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Basal Rate Formulas... which do you use?

S

sw11bloke

Well-Known Member
Messages
207
Location
Battersea London
According to Dr Bernstein's BI formula, I should be on about .5units Basal per hour which means I should be on about 12 units Levemir per 24 hour period.
This is quite a specialised formula as it takes the average weight of a healthy person and divides it by your weight then multiplies that by the anticipated blood sugar drop from 1 unit of levemir. (pg 294 of Dr Bernsteins Diabetes Solution)

According to DAFNE my basal insulin should be between .5 to .8 multiplied by my weight in killos and then divided by 2. This means that my Basal should be between 17 and 27 units.

Then there is the Basal Caulculater app which takes your weight, height and age into account and advises me that my basal should be.38 units/hour so over 24 hours, I should be on about 9 units BI.

I just find it a bit weird that my diabetic team have never actually sat down with me to explain my basal rates that I am on. There is a huge difference in all these formulas - from 9 units to 27.
Currently I am on 22 units a day but my BG readings are not stable. I yoyo up and down between 4 and 20. My diabetic team seem to focus more on my CHO/Insulin ratios. I am convinced that its my basal rates that need sorting first.

I usually split my levemir into 2 doses. 13 at 8am and 9units at 10:30pm.
Last night I had dinner at 6 then did not eat again. I tested at 11pm before bed and I was 12.At 1am I was 8. This tells me that my pm BI was too high so will drop to 7units tonight.

I'd be interested to hear what formulas other type 1's on MDI are on. I have now decided to ignore my diabetic teams advice and am going to strip back and start again.
I tending to think that Dr Bernstein and the 3rd formula on the basal calculator may be the way forward which is between 9 and 12 units basal per day.
 
Hi

Using a forumula to work out correct basal dose is a new one on me........ I just used trial and error to work everything out and didnt worry too much which insulin was responsible for what.... As long as I could get decent bg levels when I tested then that's all that mattered.

From reading your messages, I think you may find that the less basal insulin you use, the more bolus you will need so you will need to find your own ideal basal with the ideal bolus....... Loads of testing and loads of frustration with trial and error.........

Happy testing..............


Thinking about this a bit more...... I did use a sort of forumula to work out my ideal insulin need and that was to weigh myself and use that to determine my basal and bolus such as whatever I weighed I allowed for 0.5 to 1.00u of insulin. As I didnt know the correct amount at the time I just went for mid way and used 0.75u per kg body weight and then divided that by 2 and then used trial and error to work out whether to increase the basal up a bit or to leave it alone and just alter the bolus carb ratio.

If you try to do some morning and afternoon fasting without eating any carb and just use your basal you will start to see how it affects your bg levels. I found that I could stay at a nice 7mmol all morning but by the afternoon I then dropped to 4mmol so that then explained to me why I needed to use more bolus in the morning but less bolus in the afternoon.
 
I think that formulas can only be a starting point
When I was diagnosed they didn't tell me how they worked it out but in retrospect it I think they used a very common formula ( 0.55 X Total Weight in Kilograms for the total daily dose.)
http://dtc.ucsf.edu/types-of-diabetes/t ... ulin-dose/

This was divided 50% basal, 50% bolus . The carbs I was .prescribed' computed at 10-12 carbs per unit (dependent on meal). Very rough and ready but it worked OK until I started exercising, then basal was too high. When the exercise increased to quite high levels, it became very much too high.


Almost eight years later, I take less basal than originally told (though now on a pump). The crucial factor remains how active I am. Bolus ratios haven't really changed that much.
I don't think any formula can take into account your lifestyle, that's where the trial and error comes in.
 
Thank you guys.

I do go to the gym for an hour 6 days a week and I am extremely active and fit. This is another reason why I know my basal is too high.

I will be missing meals and testing more so that I can fine tune my doses. I think I am going to go with the Dr Bernstein and Height, weight, age formula. Both those formulas are between 9 and 12 units of basal so Im thinking Ill start off with 6 units am and 6 units pm. according to last nights testing.... It does appear that 6 units would work for my overnight basal.
 
Hi

I have a feeling that the formula Dr Bernstein refers to is based on people eating a low carb diet such as the 30g carb per day. I dont think it will work for people eating more so be careful and be prepared to do lots of bg tests................
 
Strip it back and start again, once you get the basal right your half way there.

