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Basal/Bolus Ratios: Is yours 50%:50% ?

L

lilyfleur

Well-Known Member
Messages
59
Location
Lancashire
Type of diabetes
Type 1
Treatment type
Pump
Hello everyone,
What kind of basal/bolus ratios do you have and how do they work for you? I'm on an insulin pump and I started a low carb diet a few years ago because I was struggling with binge eating disorders and high carb foods seemed to trigger it, and it really improved things for me. I had no more mood swings, stopped binge eating, felt generally healthier and my blood sugars stabilised significantly. But when I saw my consultant, he said that my basal/bolus ratio was "wrong" (it was around 65% basal, 35% bolus) and told me to up my bolus ratio, and drop my basal rate (despite the fact that my control had improved). As a result I started having hypos after meals, and then rebounding highs, and with the ups and downs in my blood glucose the mood swings came back and I started binge eating again. Anyway fast forward a few years of bad control (and having to come off the pump due to infections) and I've started on the pump again 3 weeks ago, my binge eating worse than ever so somehow found the willpower to give up sugary or high carb food again a few days ago. Since then my basal/bolus ratio has settled around the 65% basal 35% bolus mark again and I know my DSN is going to tell me to sort that out next time (because last time I saw her she'd commented that it was perfect at 50%:50%), but I just don't understand what the problem is if it means my blood sugars are more stable?
I tried to tell my consultant the first time that I wasn't eating many carbs and surely to have a 50:50 ration I'd have to start eating more but he still wanted me to change it.

Anybody else on a low carb diet have any idea what their ratio is?

Thanks,

Sarah
 
I'm on a low carb high fat diet, and it's helping me no end. Over the last week my bolus/basal ratio is 45%/55%. I can't help you with understanding the whys and wherefores of this : I don't understand it myself, so hopefully someone will post who will help both of us understand the optimum ratio. I'm ashamed to admit that I've been on 3 dafne type courses, but I still don't get how to adjust my doses properly. I'd appreciate some recommendations on links / what to read.
 
I find it interesting that the doctors seem to think a 50:50 ratio is the best because surely when we all have different lifestyles with different levels of activity, different amounts of food we eat, different metabolisms and different insulin sensitivities etc, I would've thought a basal/bolus ratio couldn't possibly be a textbook number?
Anyway, no shame to be had in repeating the DAFNE course, some people understand exactly what to do but still can't get it right (like myself), but did they give you the book with all of the information in it? I'm guessing it didn't help you anyway so have you tried reading the diabetes.co.uk advice?
http://www.diabetes.co.uk/insulin/adjusting-insulin-doses.html
x
 
lilyfleur said:
I find it interesting that the doctors seem to think a 50:50 ratio is the best because surely when we all have different lifestyles with different levels of activity, different amounts of food we eat, different metabolisms and different insulin sensitivities etc, I would've thought a basal/bolus ratio couldn't possibly be a textbook number?
Anyway, no shame to be had in repeating the DAFNE course, some people understand exactly what to do but still can't get it right (like myself), but did they give you the book with all of the information in it? I'm guessing it didn't help you anyway so have you tried reading the diabetes.co.uk advice?
http://www.diabetes.co.uk/insulin/adjusting-insulin-doses.html
x
Click to expand...

Thank you, lilyfleur,

I was given lots of hand-outs and a 'Diabetes Type 1 Workbook'. I've kept all these in a file, but they don't tell me enough. There is nothing about calculating basal, though there are exercises in calculating bolus requirements. Nothing about bolus/basal ratio. From what you say, it sounds as though the book didn't exist when I did the course(s!) - which, admittedly, was in 2005, and I think DAFNE had only just started, and was called DAFYDD where I live! (Dose Adjustment for your Daily Diet)

Thank you very much for the link - I will get studying and try to better understand where I'm at. What you said about a textbook ratio seems to make sense to me. All those variables - diet, metabolism, exercise - must make it very difficult for doctors to arrive at dosing decisions, especially if the patient (me, for example!) hasn't kept adequate records. :oops:
 
I'm on MDI and my basal/bolus split is near enough a 50/50, however I can't see the problem with a 65/35 split provided it is keeping your bg stable, perhaps your HCP's are not aware of how insulin ratio's change when following a low-carb diet..........who knows!!!!
 
