I want to try keto low carb, but my basal runs higher when I do. I’m pretty much flat lined at 8.0 or around there. It’s the same basal I used for when I’m eating regular carb, so IDK why it’s running at a higher rate, except that my boluses are smaller, obviously, because my carbs are less. Still, I’m bolusing for the right amount of carbs. Should I increase my basal or increase my I:C bolus ratio? I’m on the tandem tslim.
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It might be that when you were bolusing for carbs, part of your bolus was covering for insufficient basal. So now that you are not getting that extra bolus insulin, you see the higher BG.
A basal increase sounds like a reasonable thing to try.
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You are running high because of the glucose that is released into the bloodstream from the digestion of fat and protein. As a first rule of thumb, they say about 10% of the grams of fat slowly turn into grams of glucose during digestion, and about 40% of the grams of protein also slowly become glucose during digestion. With a normal diet we ignore this, because the great bulk of the BG comes from the carbs we eat, so we simply end up setting the insulin:carb a little bit stronger so that it covers the protein and fat too.
But on a keto low carb diet, lots of the BG comes from the digestion of the fat and carb we eat, and so it would be right to bolus for that. The name “TAG Bolusing” is sometimes given to this approach (TAG is “total available glucose”). To do this, start by reducing the insulin:carb ratio, and then bolus for 100% of the carbs in the usual way, plus use a 6-hour square-wave extended bolus for 10% of the grams of fat + 40% of the grams of protein. All these numbers are just a starting point for experimentation, and likely will require adjustment as you learn how it works.
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