We had a guy on our DAFNE course who was injecting around 70 units of lantus a day and was always chasing hypo's, by the end of the week he was down to 42 units with much steadier control, some mistakenly believe that basal doses are set in stone but they do go up and down due to illness, exercise and weight gain/loss etc.
 

Yes, I think that's right. I eat about 50g carb per day and my basal remains pretty constant as do my BGs (except if I'm ill). However, if I significantly increase my carb intake for a few days, my basal is not enough to hold me steady and my background BGs start to climb so I find they are higher pre-meal. Obviously, I can just jab those down again with the bolus for the meal, but realistically, my BGs are at a higher background level when I increase the daily carb amounts and I have to increase the basal to keep them level and within my target range. Increasing the bolus isn't enough - it works as a correction rather than as a steady state. I have tried this experiment many times. I firmly believe you have to decide on a rough amount of carb and stick to it if you want to keep stable BGs. Obviously, I think low-carb is the best bet, but dotting around between significantly different amounts of carb per day seems to be the worst of all worlds.

Smidge
 
Hi Smidge

50g of carb a day? What do you eat that is low carb that fills you up?
what would be a typical breakfast, lunch and dinner?

a breakfast cereal is at least 30grams.... a sandwich is at least 45grams...... veg with dinner is at least 30/40 grams??
 
Eggs, meat, fish, nuts and non-starchy vegetables - you would swap cereal for scrambled eggs with bacon, sandwich for grass fed steak with vegetables, etc. Great if you love meat, I suppose.
 
Hi mate,

if you're looking to build mass/body building I wouldn't go low carb. Keto bulks are difficult enough unless you have spare time in abundance preparing meals/enough money to fuel your body solely off lean meats/fatty products.

Not to mention it's not practical if you have a social life/dynamic life style. E.g. going out for a meal with friends becomes a bit more difficult when you have strict dietary requirements, low carb options are not always available.

Eating within your caloric requirement and taking Insulin as needed would be your best course of action, IMO.

Working out your Insulin, there are guides out there, but considering there are so many variables I followed my GPs advice to start with 10 units and keep increasing until my morning numbers are within range. I split my dose, I'm using Levemir. This has worked well for me.
 
Formulas are devised & based upon a few samples of people under laboratory, specific conditions....they are a starting point only and really as a basis to keep users out of hypoland.
You have them to adapt the starting point by testing and changing...and oh, our bodies react so differently to the next person at the clinics/dafne courses etc.
Only thing to do is to test and change and also to consider whether the carbs and fat you are eating are good for you, or whether they need tweaking too.
Perseverance for a short while will pay dividends in rewards....
 
I believe only from my pumping experience the more carbs I eat, aswell as bolus increasing, so do my basals. Xmas i will have double rates for my basals running... And thati is solely because I eat more carbs.... And of course my bolus's are also doubling!!
I personally cannot stick to eating the same amount religously of carbs each meal, each day of my life.
Also, if I eat bacon &egg that gives me huge rises despite checking that the bacon is 0 carbs... But because of the fat...the higherthe fat content for me.. The higher my basals run too!!
My fruit and veg each day alone will add to 50g cho...
 
Hey sw11bloke!


Well, today's menu was:

Breakfast - 50g raspberries, 75g Total greek yoghurt, 15g Dorset Cereals granola (15g carb)
Lunch - Chicken salad made with a whole chicken breast, small clementine, spoonful of cream (13g (ish) carb)
Tea - bowl of home-made chilli, bowl of low-carb chocolate, orange and Cointreau ice-cream (21g carb)

Total: 49g carb. Also had some cheese mid afternoon.

Other days I might eat steak and salad or chicken and vegetables for tea, or Moussaka and salad for lunch. Sometimes I swap the breakfast for a mushroom and cheese omellette. There's all sorts of food you can eat that are low-carb and filling.

It does take a bit of planning and effort to low-carb, but for me it is worth it to keep stable BGs, take small doses of insulin and have my HbA1c in the 5s. Maybe other people find another way that achieves all that for them, but this works for me.

Take care

Smidge
 

Hi My hospital diabetes doctor or DSN hasn't ever discussed this fully with me , my DSN said that I over estimate. I have never split my Levemir and it has never been discussed with me, I take my Levemir at bedtime only and its 12 units. With the Novorapid, 3 times a day, it adds up,on average, to about 16 units per day.

I know, after many years what my body can take and how it reacts.

Good luck RRB
 
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