Well, your DNS is an idiot - obviously the radio will depend on what you eat; and adjusting your insulin dosages without looking at your data is beyond idiotic (why do you they think you test your BG?)... Unless you are saying that the consultant wanted you to eat more carbs, which I would disagree with (the point of DAFNE is that you can eat what you want, including little carbs if that's what you want) but the advice wouldn't be mindbogglingly idiotic ("your current insulin doses keep BG exactly on target, so tomorrow I want you take a lot more insulin")
 
Mine is similar to yours - 64% basal 36% bolus. My consultant has no issues with this so I don't understand, like you, what the problem is. If it works then surely that's fine.
 
Mine is around 30:70 and my dsn mentioned 50:50 is "the best" but if that works for me then it's ok.
From what I learned there are no gold rules in diabetes, it's about what works for you. And since you're low carbing your ratio will be a bit off.
 
More **** advice, the conversations my wifes recently had with a few type 1s/2s who she works with is truly shocking. Never heard of basal tests,dafne. Didn't even know the terms basal/bolus or understand carbs turn to sugar!!! just they had 2 types of insulin, and diagnosed much longer than me.
anyway, for basal, yes 50/50 is usually used as a starting point which is then adjusted to suit the individual due to weight, activity, insulin sensitivity etc. need what we need, no set amount.
Myself, been on roughly 30% basal and 70% bolus. (not low carbing) and have recently done appropriate basal testing to know my basal is correct. If I were to increase to a 50/50 I would be having multiple hypos when fasting/starving.

Sent from the Diabetes Forum App
 
I'm nearer 60:40. Basal:bolus

Reading Think Like a Pancreas on the train this morning, when I go onto a pump later in the year, I'd be expecting the basal to drop and be nearer 50:50, but I can't see that as a magic number, much like DAFNE reies to teach a 10:1 ratio which would give me no end of problems. I'm pretty happy on a 15:1.
 
I have this discussion with my pump consultant each time I attend a clinic. The 14 day average on my pump is 77% basal 23% bolus. I am happy with the amount of carbs I eat and my HbA1c is good. The consultant always says that he would rather see it at least 60 basal 40 bolus if not nearer to 50:50. I asked how I was supposed to achieve that as my basal levels are correct and I have managed to cut down the frequency of hypos. I don't understand how one plan can come close to fitting everybody and surely the fact my ratio works for me is the most important thing in keeping control.
 
This really winds me up and I had a bit of argument about it with the DSNs on my own pump course. The 50/50 ratio is nothing more than a rule of thumb. It's just like saying 1 unit of insulin per 10g of carbs or 0.7u of basal per kg of body weight or 1 unit of insulin will drop your blood sugar by 2-3 mmol/L. These are all approximations for doctors to use in the absence of any actual real information! They should never be used prescriptively, you should never be "told" to adjust your basal/bolus ratio. At best the ratio is an indicator for the doctor to investigate something. But they should investigate, not lecture you in the absence of any facts. (For example, sometimes too high a basal proportion means you are using basal to cover some of your typical day's carbs. That can be investigated by fasting for a day or half day to see if blood sugar remains stable.)

