Pumpers...is your basal rate higher than your carb rate?
Every doctor and nurse I see says that my basal rate should be about double the amount of insulin I take for carbs. I actually take only 13.47 units per day for my basal and about double that for my carbs. However, everytime I fast to check my basal rate, it's good. Is anyone else like this? My A1c is 8% right now and I'm really trying to figure out how to fix this. Any suggestions would be appreciated!
Replies to This Discussion
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Permalink Reply by Joe on
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kim, I have had T1 for 31 years and I never heard that. I was blown away when the topic came up(in another forum) and, in that discussion someone said their doctor recommended 50%.
my a1c was 6.4 and 6.8 last 6 months - it's higher now because I have had to eat at restaurants for the last 6 months, but wow I never heard such nonsense.
my current 31 day average is 32% basal, 68% bolus.
fixing an 8% a1c? when are you high? hows your overnights? 2 hour after-meal bs? my niece just dropped a whole percent by bolusing before a meal instead of after.
cheers!
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Permalink Reply by Laura on -
Wow Kim I never heard that and I have been pumping 81/2 years now. If my basal was that high I would be dead :(
My carb is 1 to 15, my fat is 1 to 8% of fat and my protein in 1 to 12%. My basal are mostly .6 or lower some only .3 My A1C was 8.5 now 8 it is coming down thanks to my CGM. I take less insulin now and its coming down because my liver is not shooting me high to make up for night lows. I am not chasing my low to high's anymore. Still working on my 2 hour post easting high's but much safer now.
I would look at your 2 hour post and your 4 hour post eating. I would fast breakfast one day, lunch another and dinner another and see that your BG does. I would do a few 3am checks see what is the difference between that check and what it is when you wake. If your BG rises when you fast you might need to adjust.
Be well and be loved
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Permalink Reply by Kevin on -
Basal rates differ greatly from person to person. My basal rate is 24.55 units/day. It works wonderfully for me. My AIC is at 6.4%. I'm hooked up to a CGMS and it really has helped me figure things out.
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Permalink Reply by Laura on
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Yep I know they do. I just am wondering why double the carb ratio as a measure since your carb ratio is covering the food. Even at 24.55 a day your just a bit over 1 unit per hour and I am thinking you would need more then 1 unit to cover food....grrrr I might be confusing myself which is not hard to do :P
am I making sense?
If not ignore me
be loved
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Permalink Reply by Kevin on
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That sounds absolutely ridiculous.
It sounds like your basil rates are OK. You need to change your insulin to carb ratio for your boluses. If you're dipping to low too quick you can try a dual wave bolus.....that works great for me. I'm willing to help..... I need more info to know exactly what it is you're going through.
Kevin
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Permalink Reply by Kevin on
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My basil rates are about 40% (on average) of my total insulin intake...... that is what I and my health care providers (Endo / educator) have concluded. They have never tried to fit me into some preconceived mold.
Every diabetic is different!
Kevin
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Permalink Reply by Riette on -
On our pump we check the % ratio for basal and bolus for 24hours My doctor said it sould be more or less 50%. I noticed that if the basal is too low more high BG's occur and more correction bolusses is necessary. (Our carb/insulin ratio is 12/1, Bg/insulin ratio 2/1..) I should add my son is in puberty and do need more insulin.
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Permalink Reply by Dave on -
I have yet to read anything that really explains why doctors recommend a 50/50 split on basal and bolus. My basal is about 60-70 percent of my total insulin. My average total insulin is around 26 units.
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Permalink Reply by Laura on
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So maybe I am confused I read the OP like if you took 1 unit for 10 carbs and and ate and average of 30 carbs per meal 3 times a day it would be 9 total daily and then she was told to take 18 basal a day double the carb coverage. What am I missing?
:) I get confused :)
Be loved
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Permalink Reply by Sweeter Cherise on -
Kim-
Hello! I have never heard of this before. I can tell you that everyones insulin requirements are different. I use about 22 units a day (basal and bolus). You might want to ask them why they think your basal should be higher than your carb rate. I don't get it either but I am not a Doctor. I wouldn't change anything until they give you a solid answer. Once you get the answer can you let me know...I am a little curious. Your A1C is a 3 month average...maybe you are experiencing a lot of highs. You might talk to your physician about changing your carb to insulin ratio. You maybe not be giving your self enough insulin to cover your meals; that happens to me at night.
Cherise
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Permalink Reply by Holger Schmeken on -
This is just a rule of thumb and not a law. A minimal approach to check your basal rate would take two days. The first day you check your morning basal rate (1/2 day without carbs) and the next day the afternoon basal rate (1/2 day without carbs). If this works with your current basal rate then it is a correct setting.
But I must admit that I can understand the idea of the rule. There is much potential for improvement in the basal rate setting. I have seen some pumpers with a basal rate that is too low for their needs. As a result the basal rate check shows a more or less stable value that is much higher than the target value (like 130 instead of 100 mg/dL).
I would recommend a percentual approach to change your basal rate - just to follow the idea of your doctor and nurse that there can be something wrong with the basal profile. As an example you could increase every hour of your basal rate by 5%. This way you will not change the characteristics of your profile. After one week you can make a judgement about the change. Have I experienced more lows? Have I seen improvements and where? The next week you can do another percentual increase of 5%. This is a slow but progress oriented approach and it is better than sticking to the old routine that resulted in your current A1c.
Please do that with caution and increase your test frequency to get the full picture of the dynamics of your blood glucose.
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Permalink Reply by Laura on
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Holger I was always taught to fast a meal to see if my BG went up or down to adjust my basal is that what you mean?
And I want to add this is a discussion so doctors idea's always rule above so Kim testing your doctors advice is right. I am just curious and a bit perplexed so I would like to know how it goes also.
Be well and be loved
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