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Re: [IP] Basal vs. Bolus Ratio Mystery

Hi Kim,

> does it sound like a mistake in calculations to you?

How are you calculating your hyperglycemic correction factor (HCF) of
110 mg/dl/unit?

"Pumping Insulin" suggests using the "1800 Rule" (see p. 116) for
Humalog. I use about 35 units per day. The 1800 rule suggests I need
1800/35 = 50 mg/dl/unit or an HCF of 50:1. I find, in fact, that this
reflects what I actually need to correct hyperglycemia, up to 250
mg/dl. (Above that, I need more insulin to correct.)

If you're only using 16 units per day, your body is probably still
producing some insulin. Your calculated ratio will be about 1:110, but
it's unlikely to reflect your real needs when you're hyper, since your
body probably doesn't react very efficiently to hypers any more.

You might try a test to measure the HCF when you're at normal bg
levels. You'll need to fast for two mornings. The first morning, test
your bg after you wake up, and test every two hours for 6 more hours
(3 more tests). If your basals are well-adjusted, your bg should
remain fairly stable. If they're not, adjust the basals first.

Once your basals are adjusted, choose another testing day. When you
wake up, test your bg. Wait 2 hours and test again. If it's stable
(should be now that your basals are OK), eat 15 g of carb (5 oz of
OJ), wait 2 more hours and test your bg again. Wait 2 more hours and
test a last time. If your bg went up by 100 +/-20 mg/dl, the ratio's
correct at normal bg levels. My guess is that your bg will go up no
more than 30 mg/dl. (I'd be curious to learn your results.)

The number you'll measure is the HCF at *normal* bg levels. It will
not necessarily be the ratio you use for correcting hyperglycemia. The
only way to measure the HCF when hyperglycemic is to see how much
insulin it takes to lower your bg from around 225 to around 125. Since
you're diabetic, you're sure to have such an occasion. ;-) If you need
only a single unit, then the ratio you stated, 110 mg/dl/unit, is

regards, Andy

P.S.: I have a carb-to-insulin ratio of 15:1. My hyperglycemic
correction factor is 50:1. It falls to 30:1 above 250 mg/dl.

Wednesday, April 3, 2002, 5:05:00 PM, you wrote:
> I have been reading J. Walsh's Pumping Insulin and trying to figure
> out my correction and carb ratios. Here's my problem: the ratios
> seem correlated in the book, and I would imagine they should be
> within a certain range of each other. (Like the initial trial of
> 1:15 carb/1:30 correction you get from MDs). Mine seems to be way
> off (yes, yes, everyone's different....) My carb ratio works around
> 1:16 - 1:17 but my correction bolus is 1: 110. Could this just be me
> or does it sound like a mistake in calculations to you?
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