Ratio of long to short acting insulins

Steven has 31 units of levemir a day and about 39 units of meal insulin a day.

martinbuchan said:

Hi

have gone fairly low carb since Easter and lost 1 stone . No exercise yet due to foot problem and procrastination. Now on twice as much long acting than short acting (88 Units levemir once a day and about 30-50 novorapid). I was advised initialy to be on about the same dose of bolus to basal insulins. At new year I gained one and half stone when I went of sick. Was using levemir 30+70, and about 80-90 Novorapid. It might have been higher at that time due to my bone infection.

What ratios do people use out there? I suspect going lower carb has that affect.

Last HbA1C 6.0% May 2008. Type 2 on MF as well. Morning BSL 5.0 to 5.9.

Click to expand...

Hi Martin

An a1c of 6% is excellent in terms of overall control. People on MDI will have problems with hypos if they try to get their a1c much lower.

At the moment, I use a combo of fast and long acting stuff and my ratio is about 60% fast (Apidra) to 40% slow (Lantus). I inject the Lantus just once a day about 10pm. My last a1c in December was 6.4 so my control is now much better, but this is down really to watching my carb intake a bit more and doing more bg tests. I am always guided by what my bg is before breakfast as to how much Apidra I inject. Since switching to MDI, my ratios have varied from 80% fast to 20% slow to 50/50 lol. I never stay the same for too many months ! Different insulins will have different effects on how they lower bg levels according to their action.


I have been type 1 diabetic for over 40 years and on average my a1c has always been between 6.9 and 7.2, not brilliant I admit, but not bad either. I have had carpal tunnel syndrome needing surgery when I was in my late 20's and also had the misfortune to suffer with frozen shoulders in my mid 40's. However, neither my diabetic consultant or ortho consultant advised me to tighten up my control. They just thought that I was doing my best to look after myself and bent over backwards to help me, especially my ortho consultant who ended up doing 3 MUA's on my right shoulder and 1 on my left. I am now all ok lol I hope I never get frozen shoulders again?

On MD1 (until April) I was at about 50/50 16 lantus + aprox 18 novorapid. I had a very low HBA1c but a lot of hypos.
On a pump with Apidra I'm using an average of just under 11 basal, and about 15 bolus(42%/58%). I'm now able to reduce basal for exercise which was the reason for pumping.

Walsh and Roberts suggest that 40% basal corresponds to children and adults who are fit, people on high carb diets and occasionally people in the first 5 years after diagnosis , 50% most people, 60% some adults, many teens, most people with insulin resistance, people on low carb diets, people using drugs like Symlin.

I take far more short acting than long: 8 units basal and between 12 and 20 fast depending on how much I eat and how much exercise I take (so between 40-60 and 28-72). I'm eating a moderate amount of carbs (between 110 and 160g most days) and exercising between 30 and 60 minutes a day.

I've read John Walsh's book which recommends a higher ratio of basal, but if I increase it I get hypos and it's a lot less flexible for exercising. I have no indication that my basals are too low except for a strong dawn phenomenon which increasing the basal does not help.