Combo Bolus

Diabetes Technology Insulin Pumps
#1

Well my son has been on the pump about 6 weeks now and wanted to start to get familiar with the combo bolus so I trial. Was hoping those that use this feature can put some perspective on my results.

At 12:30 pm yesteday afternoon his BG was 216. He went to lunch at school and came back to the nurses office at 1:08 where he bolused 16 units to cover the lunch. The nurse always tests him before he gets on the school bus and yesterday at 2:30 pm he was 148.

Right before dinner at 5:30 pm his BG was 192 and I had him bolus 1 unit for correction.

This is when the test started.

He had pizza only - 30 carbs to a slice and he had 5 slices.

I had him combo bolus at 50-50 so 7.5 units of normal bolus and 7.5 units spread over 2 hours.

His premeal BG was 192 ( I know the best case scenerio is to start in in a good range) but . . . diabetes is not perfect.

So Premeal was 192. At the one hour mark he was 179, at the two hour mark he was 168. So if I understand the purpose the 2 hours is to see if the first portion of the bolus was the correct amount needed to maintain nomal BG levels 2 hours after the meal.

I checked again at 4 hour mark and BG was 193. As I read the purpose of the four hour check is to see if the 2nd portion of the bous - the extended bolus was the ocrrect amount needed to maintain nrmal BG levels 4 ohus after the meal.

I tested him at the 5 hour mark and he was 186.

I was supposed to check him at the 6 hour mark and not the 5 hour mark but he had reached the point where he needed to adjust his basal level for sleep so I corrected the 186. He woke up at 119.

So I guess my question is did the 50-50 combo bolus do what it was supposed to do or did I need to ensure he was within normal range before starting the test. It seems to me based on the testing done his numbers were dropping and at the 4 hour mark they were within one point of the premeal bolus.

At the 5 hours point they were lower so a fair assumption would be that had I tested at the 6th hour he would have been in the 160-170 range.

Would love your feedback.

#2

Ideally, a proper test would be to start from where he is not coming from just correcting for a high and is in a more normal range. Also it would be better to test when the meal has fewer carbs. But it appears you have the concept correct. Has you trainer - trained you on the use of the combo bolus?

I would suggest you purchse “Pumping Insulin” by John Walsh from Amazon. Both you and your son shuld read this. It will describe the appropriate testing of carb ratios, correction rations, basal settings etc. It also discussed the combo bolus - also called dual wave bolus.

#3

we met with an Animas trainer in a group and have an individual session with her next week. The training group was on the combo bolus. She said the same thing as you - however, mentioned that the ideal world would have the test in a normal range but for teens that can be tough.
I have heard a lot about pumping insulin and will check out the book at the bookstore.

Good idea on the fewer carbs - I will try that.
Oddly, my son wanted pizza again so I repeated the test. He had a bit more pizza (180 carbs - 18 units). However when I tried to do the combo bolus the pump only went up to 16 units so I left it at that realizing that test would not be ideal either. He started at 79 and after 4 hours was 171. My guess is that the extra one unit he did not receive on the normal bolus or the 1 unit he did not receive on the extended bolus probably had something to do with the why he rose after 4 hours.
Would you know if 16 units is the most the pump goes up to for combo or is that a setting that needs to be changed.
Thanks

#4

Keith, On the Ping, you can go to “Setup” -> “Advanced” -> “Screen 3” to adjust the maximum bolus limit.

Just as an observation, you folks seem to be dealing with awfully large carb loads. The recommendations I’ve received are to try to stay somewhere near a 75 carb max for each meal. I will note that I am an adult, not a growing boy, so the guidelines may be different.

#5

Hi Bob
Thanks for the input - our recommendations were 75-90-90 for breakfast lunch and dinner. Sometimes he goes thru these insatiable eating cravings where he can’t get enough. I guess its hormones, growing etc. He just turned 15.
You mentioned setup - advanced and screen 3 on the ping - I couldn’t find set up / advanced etc on the meter. Can it be done from the meter?

#6

You can only set this on the pump, not the meter

#7

right you can only adjust the limits on the meter.

#8

Based on what I’ve read you have the right formula. However from personal experience, pizza isn’t a good food for any eval. Takes too long to digest and is never very accurate. But you seem to have done very well :). I use a 1 hour combo to get back down faster but, I hardly ever eat more than 60 carbs. I’m an adult though and not a growing boy. I really wish I could wake up at 119 after just 2 slices of pizza for dinner. Just goes to show you how different everyones body responds to food and insulin which makes it really hard for us to give you accurate advise. I think you’re doing great though. Keep it up!

#9

Hi Keith -

I think you might be interested in TAG (total available glucose) - http://www.tudiabetes.org/group/tagers

I use the combo bolus exclusively.

Let me know if you have any questions.

Cheri