Insulin Totals/Bolus vs Basal Percentage

I've been "podding" for about a little over a month now, and have been having quite a difficult time adjusting my basal rates. While on the Minimed Paradigm, my bolus to basal ratio for the day was somewhere in the 40% bolus to 60% basal range. The Omnipod CDE/trainer had advised me to change my basal rates to get into the optimal 50/50% range. I find it difficult to obtain good blood sugars while trying to obtain this 50-50 goal. I'm either too low or too high and I really don't want to mess with my IC ratio AND basal rates. What are some of your basal/bolus ratios looking like? Do you try to maintain the 50-50% ? Or do you just use what works best for you? Are there any benefits (health wise) to the 50-50 ratio?

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Replies to This Discussion

Permalink Reply by daneenm on December 15, 2010 at 8:56pm

We just use what is best for us. Right now my son (9) is at about 40% basal, 60% bolus.

Permalink Reply by Natasha Bowlds on December 15, 2010 at 9:15pm

Same with our 10 year old.

Permalink Reply by Schmutz on December 16, 2010 at 5:06am

Hey Kati...I'm not sure I've ever heard that before. I don't see how you can maintain a 50/50 split as you would have to maintain or eat the same carb intake each day? I would think that once you can find your basal rate it really should not change much other than if your sick or have heard some having different basal for travel or different in winter vs. summer. I am at about 60% bolus 40% basal but there are days where I will go 70% bolus depending on how much I eat since I have a low basal rate. I think ideally you want to find the basal rate that holds your numbers when your not eating and once you have that you should be set and then it is a matter of finding the bolus amount that works as I use higher bolus for certain foods etc. I would use what's best for you and helping you to keep your numbers where you want and that will be you best health benefit!! Good Luck ~Schmutz

Permalink Reply by Jen in CO on December 16, 2010 at 6:42am

I am at around 60% bolus, 40% basal as well. My endo said that was fine - "close enough to 50/50".

I think that is very interesting that your basals are not the same on the two pumps (minimed vs. omnipod) - why would that be??? How are your thoughts so far on the switch? I am new to Omnipod and pumping (about 2 months), but I've been a diabetic for over 20 years.

Permalink Reply by Kati * on December 16, 2010 at 11:52am

I'm extremely happy with the pod- despite the 5 pod failures I've had in a little over a month (although I think 2 were due to being left in my car in the cold weather) and as soon as I get my basal rates tweaked just right all will be well. Although, I have run into two occasions where I was getting some insulin, but was running around 250-280 despite corrections and skipping lunch. I decided to do a pod change and discovered a nice amount of insulin seemed to be leaking out at the top of the cannula (where it connects into the actual pod), Go figure. I'm still so elated about being tube free, I'll take the minor mishaps that go along with podding then getting tubing caught on a door knob any day. :)

Permalink Reply by Bradford on December 16, 2010 at 6:44am

I agree with the others. I'm like Schmutz: 60% bolus, 40% basal most days, but also go up to 70/30 (I love carbs. . . a lot!). I've heard about the 50/50 split before, but never really made it a goal to obtain. I believe it may only be used as a reference "starting point" for those who switch from MDI to pumping (so they know what kind of basal to start at). I also do not know of any healthy benefits for keeping it at a 50/50 range (but I also do not have "MD" behind my name ;-)

While I do not discount that the CDE/trainer probably has plenty of didactic experience (and maybe even have plenty of clinical experience), I think your personal experience is going to trump the CDE's any day of the week. I'd go with whatever works for you.

Permalink Reply by Jenny on December 16, 2010 at 9:54am

I've found that I've had to adjust my basals a little bit with the Pod from where I was on the MM. Not sure why, other than perhaps the site doesn't go as deep as the MM did and therefore, isn't running into scar tissue or whatever else might be lurking after 12 years pumping. :)

Permalink Reply by Kati * on December 16, 2010 at 11:50am

When I first got on the pod I was constantly low all day long, the trainer told me it had something to do with the cannula and lack of tubing? I love that I now have multiple pod sites available throughout my body without that gosh darn tubing attached to me and they are all for the most part scar tissue free :)

Permalink Reply by Marlon on December 16, 2010 at 1:54pm

Well I'm not sure what the 50/50 means to ur doctor. My bolus is 48 & basal is 52 on a normal day for me. If I was you I would just focus on tighter control because some days you may not each thee amount of carb that will match your total basal for that day.

Permalink Reply by MelissaBL on January 4, 2011 at 8:08pm

I've fought that battle with various CDEs over the years. Sometimes they say 50/50, sometimes 60/40, sometimes 55/45... The right measurement is the one that works for you. I have days where I'm 52/48, days where I'm 60/40, etc. Here in the real world (rather than the textbook one where they often live), your daily needs will change based on your diet and activities.

Permalink Reply by Hockey Mom on January 5, 2011 at 8:51am

My son went on the Pod this summer and they had us do fasting basal tests for different times of the day to set his basals. They wanted his BG to stay stable (or within 10-20) for the entire period of the test. He had to eat low carb/fat prior to the test to eliminate as much as possible any effect from food to the equation. We tested every hour or two during the test and he would stay at a perfect 100 after some minor adjustments for some time periods. (His BG would be great if he just didn't have to eat!)

His basals are a little too high now that he is in school and a little more active than he was this summer. We will be in the process of re-testing to re-set his basals as soon as finals are over this month. It's harder to do this during school but it may be more accurate for the majority of his year.

How are they determining your basals ? I really thought the basal rate had nothing to do with the carbs you ate or the bolus for those carbs.

Permalink Reply by Kati * on January 6, 2011 at 8:24am

I was using my basal rates from my previous insulin pump and just tweaking them a bit. The CDE from Omnipod was very concerned about my 40% bolus to 60% basal. I see my PCP for my diabetes care and normally adjust my settings myself unless I come across a really big problem. Anyways, the CDE suggested I should adjust my basal rates to fall within the 50-50 range. I find that difficult to shoot for on a daily basis- I'm beginning to just go with the flow with what works best for me. I've been given the basal testing forms and will be doing some to see where my current basal rates stand.