Basal to Bolus Ratio- Whats the big deal?

I went to my endo 2 weeks ago and got lectured about my basal to bolus ratios. Since Ive been doing low carb for 7 months they are about 75/25. My a1c is down to 7.1. She says it has to be 60/40. Well if 75/25 is working for me i dont see the problem. And if I am eating low carb and taking less insulin wouldn't the numbers be different then when I was eating 150-200 carbs per day? Of course I take everything she says with a grain of salt until I do the research and decide whether that is something I need to do or not. And I can't seem to find real clear answers, so I think I am fine with what I have been doing.

Your endo is an idiot. You're right, it isn't a big deal. The basal to bolus ratio is merely a guideline. It only makes sense that if you eat less carbs your bolus needs are less and the ratio would be skewed. Try "if it's not broken, don't fix it" on your endo, maybe a cliche will work better than logic!

If your control is decent, what's the problem? There are all sorts of guidelines for various insulin dosing routines, but they are only that. Guidelines. Do what works for you. The proof is in the a1c.


You can't fine clear answers because this is just another YMMV thing for us. If 75/25 is working for you then I think you are fine doing it. Some docs just follow that book of D and don't think we can manage on our own. Could be your basal to bolus ratio will change again some day, so good for you for understanding it at all.

The basal/bolus ratio thing came about based on a diet that is based on 45-65% of calories from carbs. If you reduce carbs, then you would expect a change in your ratio. My ratio varies between 75/25 and 80/20.

Having a good A1c doesn't automatically mean that your ratio of basal to bolus is optimal. A more relevant question is - are you having lows 4 or more hours after your meals? If you are bumping up the bolus and reducing the basal a bit might solve that problem.

I don't understand. If your control is good, what's the issue? I could understand your endo being concerned if you were having lots of lows or having to eat frequently between meals to keep your BG up, but that doesn't sound like it's the case. Diabetes is different for everyone and everyone's insulin needs are different due to factors such as diet, exercise, stress, hormones, stage of life, schedule, etc. There is no "right" answer here, assuming that your BGs are controlled and your A1c is within a target range. Yes, most people see an change in their basal/bolus ratio when going low-carb. That is normal. If 75/25 is what works for you, don't change a thing!

I really hate endos sometimes.....

My endo is good for one thing and one thing only, he can sign prescriptions. Beyond that I'll ask my cde who knows a crapload more than the endo, and as a general rule she agrees with what I am doing. If it ain't broke don't fix it.

I would think that rather than worrying about the precision of a ratio, they'd worry about the BG numbers? If you're running up at a specific time, like after lunch or after meals, I'd take more bolus for those particular situatiions to see if it might improve things? Maybe not a lot. This would inherently nudge the ratio somewhere but my goal is the BG that leads to the A1C and all the other stuff, not a ratio. I think a lot of docs use 7.0% as a cut-off but I don't think lecturing about ratios is the correct approach. She should be able to identify which ratios need adjustment based on a log. You probably can too. If you don't totally hate the endo, maybe try to kick her butt doing it your way and continue improving while not doing what she tells you? Then again, you and your insurer are paying her and, if you think she's not being helpful, maybe you should tell her: