Basal to Bolus ratio: What's your number? And other questions (as usual)

[Gary_W]

Hello all,

According to the John Walsh books, most people's basal to bolus ratio is around 50:50. His tables go as far as showing 60% basal with 40% bolus and vice versa. He also suggests that those with higher bolus doses will be the extremely active and those on high carb diets. As the diet advice he seems to subscribe to is pretty standard (i.e 200-300g of carbs per day for most adults depending on weight) then his definition of high carbing would be very high indeed methinks.

Anyway, on MDI I was always low on the basal (once I actually understood how to use insulin but that's another story) and now I'm pumping this is even moreso the case. I finally got my software setup and it's telling me that 70% of my dose is bolus insulin with only 30% basal. I am not particularly active, I am not a child (though some who know me may disagree), I eat 220-250g of carbs per day so am not high carbing (at least by his definition).

So my question really is 'should I be concerned?'

I've basal tested extensively at night and have the right numbers plumbed in for that; I'm pretty much flat overnight.

I basal tested this AM and found a very slight rise mid-morning, so I've a minute tweak to do as far as that goes. But I'll still be like 69% bolus. I have yet to do the afternoon and evening basal tests, but I don't think I'm a million miles out. My evenings seem pretty flat (the carb bolus for my evening meal usually works out fine). Afternoons, if anything, need taking BACK a little towards late afternoon.

My only real problem so far is that I'm spiking quite badly after breakfast; on the last two days, I needed correction shots. As my morning basal is really not far out at all, it's suggesting that I need to alter my ratio in the AM for more bolus insulin still.... Lunchtime has MOSTLY been OK, but a couple of weird spikes have occured but not consitantly...

Am I just very odd or does anyone else work in this way?

Gary

[xMenace]

I do 23.4 units of basal a day. I shoot for 70 total units, but often it's in the 80's or even 100's.

[milfordj]

My ratio is very similar to yours. I eat slightly less carbs (generally, though there are certainly exceptions -- like when I go out to Macaroni Grill for supper) and now that it's summer I'm much more active than through the winter. I got my pump last December and, like you, did all my required testing for Basals, Correction Bolus, I:CR, and ISF. I too read and studied the "Pumping Insulin" bible and found my Bolus / Basal ratio no where near what he said it should be. I recently input totally different info into my pump for increased summer activity, and this dropped my Basals considerably and made the ratio even worse. I've come to my own decision that there's no real reason to have the total Bolus insulin amount be nearer to the total Basal insulin amount as long as my control is good and my weight is maintained. I've got too many other things to be concerned about. Maybe someone else has other thoughts on the reason for maintaining this "50/50" ratio, in which case I "MIGHT" reconsider (but probably won't).

[Lloyd]

I set my basal so that if I skip a meal, my glucose level remains constant.

This is simple and it works very well.

-Lloyd

[xMenace]

I set my basal so that if I skip a meal, my glucose level remains constant.

This is simple and it works very well.

-Lloyd

Same here. IMO this is the foundation of good control.

[Gary_W]

I set my basal so that if I skip a meal, my glucose level remains constant.

This is simple and it works very well.

-Lloyd

Me too, but it seems strange to me that I'm so 'far out' from the published norm in a well respected text book. I'm a fairly regular person as far as height, weight, activity (i.e. not much) goes so you'd think that the likes of me would fall somewhere INSIDE the norm rather than outside it. I was just curious as to what the norm actually is and from the responses so far it seems that a much higher bolus dose vs basal is quite common...

[fgummett]

OK... job one: Define a Normal Human Being :D

I also test my basal by fasting and I say if you find what works for you, you are probably onto a winner :top: The book is a great place to start from...

---

BTW as a type 2 with insulin resistance in the picture, my numbers probably don't count in this discussion; but I am actually about 70% Basal to 30% Bolus

[Jan B]

Hi Gary,

I eat pretty low carb and I'm the other direction outside the norm. My morning numbers got WAY better when I started eating an omelet for breakfast instead of oatmeal. I can handle carbs ok (not great), but I don't handle them well at all in the morning.

My daily basal amount is 15u and my bolus amount is approx. 3 to 4 units per day.

When I eat more than my normal about of carbs, the amount of insulin to carbs raises substantially. My normal is 1 unit for 16 carbs, but if I have say, a 40 carb meal, I need more like 1 unit for every 10 carbs. This seems to have gotten much more obvious after I started "low-carbing". Plus my correction is 1 unit to lower 54 points, but the higher I am, the less one unit of insulin lowers my bg.

[Funnygrl]

My 30 day average shows 57% basal, 43% bolus.