Basal/Bolus ratio

MikailasMom · #1 07-24-2010, 02:13 PM

I downloaded her pump and noticed that her ratio is nowhere close to 50-50!
She is more in the 25-75% catagory. Her basal needs are pretty small (.1 -.25) throughout the day but her I:C ratio isnt so small, 1-8 -1-13 variation by meals.

Her endo mentioned that based on bolus needs she may be at the ending of honeymoon, but it that possible with such small basal? I know if she misses any of that basal she shoots up into the 400's very fast.

Im just curious to what you all think..I know YDMV but is it common to have a 25-75 ratio?

I am trying to brace myself for the end of the honeymoon craziness if that is the case. Is that based on TDD, ISF, ratio? Thanks everyone!

Candi

emm142 · #2 07-24-2010, 02:24 PM

In the first two years or so of D, I wasn't honeymooning according to my insulin amounts, but I had really low basal requirements (0.00u/h to 0.3u/h, for the longest time). At that point I was on normal, non-honeymooning amounts of novolog, roughly a 1:10 ratio. As time went on, my basals got higher and shifted to more like 50/50.

Now my basals are higher I see more of a problem if they are slightly higher or lower than they need to be, and MUCH more of a problem if insulin delivery is impeded for some reason. I think my pancreas just kept some basal production for longer than it kept bolus production. YDMV.

zakksmom · #3 07-24-2010, 02:29 PM

My son's daytime ratio is 1-80. It has been since diagnosis in Oct 09. Come 6ish the ratio is like 1-35... minimal basal starts 7pm--7am..

Depending on what he eats he spikes into the mide 200's and we correct. Sometimes I think he's going out of honeymoon but his little pancreas just keeps on keepin on. (for now..)

Michelle'sMom · #4 07-24-2010, 03:18 PM

When we saw the CDE a month after starting on the pump, I asked her about the ratios. She said not to be concerned with ratios during the honeymoon.

ETA: The reason I brought it up in the first place was because our basal/bolus at that time was closer to 20/80. We're dealing with the end of the honeymoon & we're getting closer to the 50/50 every week.

quiltinmom · #5 07-24-2010, 03:42 PM

I don't know how much this translates, as we're on MDI, but his lantus/novolog ratios aren't very near 50/50, either. (He's a little younger than your CWD and was diagnosed around the same time.) He's been about 75% novolog/25% lantus. I've been wondering if he is nearing the end of his honeymoon also, because he's been having way too many 200's, so he's been taking more insulin lately for corrections. We've also increased his lantus recently, and it seems to be helping. I miss the nice, perfect numbers we used to get!

HTH!

MikailasMom · #6 07-24-2010, 10:56 PM

Thanks for the input ladies! I really appreciate it!

Darryl · #7 07-25-2010, 08:51 AM

I have never understood why doctors talk about this "ratio". Basal needs can vary greatly from day to day depending on growth, etc., , and bolus needs depend on what you eat, and how much you eat on a given day.

When this topic came up previouly, someone suggested that doctors are looking for a 50/50 ratio between basal and correction boluses. But even then, corrections should theoretically be zero if basal rate is fine-tuned throughout the day.

The ratio may have more applicability to MDI (Lantus + fast acting insulin) where the average amount of Lantus needed is about equal to the average amount of bolus needed. But you're on a pump so I would't worry about that either.

???

StillMamamia · #8 07-26-2010, 07:47 AM

Quote:

Originally Posted by Darryl

When this topic came up previouly, someone suggested that doctors are looking for a 50/50 ratio between basal and correction boluses. But even then, corrections should theoretically be zero if basal rate is fine-tuned throughout the day.

Got a question for you, Darryl. Isn't fine tuning basal throughout the day essentially correcting (without it being via a bolus) ? I totally get what you're saying - basal needs vary everyday so adjustments need to be made everyday (several times a day). However, if you keep "correcting" the basal needs, you're basically correcting anyway. Which brings me to my 2nd question

- do basal needs really vary THAT much all the time? Don't they stabilize sometimes that you don't need (you = general you) to tweak them daily and throughout the day? You may shoot me now.

I'm trying to see if this is maybe doable for us, without a CGMS.

I/o bolus corrections, to use basal tweaks all the time.

Thanks.

Oh, any studies on a non Type 1 D person's insulin secretion would be good too, if you have any.

kiwiliz · #9 07-26-2010, 01:38 PM

https://www1.accu-chek.com.au/multim...r_basal_au.jpg

kiwiliz · #10 07-26-2010, 01:45 PM

Can I just add one note though - THE BEST daytime numbers we have ever had were about four months ago when dds insulin requirements dropped by over 40%, we think she stopped a growth spurt. She was having no bolus for food at all during the day and it was bliss. Obviously she needed to eat - but it was only exactly what she wanted to eat anyway and if she had wanted to "go without" food, or exercise, we just lowered her basal temporarily. Our endo squirmed at this for a bit but then said "whatever works!" We were persuaded to try and get basal/bolus back to 50/50 by the next endo and it all went to custard when dd forgot to bolus!
I don't think there is just one right way to do this.