making sense of basal/bolus ratio

[Eddy]

I've posted a few times that I question the "50/50 basal/bolus" rule... largely because it doesn't work for me. :)

Yet there does seem to be some correlation between basal and bolus amounts. I recently have had a few large lunches (estimated 200-250 grams of CHO). Bolusing is easy enough. Yet 5+ hours later, I end up needing corrections... and then tend to run higher during the night.

I don't know whether it's insulin resistance (and needing a larger basal), or if I'm simply releasing more glucose after being a glutton. It's interesting, though.

What's ironic is how steady my BG tends to be. If my numbers are good, yet I still feel stuffed: I mix a little Novolog with some N (about 1.5U of each), bolus, and check again in three hours.

That said, I tend to become sleepy and feel "ketone-clouded" (haven't checked for actual ketones, as BG is in range and I don't keep strips on hand) after such large meals. I generally avoid them; but, having had a few recently, thought I'd share my ramblings -- er, observations.

[BlueSky]

... I recently have had a few large lunches (estimated 200-250 grams of CHO). Bolusing is easy enough. Yet 5+ hours later, I end up needing corrections... and then tend to run higher during the night.

I don't know whether it's insulin resistance (and needing a larger basal), or if I'm simply releasing more glucose after being a glutton. ...
I put my money on the increased insulin resistance. Eating more carbohydrate than your body needs at the time and pumping in insulin to cover it will obviously increase insulin resistance. How else can organ and muscle cells deny entry to unwanted glucose? The problem is that the effect continues long after the meal has been digested, the stomach has emptied and the bolus insulin has run its course. If you are not eating like this at every meal and eevery day, increasing you basal won't help.

[Real4]

I recently have had a few large lunches (estimated 200-250 grams of CHO).
How does one eat 250 grams of CHO in a single meal? 250 grams of CHO is equivalent to about 12 ounces (2 oz = 42 grams) of dry spaghetti. Cooked that would easily overflow any plate I've ever seen!!!

P.S. On the basal/bolus question, I think a better explanation than usually given is that the liver stores about half of the carbohydrates it normally takes in and then gradually releases that as glucose during non-digestives hours. The 50/50 ratio is an outcome of that more than anything else.

[xMenace]

I recently have had a few large lunches (estimated 200-250 grams of CHO).

Resaurants? You have to consider at least some protein and probably at least as many calories in fats. This could easily be our Chinese/Pizza syndrome. Such meals are nearly impossible to nail perfectly.

[Eddy]

I put my money on the increased insulin resistance. Eating more carbohydrate than your body needs at the time and pumping in insulin to cover it will obviously increase insulin resistance. How else can organ and muscle cells deny entry to unwanted glucose? The problem is that the effect continues long after the meal has been digested, the stomach has emptied and the bolus insulin has run its course. If you are not eating like this at every meal and eevery day, increasing you basal won't help.


Makes sense. Levemir is short-lived enough that I could increase my overnight dose. (Of course, eating sane meals probably is a better tactic.)

It would be intriguing to see if people prone to weight gain have smaller postprandial spikes than those who seem to have no trouble keeping the weight off.


How does one eat 250 grams of CHO in a single meal? 250 grams of CHO is equivalent to about 12 ounces (2 oz = 42 grams) of dry spaghetti. Cooked that would easily overflow any plate I've ever seen!!!


Hungry before, stuffed afterwards. A quart of potato-based soup, a fair amount of pasta, a few slices of bread, another dish... it's doable. Yes, it requires well more than one plate -- not to mention an hour (sometimes a little more) to eat everything.

You should have seen my pre-DX meals. And I was still losing weight...


P.S. On the basal/bolus question, I think a better explanation than usually given is that the liver stores about half of the carbohydrates it normally takes in and then gradually releases that as glucose during non-digestives hours. The 50/50 ratio is an outcome of that more than anything else.


Hmmmm. So we high-basal people just like to stockpile, eh?

Resaurants? You have to consider at least some protein and probably at least as many calories in fats. This could easily be our Chinese/Pizza syndrome. Such meals are nearly impossible to nail perfectly.

I've heard the protein/fat theory. Never happens to me with sane-sized meals. Perhaps excess * gets converted to glucose; that's what I was trying to say by "releasing more glucose". And if high-basal people like to "stockpile", perhaps that's why I need a crazy-large meal to observe the latent upward drift...

FWIW, I actually seem to have an easier time nailing those huge meals. Large quantities of food digest more predictably, and any insulin-measurement errors are dwarfed by the total dose size. The problem is guesstimating the portion size... but spreading the release (of both glucose and insulin) over five hours instead of two makes things easier to me.

[shiftzor]

Makes sense. Levemir is short-lived enough that I could increase my overnight dose. (Of course, eating sane meals probably is a better tactic.)

It would be intriguing to see if people prone to weight gain have smaller postprandial spikes than those who seem to have no trouble keeping the weight off.

I wouldn't raise my basals to deal with a meal like that, I think your better off injecting and firefighting later, as i guess you would have done. Raising basals will only cause problems the next day as you will end up with too much insulin in your system.


Hungry before, stuffed afterwards. A quart of potato-based soup, a fair amount of pasta, a few slices of bread, another dish... it's doable. Yes, it requires well more than one plate -- not to mention an hour (sometimes a little more) to eat everything.

You should have seen my pre-DX meals. And I was still losing weight...



How can you loose weight with that kinda meal, thats impressive.


Hmmmm. So we high-basal people just like to stockpile, eh?


I prefer the term "hording". :D



I've heard the protein/fat theory. Never happens to me with sane-sized meals. Perhaps excess * gets converted to glucose; that's what I was trying to say by "releasing more glucose". And if high-basal people like to "stockpile", perhaps that's why I need a crazy-large meal to observe the latent upward drift...

FWIW, I actually seem to have an easier time nailing those huge meals. Large quantities of food digest more predictably, and any insulin-measurement errors are dwarfed by the total dose size. The problem is guesstimating the portion size... but spreading the release (of both glucose and insulin) over five hours instead of two makes things easier to me.

Fat definitely effects my carb intake giving me spikes later in the day/night. I guess if you take that many carbs, your body will have to put it some were and it can only metabolise food at a certain rate so it’s quite possible that your belly still contains food hours later, which results in a constant upward spiral. There is my non-technical explanation.:D

[Eddy]

I wouldn't raise my basals to deal with a meal like that, I think your better off injecting and firefighting later, as i guess you would have done. Raising basals will only cause problems the next day as you will end up with too much insulin in your system.


Keep in mind that NPH only lasts 5.5 hr in me, and Levemir fades noticeably around 11-13 hr.

Latent postprandial rapid+R+N mixes work great until bedtime... but then my BG creeps up about 25 mg/dL overnight. Hence my thoughts about using a little extra bedtime basal.




How can you loose weight with that kinda meal, thats impressive.


By being a raging, uncontrolled type 1 diabetic, I suppose. ;) In retrospect, I was probably doing 5000 Cal/day, and still losing weight. The amount of cheese I ate was scary.

FWIW: I no longer lose weight when I eat like that. Not even close. :eek:


Fat definitely effects my carb intake giving me spikes later in the day/night. I guess if you take that many carbs, your body will have to put it some were and it can only metabolise food at a certain rate so it’s quite possible that your belly still contains food hours later, which results in a constant upward spiral. There is my non-technical explanation.:D


Although it's constant upward, at least it's slow and controlled. :)