I think around a two third / one third ratio of basal to bolus is in the range of pretty typical for low carb. But basically your basal need is more or less completely independent of your bolus need, and your bolus need is almost entirely dependent on your carb intake. So trying to advise a basal/bolus ratio is a complete nonsense. In my grumpy and irritated opinion, anyway. ;-)
 
Thanks for all of your responses, I'm glad to see I'm not the only one on more basal than bolus! I believe it's quite common to be the other way around (and apparently the doctors don't mind that as much which again I don't understand!) but hadn't managed to find people with similar ratios to me.
It's also good to know I'm not crazy for questioning what the doctors want me to do, I'm beginning to think I need to have more faith in my own judgement! I feel so much better on the low carb diet and if they do tell me to change the ratios again next time I'm in I'm definitely going to challenge them on it because as I think I said earlier, my control is so much more stable and my average blood glucose is the best it's ever been, so I have clear evidence that 65%:35% is working for me now, and I have a 14 year history of the 50%:50% ratio fuelling my binge eating habits, depression and consequential hbA1cs of over 14%. And if they disagree with me this time I'm just going to have to stand my ground! :)
 
lizdeluz said:
Thank you, lilyfleur,

I was given lots of hand-outs and a 'Diabetes Type 1 Workbook'. I've kept all these in a file, but they don't tell me enough. There is nothing about calculating basal, though there are exercises in calculating bolus requirements. Nothing about bolus/basal ratio. From what you say, it sounds as though the book didn't exist when I did the course(s!) - which, admittedly, was in 2005, and I think DAFNE had only just started, and was called DAFYDD where I live! (Dose Adjustment for your Daily Diet)

Thank you very much for the link - I will get studying and try to better understand where I'm at. What you said about a textbook ratio seems to make sense to me. All those variables - diet, metabolism, exercise - must make it very difficult for doctors to arrive at dosing decisions, especially if the patient (me, for example!) hasn't kept adequate records. :oops:
Click to expand...
Oh and re: lizdeluz....
Yes I think it is possible the workbook is a more recent thing, although having had a flick through last night it was more useful for MDIs than basal/bolus but I'll have to get back to you on this because I'm currently low so can't concentrate well enough to understand even what my point is let alone anything else haha, I'll come back to this when my treatment kicks in! :)
 
Hi. I'm not on a pump but surely your Basal is to balance your liver's background output and the Bolus is to manage the food you eat. These are not connected so the ratio must change depending on your eating habits; simples. I agree with Spiker.
 
Hi there!
I just run into this post. I know it is a 2 yo one, but I would like to share my experience. I used to have my pump set to 70:30 basal to bolus, eating 300 carbs a day. One day I started to investigate about how doses are calculated, how ratio and sensitivity are determined and how you can test your basal insulin index. For my surprise, everytime I skiped a meal, my basal was high enough to drop me to a hypo. Of course I didn't realized of this because I was eating a lot of carbs and the little effect of my boluses was supported by the huge basal. I decide to calculate my basal again and test it for different times of the day. As an example, my basal for night time dropped from 1.2u to 0.35u. My total basal insulin went from 28u to 12.
Im not saying this is what everybody need to do, but it is quite likely that if your basal:bolus is 60:40 or more, your basal has been wrongly calculated.
Hope this help you. Try to skip meals and see hoe your basal behaves for 4-6hrs, then adjust your ratio for every meal.

Cheers!
 
Ok well the split is to offer balance and eliminate as much peaks and valleys as possible in your wave pattern. For example if you are on a low basal and high bolus, the odds of you getting a hypo are significantly higher. Reason being is that you are over medicating for the meals and supplementing the basal medicine. Now some people can get away with this, especially those that have a high workout routine. But, they are using work outs as a basal supplement.

If you have a high basal and low bolus ratio like your issue, there is some supplement to the ratio causing the shift from 50/50. So when you are eating low carb diet, obviously this will supplement your bolus numbers and cause the shift.

So while most everyone will be around a 50/50 benchmark there are those that are supplementing insulin like working out for basal, sitting out in the sun all day for basal, or low carb/pelo/keto for bolus low, high carb/fried foods will rise bolus. So you Nutritionist should have said they wanted you to eat a more balanced meal and achieve a 50/50, but eating the same and trying to achieve 50/50 would be near impossible.

But everyones body is different, so 50/50 is generally a guideline to reach. Just like BMI, just a benchmark. People that workout and have more muscle mass will never achieve BMI numbers. But that is fine. My doctor uses waist length and body fat % for this reason in stead of BMI.
 
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