When switching to a low carb approach to T1D from a different regime how might one go about calculating a basel rate and how do you decide whether to split the dose and at what ratio? On my non-low-carb approach I was taking 16 units of Levemir at night. I’ve now split it into 8 units at 10pm and 8 units at 7am. How does that sound? As I only take about another 3 or 4 units of rapid acting to cover my food now, the basel amount seems rather high. I’ve read Dr B’s wonderful book but still can’t work this out. Any advice please.
If your basal is accurately set up, what you eat, when or how much shouldn’t affect it at all. The basal is ONLY designed to keep you steady when you’re not eating. If you’re noticing a difference based on going low-carb, maybe your basal has been covering part of your meal needs, and you need to go back and do basal testing again. Walsh’s book Stop the Rollercoaster tells how to do that, but there are other books as well. And other people may have good suggestions, too.
I agree with Natalie, your basal insulin should not have anything to do with what you eat. When I do basal testing, I do it for 24 hours so I know everything is working right. Most people do theirs in 8 hour shifts. When you do the testing, you want to make sure all food is out of your system as well as fast acting insulin. You don’t want to drink coffee or other caffeinated beverages, eat or take fast acting insulin. The idea is not to go up or down by more than 30 points – if you start at 100, you should not go above 130 or below 70. Test your BS about every hour during the course of the test. If you stray outside the 30 point spread, you know you need to adjust your insulin accordingly and then try again another day.
Spitting your Levemir in half to start with is a good start but you may need to adjust it. Some people need more basal over night and others need less. You won’t necessarily end up with an even split. I take my Levemir 3 times a day and have 3 different amounts with the most being in the morning & the least in the evenings – overnight is in the middle.
Thank you both for your replies. Does my basel rate of 16 units Levemir seem high to you, especially as I take so little in bolus doses? Could I ask what your daily doses of basel and bolus look like?
Thanks for your replies. I’ll do a 24 hour basel test and see what that looks like. What kind of doses do you two take averagely, if that’s ok to ask?
There are many sources that tell you that you basal/bolus ratio should be 50/50. But that is all based on a high carb diet, one where you get 45-65% of calories from carbs. For a lower carb diet, this rule just does not apply. My ratios more like 75/25 or even 80/20. Think about it, if you are the same person and you just lower your carb intake, your daily bolus requirements drop, your total daily dose drops, but your basal will stay pretty much the same. I have a pretty active liver, a strong Darn Phenomenon. My basal rates are what they are, pretty much independent of how many carbs that I eat.
ps. If you eat three meals a day, 3-4 units/meal, that is 9-12 units of bolus a day. that is a ratio of about 60/40, hardly as lopsided as mine.