Should I strive for a basal to bolus ratio of 40 / 60 ?

Hello and welcome to the forum

My interpretation of this is that it's just a guide, where did you read it out of interest ?

I am 7 years on insulin now, 2 of those on a pump, looking at my daily basal/bolus ratios they change every day based on exercise, stress, hormones, food eaten, illness, etc etc, we are all different so mine would certainly not be right for you and vice versa.

Hello and are you a type 2 who has gone onto insulin or a type 1?
This would make a difference given that you are likely to need more basal if you are very insulin resistant.
Your dose sounds quite high which could be due to body size or insulin resistance but your doctor is probably right to be focused on getting your sugars into range across 24 hours with a meal time top up as necessary. There is no right amount of insulin btw other than that required to cover your need to keep blood sugars in a tight range. My own ratio is 75:25 generally because I eat low carb so my bolus doses are low.
The rules are that you may need a lot more insulin (basal) if your weight increases, you suffer stress or get an infectious illness or become more sedentary or take steroids for any reason.
The converse would be true so hopefully you are keeping an eye on things across the day e.g. fasting, before a meal and before bed (or 4 hours after last bolus dose or meal).

I wasn’t aware there was any such kind of ratio. I take only 9u of Lantus at night and about 30u Novorapid in a day which of course varies with what I eat. My doctor thinks my control is very satisfactory. I must add that my insulin intake has gone down significantly since I started using Freestyle Libre about 5 months ago. I have been Type1 for 44 years, weigh 60kg and have no complications that I am aware of.

I think this ratio is pretty meaningless tbh. Take whatever dose of both insulins that do the job of keeping your levels stable and in range as much as possible. It all depends on your carb intake, really. FWIW my basal tends to be anywhere from 75-90% of my TDD.

Hi. I wouldn't worry about the Bolus to Basal ratio; I've no idea what mine is. The important things are to get the Basal balance right and then get to know your Bolus ratio to keep your BS in the right range.

Basal/Bolus ratios are just a starting point, but mean nothing in the long run. You take whatever is needed to maintain proper control. Some people need a lot more insulin than other people too. So whatever works is right for you!

Just a warning here, I don't know how long you have been a type 2? But I always like to warn people they could be a misdiagnosed type 1. Unfortunately this occurs a lot still. I was misdiagnosed and put on insulin fairly early because the medications made me sick. LADA/Type 1 can take up to 8 years plus to fully develop and during that time your body will still make some insulin until it doesn't. So one of the warning signs is being switched to insulin within 3 years of diagnosis.
Just keep it in mind.

lsrpm1964 said:

Can anyone who has been on insulin for a while now explain something to me?

I have read that ideally, the amount of units of basal compared to bolus should be somewhere in the vicinity of 40% basal and 60% bolus. If that is ideal, then I am way off. My doctor started me in September last year on just NPH and my dose got quite high. (65 units in the evening and about 45 in the morning) Then he added the bolus, "as needed", without an adjustment.

He did say that as long as I was taking consistent readings, and was able to do the carb counting, that I could adjust the bolus to match my readings, trying to figure out the carb ratio by trying to maintain a difference of no more than plus/minus 2 mmol/L between before meal and after. So I am doing that, and staying in the range as best I can (with the occasional hypo)

But my question is, would the numbers possibly be more consistent if I reduced the basal and increased the bolus so that the TDD ratio of basal to bolus was closer to the 4/60 I have read about?

Opinions and advise welcome. Doctor has been helpful but basically said everyone is different and it takes trial and error to adjust for optimal numbers. So I am trialing carefully and being prepared for errors with glucose tablets always on hand if I need them.

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Hi, I wanted to share three resources that have been invaluable to me in managing my diabetes, as an insulin user and now a pumper. From reading your post and replies, we have similarities in both our insulin needs, our make -up/composition, fear of bottoming, as well as a desire and abilities to research and then incorporate with our providers for best results.

The first two resources are very academic and professional. Both are intended for medical professionals. One is meant for an Endocrine fellow or advanced medical student, however I have found it to be formatted in such a way that anyone can follow in any area that is of interest to them. A ton of great clinical endocrinology information not just diabetes and insulin. The other is simply a wealth of knowledge and current treatment guidelines and accepted practices of all things medical. The final resource was originally recommended by another of my physicians who is also a diabetic. It is written for the diabetic patient. Just about everything you could possibly want to know about insulin dosages, rates and most importantly determining what is best for YOU is in here! The author has several resources specific to diabetes, this particular one is focused on pumpers, however, I was able to use all the info and "checks" before I ever started pumping. It is what convinced me that pumping was the way to go for me. I brought it with me to my Endocrinology Dr and he was enthralled going out and getting his own copy then proudly showing it all marked up at my next visit and stating he was recommending it to ALL his diabetes patients regardless of pump or insulin status. About a year later, I found out from the practices diabetes education group that my Dr had distributed copies to the staff instructing them to incorporate it into their patient education interactions. In a relatively short period of time, the practice has seen a significant reduction in the number of direct diabetes hospitalizations, droppage of A1C numbers, less blood sugar extreme excursions, better insulin effectiveness, carb control, etc. With the biggest gain in not only patient compliance but with patient confidence in themselves and being better partners and communicators and advocates in their health and lives! It has been fun to watch the transformation as a regular patient and knowing it started with a little book recommended by a doctor in a different specialty who just so happened to be diabetic and shared with their patient who was a struggling diabetic! With these resources, I have also been able to learn about other things and better ask questions and pinpoint issues.


