Should bolus rates be consistent irrespective of activity?

Struggling with control of numbers with my very dedicated 14yo daughter. We're working constantly to steer a more even course but lately have been yo-yoing a lot with too many hypos (she's hypo-unaware and always has been since dx 4y ago).
One thing we're looking at is bolus rates. On her pump there is only a provision for a single set of bolus ratios (broken down by hours/day). However, we have 2 sets of basal rates - one for active (weekdays) and one for sedentary (weekends). These are approx. 15units basal for weekdays and 21units for weekends so you can see there is substantial difference.
However, we note that we bolus at the same carb/unit ratio on all days and wondered should be also be increasing the rate (along with the basal) for the more sedentary weekends?
Thanks for any advice,

I would start again with basal testing, it can change over time..without the basal properly done, you may be chasing your tail, this is in UK measurement but there would be USA ones.

I tend to run the same bolus to carb ratios and make the changes to the basal rate. Maybe her basals need to be retested?

Maybe you need to retest all her I:C ratios?

Have you thought about getting her a Dexcom G4 - or using CGM if she has a Medtronic pump? I think this would give you valuable information and it would also alert you of upcoming lows. Most insurances will cover it if she is hypo-unaware.

However, we note that we bolus at the same carb/unit ratio on all days and wondered should be also be increasing the rate (along with the basal) for the more sedentary weekends?

First, a quibble on terminology just to ensure I am understanding your question correctly. I think you are talking about the settings in the pump's "bolus wizard" feature for Insulin to Carb (I:C) ratio, the Insulin Sensitivity ratio, the length of time insulin is active. Yes? The term "rate" is usually only used to refer to the background basal insulin since this specifies an amount of insulin over a period of time. A bolus is a one time, single dose of something.

As to whether or not bolus amounts should be adjusted to account for activity/exercise, I would be surprised if they did not need to be changed unless the change in physical activity is very slight. But I think this really does depend very much on the individual and how their body's sensitivity to insulin is changed by exercise.

In my case, since I tend to inactive more often than active I will override what the bolus wizard suggests and reduce the amount of the bolus before or after a period exercise. However, I tend to be very sensitive to exercise. If I forget to adjust my bolus amounts it can lead to a hypo later.

The timing of the change can also vary. You obviously expect that there might be a change in the amount of bolus insulin needed either just before or after exercise. However, it can also affect insulin needs hours later. You really do have to find out how it affects the specific person. I do not think it is safe to make general recommendations much beyond "watch out!"

Insulin & exercise is potentially a very complicated topic. How to adjust both basal rates and bolus amounts depending on activity level is something folks like John Walsh ("Pumping Insulin") & Gary Scheiner ("Think Like A Pancreas") spend a lot of time trying to work through both in their books & on their websites. John Walsh has a number of powerpoint presentations on his web site. They tend to be rather dry & technical, but maybe they be of some help?

And, yes, as has already been pointed out, the process of trying to figure this out usually does start from the bottom up. It makes no sense to talk about adjusting carb or sensitivity ratios before you know that the basal rate amounts are appropriate. Usually it is suggested you work with your doctor/CD/whomever when doing this since things can get very wonky in unexpected ways if you suddenly change basals too much.

Of course, I tend to hate checking my basals simply because it means I can not eat during that period of time. <sigh />

CGM is a bit a game changer. It used to be that the basals I trusted the least were my overnight rates. I found it really hard to get myself up & test my BG enough to verify my rates.

Now the overnight early AM basal rates are the ones I am rather more confident are correct. Those are the periods of the day when I find it it is easiest to not eat and the results from my CGM tend to be flat more often than not.


thanks for you lengthy reply and much appreciate the input. Yes, I was a bit sloppy with my terminology. And yes, I think it's time to do more comprehensive basal rate tests to ensure we have that firm foundation. Otherwise, it's all too easy to chase your tail changing other values.
We see our endo ~5 months so their advice is sometimes reactionary and we get so tired that you sometimes miss the wood for the trees. Another problem we have is that we feel her sets sometimes don't 'take' and that variable needs isolating (questioned elsewhere). And as you know, there's a lot of factors that must align to begin doing a basal test and life often gets in the way - as does diabetes.
And as for exercise, I've read both books but could use a re-read. We do document both the immediate and delayed affect that exercise (of various kinds) brings but it's hard sometimes to be conclusive that consequence A is tied to affect B.
Still, thanks for taking the time to help us stop and reflect and re-focus, it's good to hear it from others,