Does anyone know how the combo bolus feature works on the pump? I just need a quick lesson and I don’t have time to go to the class/discussion that Animas sometimes has in my area. Thanks in advance!
The combo bolus allows you to stretch out the insulin administered to cover carbs that take longer to digest (ie. pizza, rice, pasta, etc.) So say you need to take 7u, you would enter a percentage for now/later and the amount of time you want to stretch the 2nd part out. I usually do 60/40 or 70/30. The second portion is then administered slowly over the amount of time entered. So if you did 7u with 50%/50% over 2 hrs, you would get 3.5u now and the remaining 3.5u would be administed with your periodic basals.
I am not a CDE or anyone to give real federated advice, if you call Animas on the phone they’ll give you some tips. In the meantime I found a good picture here http://en.wikipedia.org/wiki/Insulin_pump there is a discussion about a multi-wave or combination bolus.
The nut of combo bolusing I have found is it’s trial and error. start out conservatively. test test and test again.
Both Mike and Jodiiiii are correct. Some now and some over the time you specify in half hour increments. I was doing 50/50 over an hour and a half. I got tired of waiting for the 50% to be delivered from my meter/remote so I changed to 100% over an hour. I also wear a CGM (Dexcom). My lines actually improved. Additionally, I was able to “set it and forget it” as the Ronco infomercials go.
I asked my CDE about spikes occurring 2-3 hours after eating. Her comment was it depended on the fat/protein to carb ratio in the meal. So different meals need different formulas was her teaching that day.
The graphs on the wikipedia article are Medtronic terms, not Animas terms. So do not get frustrated when you cannot find “square wave” in Animas literature.
Animas tech support will tell you how but they say they are not permitted to give numbers/percentages for boluses. You must have the numbers to program.
When I eat chicken and steamed broccoli, I use the 100% over 1 hour.
When I eat lasagna, which is much higher fat and carb, I use 100% over 1.5 to 2.0 hours. Still experimenting.
Hope all of this helps.
Thanks everyone for your help! It helps a lot!
We’ve used combo bolus for pizza and bagels. Usually do 70/30 for an hour. This would mean 70% NOW, 30% spread out over an hour.
Keep in mind that if the insulin remains active over 3 hours, then that 30% that is spread out will last for 3 hours beyond the timeframe you set.
In the example I gave, that means you’d have some IOB active 4 hours after the meal.
I believe this is important to understand, because the first time we tried it, we spread it out over 2 hours, and probably did 60/40. We suddenly found our daughter to be in the 40’s about 4-5 hours later. I believe it was because the pizza was mostly digested, but she was still had active insulin onboard because of the extend timeframe.
If we had given 7 units, that means 60%, or 4.2 units would’ve bolus immediately, and 40%, or 2.8 units would’ve been spread out over two hours, or 1.4 units per hour. So three hours after eating, the inital bolus would’ve been gone, but there would still be some of the 2.8 active (maybe 2.4+ units). Four hours later, there would’be been maybe 1.3, and five hours later there still would’ve been maybe a half unit. So you can see that if the food is digested, and you still have active insulin, it could cause a low.
It is trial and error… so remember to TEST frequently. The schedule I try to follow now when using a combo bolus is 2 hours after meal, and then at least every hour unil there is no more active insulin.
The formula I’ve listed above worked pretty good for my daughter for pizza/bagels, but each kid is different, and each food could be different. Lot’s of moving parts!
I took their webinar, which ended up being a very nice nearly personal phone call on advanced pumping.
You can click Community on the site, and then look for your state. Taking it from the comfort of home is a nice feature.
Btw, they taught me something I did not know about and it was pretty cool.
I believe I have a pdf from the session with the info in it.
Let me know and I can send it to you if you want it.
A question for everyone that combo boluses. Say you were eating pizza. If you did not combo bolus, would all the insulin act all at once, causing you to drop before the carbs/fat fully take affect? Or when you combo do you need to increase the I:C ratio to keep from spiking? Basically, does the fat cause an insulin resistance?
For myself yes. Pizza and a high carb Mexican food meal do this.
If I take a normal bolus, I look at my BG and think golly that is awfully low.
Then in a couple hours, it goes way way up.
I usually take half and spread half out over three hours.
Works well, but still needs a bit of tweaking.
Thanks! I’m the exact opposite. If I bolus everything at once, my tissue has some sort of reaction and can’t absorb all the insulin at once. I need to combo bolus everything over 2-3 units so it works faster.
I did this a few times and had some pretty nasty lows (38, 42), followed by horrible highs (>250) that didn’t want to come back down. I now combo bolus for any meal with a high fat content. (What did I do before my pump??).
Hi Jill -
TAGgers use the combo bolus for almost every meal - read about it here - http://www.tudiabetes.org/group/tagers?xg_source=activity
I wished I knew too…I couldn’t help you…But I would like to know myself…Darlene
You sound like me mine has went down to 20…its scarey…