Without further delay here are my top 3 favorite resources:

A. Endocrine Secrets 6th Edition (2013) by Michael T. McDermott; Published by Elsevier Saunders [I would not be surprised if there is another updated edition available by now]

B. Medscape is essentially a free online "journal depository" for diagnosis and treatment guidelines of virtually all things medical. Signup for free unlimited use and you don't have to give up your life secrets to register LOL

C. Pumping Insulin by John Walsh. Hands down the patient "Diabetes Bible." Walsh also has other titles on diabetes available. Check them out and find the ONE for YOU.


YOU got this, keep going, keep learning!

lsrpm1964 said:

Can anyone who has been on insulin for a while now explain something to me?

I have read that ideally, the amount of units of basal compared to bolus should be somewhere in the vicinity of 40% basal and 60% bolus. If that is ideal, then I am way off. My doctor started me in September last year on just NPH and my dose got quite high. (65 units in the evening and about 45 in the morning) Then he added the bolus, "as needed", without an adjustment.

He did say that as long as I was taking consistent readings, and was able to do the carb counting, that I could adjust the bolus to match my readings, trying to figure out the carb ratio by trying to maintain a difference of no more than plus/minus 2 mmol/L between before meal and after. So I am doing that, and staying in the range as best I can (with the occasional hypo)

But my question is, would the numbers possibly be more consistent if I reduced the basal and increased the bolus so that the TDD ratio of basal to bolus was closer to the 4/60 I have read about?

Opinions and advise welcome. Doctor has been helpful but basically said everyone is different and it takes trial and error to adjust for optimal numbers. So I am trialing carefully and being prepared for errors with glucose tablets always on hand if I need them.

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Hi, I’m type 1, and keep getting strange looks at my clinic when I tell them I take 4.5u of background in am and 4.5u in pm which obviously equates to 9 units but the guidelines suggest you should be taking 1 unit per hour roughly! I also have between 10-20u a day of fast acting not sure what this makes my ratio??
But they soon realise from my readings that this works so what difference do these guidelines make they are just a tool when ur newly diagnosed and actually what you end up doing is never going to match any other insulin taker. So forget what the books say and work out what suits you best and stick with it or like most of us change with the times as what works for 6 months can then change ‍

I think it’s like the 1u:10g and 1u:3mmol start points in DAFNE. They start with that and then you tweak it to suit your own diabetes. But I’m my whole two decades of this, I’ve never heard anyone attach any importance to a ration between basal and bolus.

lsrpm1964 said:

So it is probably just me reading too much on the Internet.

But it concerns me a little. When first diagnosed I was over 350 lbs. I am down now to 310 but I am still, charitably speaking, a biggun. I know that as a Type 2 size often makes a difference in my required insulin dosage, and in carb coverage, and in correction dose.

BUT

When others are mentioning their dosages, no one seems to be taking as high a number of units as me. One NPH I was doing a total of 110 units (64 in evening and 45 in am) then covering carbs with a ratio of 1:10 for breakfast, 1:10 or sometimes 1:8 for lunch, and in order to keep supper numbers under control 1:8 or 1:7

that meant that some days, depending on the meals I ate, i was shooting total daily units of 150 or more basal and bolus combined! That still seems really high. but maybe if I can keep losing weight those numbers will go down?

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As your body shrinks, your dosage will too, because there’s less of you to soak it up. Your ratios may change too, it’s constantly moving sand. The TDD isn’t that important - the right dose is the one that keeps you stable and in range. Mine has changed over the years from over 100u daily to 25u a day. If you’re type two, that implies insulin resistance, so of course you’ll need more going in, because you can’t/don’t use a lot of it.

congratulations on the weight loss and general effort, you are doing great

lsrpm1964 said:

Thanks. I think that is what I needed to here someone say.

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They say that insanity is doing the same thing over and over and expecting a different result. I’ve found that diabetes is doing the same thing over and over and insanely hoping for the same result!