Daily Totals: Bolus vs. Basal

Hi I am a T1 pumper, my doctor just told me that an ultimate goal of mine should be to eventually have my daily insulin totals be 50% Basal and 50% Bolus. Is this something anyone else has heard of?

My blood sugar control has gotten much better lately thanks to Bernstein’s strict carb diet but my Basal is almost 90% of my daily total? How concerned should I be?

At a 90-10 ratio I would be concerned that I wasn’t eating enough. I’d also be concerned that I was constantly on the edge of hitting a low. But that’s just me. If you are strictly limiting carbs it may be just right for you. Only time and testing will tell. It’s hard to judge anything on a ratio alone without knowing the actual numbers involved and how your BG’s are doing.

The 50-50 rule assumes a diet that is close to what non-diabetics eat. I first learned of it in John Walsh’s book “Pumping Insulin”, whIch I highly recommend to all pumpers. The idea is to try to keep BGs relatively level without large peaks and valleys.

It’s not a strict rule, because, as with all other things diabetic - your mileage may vary.

If my ratio was the other way around (10-90) I would be worried that my BG’s were constantly running high and about over correcting for meals.


My doctor really hasn’t told me any percentages it should be. I should be able to eat and correct for eating properly and stay within range. I should be able to go many hours without eating without my sugars spiking or dropping. But it tends to average out to about 50-50.


Because you are on Bernstein’s diet, the standard percentages won’t apply. Those percentages are assuming you are eating 200+ g of carbs. Since bolus is based on the carb/insulin ratio, if you cut way down on your carbs you won’t need much bolus insulin.

There are several type 1s who are using pumps who post on the bbs associated with Dr. Bernstein’s forum, and I’d advise checking in there to see what they might tell you. They have A1cs in the 4% range which is pretty amazing. The board is HERE. You have to register to access it. But if you are a Type 1 doing Bernstein it’s worth it.

I disagree with Terry mainly because the entire basal vs. bolus debate is contrived by medicine, but is completely arbitrary based on a few samples of patients in tightly-controlled clinical trials without having large ranges of diverse age groups, ethnicities, stresses in their lives, etc. – but its not how things work in reality. The 50-50 “rule” is complete BS and is meant to be a guideline only, IMHO.

I am a type 1 adult male, and even when I was pumping (I returned to multiple daily injections for a variety of reasons unrelated to this), more than 95% of my total daily dose is bolus only, with less than 5% being basal. In essence, if I don’t eat, I don’t need insulin to keep things steady but after 32 years with type 1, I also happen to have a fairly high C-Peptide indicating that I still make some of my own insulin, but there are many people do not and therefore require more basal insulin. Women, in particular, are much more likely to need a higher basal because of the presence of certain hormones in the body which can interfere with insulin’s ability to bind to the cell receptors.

Remember, in normal physiology, there is no such thing as basal vs. bolus – insulin is automatically secreted whenever its needed regardless of what causes the need. The notion of basal/bolus does not provide plasma glucose regulated insulin replacement or secretion as functional pancreatic beta cells do. However, you should not be concerned about the percentage of your total daily dose (TDD) which is basal or bolus, just as long as your TDD is not comparatively higher on a per kg of weight basis (unless of course you are sick or having other health issues, which will temporarily change your need for insulin).

Thanks Terry,
I haven’t had any problems with lows and the low carb amount has really enabled me to fine tune my ratios including carb and compensating for highs. I know I should be talking to an endo but I have had terrible luck as a new resident to fort worth with all the ones I have tried so far.
I am going to look into the pumping insulin book, it sounds like it offers advice on my goals.
Thanks for the feedback!

Thanks so much just signed on, hopefully I can find somemore insight here!

My endo set me up with a 50/50 routine when I started pumping in June, 2007. It was a disaster and I had to completely change my whole program. I changed the basals, ratios, the ISF and even the targets. It took me several months to have good control again. Now I have an A1c of 5.7 and things have settled down. Yesterday (4/10) I used a total of 38.1 units of Humalog of which 13.9 units were basal and 24.2 were bolus. That’s 36% basal and 64% bolus. That works well for me. We are all different. Do whatever enables you to have good control, good A1c’s and manages your weight successfully.


I take 32 unit of Lantus (split 50/50 am/pm) and my carb ratio is 1:10, 1 unit of humalog per 10 grams carbs and a CF (correction factor) of 1:25, 1 unit of Hualog loewrs my BS about 25 points. So my basal is about double my daily bolus. It been working great for me, but I may need to up my basal a bit as my base line his risen a little lately.

BASAL is properly set if your BS level stays about the same w/o eating or exercising, example If I start with a good fasting level and it STAYS about the same past lunch, I know my basal is good. If my BS is rising or falling much then I adjust accordingly. Be sure to TEST OFTEN when making any insulin adjustments and make changes in small increments to avoid serious problems.

BOLUS is best when a carb ratio is figured, but can ONLY be done properly AFTER a good stable basal is set. When the carb ratio is right, a proper bolus should bring your BS down to about where it was before you ate.