Fast acting to slow acting insulin ratio ?

Mad76

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Hi all,
So yesterday i spoke to a diabetic consultant. He told me the ration of novorapid to lantus should be approx 60 :40. I had never bern told that before, and was taking more lantus than novorapid - im thinkimg this my explain overnight lows, and also daytime lows.
Just wanted to ask if this is just another bit of common knowledge here that the professionals failed to tell me???
 

slip

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Most are told it should be 50:50, but everyone is different! And it also depends on how many carbs you eat too. What ever works for you is the right amount, but if you're dipping low overnight it would suggest you're taking too much basal (before bed?) and the only way to really find out is to do a 'basal test'.
 

Antje77

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It 'should be' whatever works for you not some random ratio. It may well be that the average is 60:40 but that doesn't mean it's right for everyone every day.
On some days I consume a lot of carbs, so I use a lot of quick acting, on other days I eat a lot less carbs so I use a little of quick acting. The long acting stays the same though, so the ratio is different every day.
 

porl69

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I was told 50:50 but looking at my pump data I am on 65% bolus 35% basal. I do eat a lot thou. AND we are all so VERY different!
 
D

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My understanding is the ratios are a guide. This is probably used when setting up someone who is newly diagnosed and is a good starting point.
But I agree with the other comments that it depends on the person and their diet.
It is always hard when first diagnosed because of the honeymoon making things less predictable when you are learning.
I don't know what others think about basal testing during the honeymoon period. It may help work out your basal dose but the unpredictability may cause problems.
(Sorry @Mad76 that comment doesn't help you but may provoke something useful from someone more knowledgeable than I)
 

evilclive

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Apparently the ratios vary a bit depending where you are - eg the Japanese tend towards the bolus rather than the 50:50 preferred by DSNs here.
 

Mad76

Well-Known Member
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319
Type of diabetes
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Its all very confusing !
I think i may be in honeymoon period as im on very little novorapid at the moment. Im on about 6 -10 units a day depending on food.
I was put on set amount of 10 units of lantus. But hes advised me to reduce lantus to 8 units. Then maybe 6. Depending on how it goes. Its a lot of trial and error i think.

But

Im quite reluctant.
Being in a foreign country
And
The trauma of my DKA being quite fresh

Sounds a bit pathetic i know
 

tim2000s

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It's a stupid ratio that doesn't reflect real life in most cases. As someone else has said, the main aim is to provide some sort of guess as to how to start someone off, but if your consultant is telling you to aim for that, they are acting in a dumb manner by not understanding that each person is an individual and has different needs.

To give that some perspective, my basal requirement is typically around 28U a day. When I eat low carb my TDD is about 38U. When I eat high carb it can be as much as 68U. On day one I have a ratio of 75%:25% basal to bolus. One day two I have a ratio of 35%:65% basal to bolus. That's why it's nonsensical.

If what they are really saying is that it's easier to manage by maintaining some sort of routine that allows you to be fairly consistent in insulin dosing then that's what they should say.
 

Yondibear

Newbie
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Thank you. Your answer has answered my question before I asked it. My doc says basal/bolus ratio should be 50/50 but I intermittent fast and eat low carb which means this is not possible.
 

becca59

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If 50/50 was the norm I’d never get to eat anything. I only have 8 units basal and take 4 units bolus to 10 carbs in the morning. By the time I’ve done a correction for my swim training Adrenalin I would basically be stuffed. But not with food! Err! One size does not fit all!
 

Japes

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I was never given any ratio regarding basal/bolus, and only got the very sensible comments from my GP at the first appointment I had with him after insulin was introduced of "The amount of Novorapid will vary, once things settle, depending on what you eat and how much exercise you do. So, don't worry about whether you're using too much or too little as long as everything's OK.".

The clinic people have mainly been concerned with getting the basal sorted, which has taken some tweaking, and I know that will continue to be the case.
 
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kitedoc

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As @tim2000s says, a set in stone bolus:basal ratio is nonsensical.
Such talk is often called cookbook medicine, and apologies to cooks of all types.
The rigid thinking displayed is unforunately typical of deficiencies in medical education.
There used to be a similar edict that for a normal adult male whose pancreas is removed would require
40 units of insulin to balance and control bsls.
Yes maybe if on the typical number of carbs for whenever that myth was formulated, with no other health conditions etc stc, - no thinking outside the square allowed !!!
On a low carb diet some of us are nearer to short:long , 30:70 or 20:80 and so on.
So ratio stated by this consultant may provide stability if you can contort yourself to what ever dietary regime. And is he really saying do not do fasting or low carb.? Communication is key as @tim2000s infers.
On hi carb you end up chasing blood sugars with more short acting insulin
On low carb you end up eating more to the action of your insulin and that often means lower short-acting, or low intermittent doses of it but more long acting or basal.
Some persons need more insulin per body weight than others. Just imagine if we were all weighed and had insulin doled out per kg bodyweight.
Sorry, you weigh less this week so less insulin for you.
..........Opps zero body weight, what happened ?