Has anybody else's doctor told them that their Humalog and Novolog total # of units taken in a day be roughly the same? Right now I'm on 5 units of long acting (taken at night), which would mean 5 units of fast acting for the day. 5 units/ 3 meals = 1.6 units of fast acting per meal. This doesn't give me much choice with food, does anybody follow this guideline?

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Comment by pancreaswanted on January 18, 2013 at 9:16am

i dont follow it at all. i was diagnosed 14 months ago as t1 and am honeymooning. there have been times where my basal bolus split was about 50/50, but my needs change monthly. right now it is ALL basal because i need a lot to make sure my morning/fasting numbers are good. so i take 5 units of levemir at about 7pm. in the am i take another unit. i do a lot of physical activity every day and this is kind of cancelling out the need for any bolus. in fact i just lowered my am basal from two to one because i was just hanging out at 70 all day.
before i changed to all basal i was doing 3 levemir at night and 1 in the am, and 1 unit for 30 carbs at breakfast. physical activity around lunch and dinner meant i didnt have to shoot any fast acting for those meals. i recently posted a question about this because the weird split had me worried too, but all of the experts said not to worry about it, that results were most important, not how i got there. a relief!!
when youre taking lots of basal, acidrock calls it "running you basal hot", adding to the language that no one else outside of D understands. i love secret code!
good luck!

Comment by mpfuchs on January 18, 2013 at 1:46pm

Nobody ever told me about that rule.
But it almost works for me.
Fast acting 2+3+4=9
Long acting =10
per day.

Comment by Clare on January 18, 2013 at 5:23pm

no one ever told me that rule either, I did read that rule somewhere on line, but I take 24 units of lantus, 12/12 and depending on what I eat about 20 units of apidra but as in everything with D, yours may be different. Go with what will keep your blood sugar in line and it really doesn't matter how much that is or what the split is.

Comment by MandiG on January 18, 2013 at 7:02pm

I have never heard of this either. I take Lantus and Novolog. The Lantus I'm on 11 morning and night (22 total) and 1:5 breakfast and dinner, 1:6 at lunch for Novolog. Obiously this varys person to person and even for me I've changed all ratios several times within the last 6 months, like pancreaswanted above) But only 1.6 units per meal.....I think you should talk to your doctor again. Do you mind me asking how long you been with this doctor?

Comment by MegaMinxX on January 18, 2013 at 7:24pm

I have had doctors mention that 50/50 is an average, and often used for starting dosages for newly diagnosed. Or if someone is struggling with highs and lows, some doctors may 'blame' it on not being close to that average, instead of actually checking the details of what the individual does.

For folks eating moderate to low carb, they often have higher basal, 60/40 - 80/20 for example.
Someone in honeymoon may do only basal, or only bolus, or anything in between, depending on their pancreas.
T2s may be very different ratios, based on their insulin resistance, oral meds, and how much insulin their pancreas is providing, and the amount of carbs they eat.

The right ratio / amount of insulin you need is the combination and amounts that keep your blood sugar in range. Period.

But if your BGs are out of control, with no patterns or clues on how to improve, it's reasonable a doctor may want to start back with a 50/50, and then adjust because that's what they are familiar with when dealing with new patients.

Comment by Brian (bsc) on January 19, 2013 at 10:59am

If you look at some of the "standard" guidance such as "Using Insulin" by Walsh. He recommends that someone eating 45-65% of their calories from carbs will use 55-60% of the TDD as basal. If you eat less carbs, then even more of your TDD will be basal.

I think the real problem is that if you are extremely insulin sensitive (which your TDD suggests), then when taking shots (which have a 1 unit minimum dose) you will have to eat a pretty large minimum level of carbs if you bolus and you won't be able to do very precise carb counting and insulin dosing.

Comment by Anthony on January 19, 2013 at 3:58pm

MandiG, I've been with her for almost 2yrs.

Comment by MandiG on January 19, 2013 at 9:30pm

You might consider talking to your "regular" doc or calling other diabetes doc in your area. Just to be safe, ya kno? But you have to again consider everyone is a little different.

Comment by Christy on January 23, 2013 at 6:15am

In my opinion, that's ridiculous. Your basal insulin needs are set based on your typical activity level, and your bolus insulin needs depend on your diet.

My basal insulin needs are much higher than my bolus insulin needs a majority of the days. This is because of my diet... with very few exceptions I stay low carb. If I took as much bolus as I did basal, I would be eating extra food to match my insulin. If I took as little basal as I do bolus, I would be fighting morning highs.

Your basal should be set at whatever your body needs to last a whole day without food. Then you add in bolus to cover food.

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