I've recently tried to begin a low carb diet and add much more exercise to my lifestyle. My TDD is usually around 50-55 units. However in trying to watch how much I eat, my TDD balance has now switched from 50/50 to 70/30. That is - 70% of my TDD is basal, and 30% is bolus. Is this considered a bad thing to have as a pumper? In the book by John Walsh called "Pumping Insulin" it mentions a desirable level is 50/50 or up to 60/40 - but I couldn't find out why he feels this way. I need help?

Actually only some people have a 50/50 ratio. When they developed the clinical rules for the first pumps they just chose 50/50 there was no scientific data.

My TDD is 40/60 and I would have to starve myself to achieve a 50/50 ratio...whatever works is the right setting if your BG control is OK. If you are having trouble with
BG control, your ratio could point you to the problem.

Example: 30/70...and 20% of your bolus insulin is correction insulin, could be poor diet or carb counting, basal set to low, incorrect I:C and or correction factor
and this is just some and not all of the reasons.

As many of us get older we can also suffer from insulin resistance...I used 30u TDD for 15 years and then it slowly moved up to 50u TDD during about a two year period then stabilized and it has been 50u for 6-7 years. If I changed my high target to 180 mg/dL I could probably get close to a 50/50 ratio but there are many days I use a little extra basal insulin to chase my BG back down below 140 mg/dL.


"Pumping Insulin" by John Walsh is a very good book but most settings, charts, and graphs are...YMMV.

I have a 20/80 basal/bolus ratio.
No set rules in this game, if I had a 50/50 ratio I would be eating a grape a day!!!

I just checked my pump for the last 30 days and it shows my ration is 48/52 (basal/bolus). For the last 14 days, it's exactly 50/50. For the past 8-9 months my insulin needs have gone up. I'm using an average of 43 units a day now. Part of it is I'm always exhausted, no matter how much sleep I get, and my exercise has been practically zero. But I think I have always needed quite a bit of basal insulin. Back when I first got my pump and as watching my carbs (maybe 125-150 grams per day) my ratio was probably closer to 65/35. The more insulin given at a time, the more it seems to affect me.

Liz -

Is it possible you have thyroid problems that cause you to feel always tired? Hope you get it sorted out soon. Hang in there - Spring is coming

I do have known thyroid problems and I'm on medication. I had labs done about 3 weeks ago and my thyroid levels are in range for my current dose of medication. Iron was also normal.

We had Spring here for a couple of days this week. Yesterday I think it hit 70, but it's back to being colder again today.

My basal/bolus ratio (for the past 31 days) was 47%/53% with an average TDD of 20.825.

36% basal 64% bolus. I am just in motion too much to have it any other way. I eat 198 carbs a day. 4% correction. It's tough to find the right combo at least for me it was.

I think the ratio of basal to bolus just depends a great deal on how much carb you eat, and there's no special reason to think that 50% basal is somehow "better" than some other percent.

Your basal insulin is the amount that makes your blood sugar tend to stay steady, not rising or falling all on its own. It is affected by lots of things like stress, illness, overall activity level. If you're living a steady life, your basal amount will tend to be the same from day to day. But your bolus pretty much depends on the carbs you eat -- that's what your carb ratio is all about. So your carb load largely determines your basal to bolus ratio.

Let's do some arithmetic. My basal is 17.55u per day. My insulin:carb is 1u/5.5g. So if I want a 50:50 ratio I would have to eat about 97g carb per day (17.55 x 5.5 = 96.53). But there is no special goodness to this amount of carb, and I see no reason to make it a goal.

I think it is sensible to come at it from the total nutrition point of view. Suppose I want a 2200 calorie diet, and I think 50% carbs is a good amount (50% carbs, 30% fat, 20% protein). This means I want 1100 calories from carbs (2200 x 50% = 1100), which means I want 275 carbs per day (1100 / 4 = 275). That would mean a daily bolus amount of 50u (275 / 5.5 = 50), so my basal percent of total would be 26% (17.55 / (17.55 + 50) = 26%) In practice, my basal runs around 30%. Early on when my family doctor said "oh, 30% basal is low it should be more like 50%" I was a bit concerned, but my endocrinologist downplayed that, and my CDE who is a long-time type 1 guided me towards eating a sensible balanced diet, controlling my blood glucose, and don't worry about arbitrary ratios like 50:50.

If you have a medical support team with a dietician or nutritionist, you could ask them for suggestions on how many calories per day would be good for you, and what percent carb, fat, and protein to aim for. That plus some arithmetic will tell you what your percent basal will be, and there's no inherent goodness if that happens to turn out to be 50%. If your diabetologist is advocating a low-carb diet to make it easier to control excursions, that is another important input. If you don't have as much professional support, surely there are sensible nutrition guidelines available on the web (as well as lots of "way-out" nutrition recommendations -- watch out!). Likely it has been discussed in these forums, but I haven's searched.

The reason I have a 20/80 ratio is because I am very active and work out a great deal and because I work out and am so active I have to eat lots to keep going. If I don't eat plenty I have no energy.
Before anyone judges I have a BMI of 19!!!
It would be boring if we were all the same!!

I am happy to read that everyone is different. Also very glad to know that if I'm not 50/50 that is OK too. I seem to vary day by day depending on food consumed, activity level and stress level. The last one is one that I have to work on as I'm not very good at controlling stress as it applies to my BG.

If you figure out a way to control stress as it applies to your BG, please post. Better yet, start a business and teach people how to do it. I think you would make a lot of money.

I know I can't do it.....

Tom

Tom,

I'm afraid I wouldn't be much of a success in controlling stress. I have an appt with my GP next week and I'm already stressing out about it. Does it make sense for me to do this? No, absolutely not, but I feel about doctors like many people feel about dentists - I detest going there. With the GP it is mostly the confrontations we've already had about me going on a statin drug in spite of a miserable relationship with that class of drugs in the past. The GP just doesn't seem to believe my history. Well, enough of that problem.

Do you find that even excitement (the good kind of stress) elevates your BG? I love my grandson dearly, but when he comes to visit during school holidays my BG goes nuts!!