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Should I strive for a Basal to Bolus ratio of 40 / 60?

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.
2 Responses
231441 tn?1333896366
COMMUNITY LEADER
To determine your optimal doses of basal and bolus insulins you need to do basal and bolus testing to determine rates of each.  You can easily find instruction for this online or ask your diabetes educator.

There is no fixed ratio.  The idea is that with basal and no eating your blood glucose should be on target and stable without highs or lows.  The bolus covers food and may be used for correction doses if needed.

For people on low carb way of eating the basal can be very much higher than the bolus.  For example, I eat about 30 g of carbs per day.  My basal is about 20 units of Levemir. My bolus is very little and i use 0 - 5 units per day on most days.
Tbd
External User
I have been dealing with diabetes for 20 years and have picked up a lot of information along the way.  Your bolus should only cover what you eat and you determine that by counting carbs.  The carb/bolus ration determines how much insulin you get per carb.  Your basal rate is what your body needs 24 hours a day to keep your blood glucose in line.  From what you describe, it seems to me you need to adjust your basal rates.  Are you using a pump?  That is the best way to make this happen.  When you get to the amounts of insulin you are using, it is just too difficult to manage with injections alone.  I resisted going on the pump, but it has been a godsend.  You can adjust your basal rate as you build up a history of usage.  Good luck.
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231441 tn?1333896366
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