm typing this with ... Oh Beth, get your mind out of the gutter! ... my fingers.

[belyro]

[QUOTE=Gangrel;222814]

Ya, well I'm typing this with ... Oh Beth, get your mind out of the gutter! ... my fingers.

Um...are you dragging *me* into this???

[jen_slc]

I think your doses are fine, Deus. Although we all know the recommendations are that it be as close to 50/50, that's not going to happen. It's just a guide. The whole idea is just to make sure you're not on too little basal and overcompensating with bolus and vice versa. And since you'd go low or high with any increases or decreases in your basal, I think you're set. You're sitting at about 42/58, which is pretty **** close anyway!

[rzrbks]

grace girl

I think it's another one of those areas where they are trying to put everyone into a box, and it just doesn't work.

Agreed! There is nothing more revolting than an Anal-Retentive with math training.

Deus, as long as you and your Dr. are happy with A1c and general health, Why be concerned?

:::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::


It's my belief that there is a class of male like us - athletic, ripped, good looking, sexy, etc -- that need much higher boluses.

I truly feel your pain. :rofl:

[lilituc]

my copy of using insulin says that basal dosage should be between 45% to 65% of your total daily dosage.

mine is more like 30% ??!!

Mine is usually between 30% and 35%. I attribute that to LADA.

[rzrbks]

I forgot to add,

18u of Lantus

1:15 ratio for everything except breakfast.

Breakfast is 9u of Novolog/NovoRapid: lunch depends on what I'm eating 2u+: supper is normally 4-10u and then I might have another 2-10u worth during the day.

and while I'm not bragging (much) worst A1c has been 5.9(once) all others have been 5.1--5.4

[Gary_W]

These days, I'm on 18 units of Lantus in one go before bed. Typical bolus doses are 10 for breakfast, 7 for lunch and around 10 for evening meal. So I'm on a 40% basal dose vs 60% bolus.

My carb ratio starts the day at around 1:5, and ends the day at 1:10. I typically eat around 200g of carbs per day (give or take).

I used to have my ratio around the other way (35 units of Lantus a day to around 20 units of Novorapid per day). Since doing the ratio this way round I feel 100% better, have lost over 30lbs in weight and have an HBA1c I can be fairly proud of.

Whilst I think the 50/50 thing is not right for a lot of people, it pointed out to me that I may have a problem so for that reason I'm really glad of this particular statistic being published. As such, I feel it is useful if you can use it to look at yourself honestly and ask 'you're wrong according to the statistic, now do you have a problem?'. My answer to that was yes, so it helped. I still disobey the stats but now I'm keeping well so I'll happily ignore them :D

Gary

[Tyler]

I don't think it really matters. The percentages are just rough guidelines.

It's heavily dependent on diet as well. If you eat lower carb, you're going to have lower bolus needs and the same basal needs, obviously the values will differ greatly.

The higher carbs come up, the close the two get until really high intakes in which the bolus will surpass the basal.

[BlueSky]

I take 12 units of Lantus, which is 41% of the TDD of 29 units. Interestingly, switching to reduced carb eating resulted in a big reduction in the basal dose and relatively small reductions in bolus amounts. Seems counterintuitive. But then I have heard it said that reducing carb consumption increases carb sensitivity. Maybe it highlights the fact that insulin isn't only used for metabolising carb.

[txrdr75765]

Sofar, That's what I read, too. My basal is 22 and bolus total around 25.
ric

[ant hill]

I don't know my ratio is but i have over a 24H pierod is 114U Baseal and 90U Bolus. So as for the ratio is concerned i think it's 5/8:1 bolus : basal
I'm one for maths. :(

[June91]

Quote from similar thread, http://www.diabetesforums.com/forum/pumping-insulin/18646-basal-bolus-ratio.html:

I have been wondering about that 50/50 rule. I believe it's a remnant from the "old days" of rigid insulin regimens. Why would you wnat to limit your carb intake or God forbid, increase it to match whatever your basal is? Both basal requirements and bolus ratios depend on so many factors.

If your basal is correct, I don't see why there should be any kind of rule on the amount of carbs you eat daily, and therefore any restrictions on your bolus amount.

[shabbie6247]

Mine is usually between 30% and 35%. I attribute that to LADA.

you could be right lilituc, something to do with honeymooning perhaps?

[Geoff]

My ratio is 70 basal 30 bolus, and my av bs is 5.5mmol/lt (99) But I have another weird effect, since I swapped from Lantus to Levemir I need no rapid insulin with breakfast. My pre-breakfast reading is always around 5.5-5.8mmol/lt, I eat 40g of carbs, and two hrs later my bs is no higher than 6.5mmol/lt. Anyone have any ideas on what is going on here? This only happens with breakfast no matter what I eat.

[xMenace]

My guess is you are one of those people who's BGs actually go up in the night. I assume you don't hypo then.

[Geoff]

Hi xMenace, I have not been near a hypo during the night since I have been using levemir. But If my bg goes up during the night what is happening by the time I take my pre-breakfast reading at around 7.:00am when my bg is in the normal range 5.6-5.8mmol/lt?

[klpants]

Ditto I'm on 17 Lantus (split) and about 7-8 units humalog depending on activity and food amount. Deus, wouldn't worry about the dosage as long as it works for you! Everyone has different physiology so will require different dosage, the 50/50 rule is just a guide after all...

[rzrbks]

klpants

Deus, wouldn't worry about the dosage as long as it works for you!

Please keep in mind that Deus supplements his insulin with Vast, say rather, Huge and Copiuous amounts of liquids which help lower his B/G.

(Sorry Deus, I just pass up the chance to poke at you.)

Listen mate, as said before, if your A1c and other indicators are in the good range why go finding trouble that isn't there?

[xMenace]

Hi xMenace, I have not been near a hypo during the night since I have been using levemir. But If my bg goes up during the night what is happening by the time I take my pre-breakfast reading at around 7.:00am when my bg is in the normal range 5.6-5.8mmol/lt?

Think of it in relation to your daytime basals. Your Levemir matches your nightime needs but is too much for your daytime needs. It could be a timing issue too,

Check out the last images: http://www.diabetesselfmanagement.com/pdfs/pdf_2161.pdf I'm a Curly.

I think maybe pictures might help too. The first is my profile. I took my hourly doses and applied a pattern for Humalog to them. My testing shows I'm 80-90% accurate. The second is a pattern I've seen on the web or in literature, but I can't tell you where (it is right off the top of my head, so don't take it as being in any way a valid pattern). All I really care is it doesn't apply to me ;) As you can see, the potential is high for low sugars during the day. This is where one needs to somehow determine how the levemir (http://www.medsafe.govt.nz/profs/datasheet/l/Levemirinj.htm) is working and match it to your needs. It is so much easier to do with a pump.

[rzrbks]

xMenace

I think maybe pictures might help too

Ross Perot would love you.

( sorry, just couldn't help it.)

[Geoff]

Thanks for the info xMenace, I see where your are going with this, but I must study it more to see if it helps me with my particular quirk.