Combo Boluses

Ok, I know this topic has been posted before, but I want to make sure I’ve absorbed the info and got it right. I made pizza for the first time in 10 months the other night. Looking back in my books, I did much better with my blood sugar last time I made it. I make really good artisan thin crust pizza and found that if I only eat one slice with a salad I can do ok. I didn’t make it again for so long simply because the recipe made 11 slices and I got really sick of it…lol.

Anyway, here is what I thought you should do. I know people with other pumps call it a Square Wave bolus that works for pizza. Since the Ping just has Combo boluses I understood that the equivalent is to do a 0%/100% breakdown. So that’s what I did, upping the dose to 3 units when the I:C ratio said 2.35 and extended it out for 4 1/2 hours as the problems in the past were that I did fine at 2 hours but then went high 3-5 hours later. Well with this arrangement, I started at 106 before dinner and 2 hours later was at 181! Did I misunderstand how to do this combo thing, or is it just the hopelessness of pizza…even really good thin crust pizza!

Now, I could be way off but what I do is take half and spread out half…so I take the dose correct for me when I eat the pizza and then take the other half over four hours and it works really well.

Of course, we’re not all the same and I sure am not a text book case, but it does work well.

I guess they found that you really can take it out for quite a few hours.

So that is like what they call an extended bolus then? And you set it for 50/50? But when you say “you take the dose correct for you and then the other half” do you mean, let’s say 3.00 was the correct dose by your I:C. So would you take 3 and spread out another 3?? Or do you mean you would take 1.50 and then spread out another 1.50?

i’m afraid i’m not much help specifically on this, since with pizza my gastroparesis usually leaves me managing it for about 20 hours. but one of the things to remember is your toppings - changes in the fat and protein will slow down the absorption rate

I think I do 1.8 and spread out 1.8. I also have slow stomach emptying (a minor case) and sometimes that doesnt quite work, but that’s what works most often.
Btw, I took an online webinar from Animas and she showed us some nice tricks to using this feature.
Go to the web site, look up Community and your state and see if they are doing any webinars.
It was so tricky, I ddint know it existed.
Just dont ask me now to remember what it was…

I’m sorry Laura, this must be my day for not understanding. I don’t know if 1.8 is what your normal dose for that number of carbs by your I:C ratio would be? So you, in effect use double your “regular” dose?

Or were you using my example of 3.00 and saying you use 1.80 and 1.80, so in effect 3.60, a bit over your usual total dose??

Zoe, one way to count how much insulin to take is TAG. The TAGers group is here. Given that I’m such a new pumper, I’m not quite at that level yet! What I generally do in meals with lots of protein/fat is estimate what % of it is carbs, then divide my dosage into carb% at once then protein/fat % over 1-2 hours.

So if my pump says to take 3u, and 60% of what I’m eating is carbs and 40% protein/fat, I’ll do a combo bolus on my Ping with 60% now and 40% over time. It’s not working perfectly, but better than taking it all at once and having my bg go up in a couple of hours. Hope this didn’t confuse you more! Do check out the TAGers group.

With Pizza I do 40% right away and then 60% spread out. You may need to play with that till you get it right. TAG is a super group. They have more information than I could have ever dreamt of. You should really check it out.

everybody responds to pizza and insulin differently. you have to play with the combo bolus to figure out what works for you.

I have found that I need more insulin than based on my carb ration for pizza, and I do need a little up front. So I do 25% upfront than extend the other 75% over 4 hours. I’m not a big pizza fan, so I don’t eat it much, but I found that this worked great for me last time

Thanks, everyone for giving me some ideas to play with. I’ve still got 8 servings left over so plenty of opportunities to experiment.

How much more do you use than your normal ratio, Donna? Have you ever had gourmet pizza? It’s a whole different thing!

Whatever the suggested dose might be, I take half of it and spread out half of it.

No, I dont double anything.

Like Sandy does 40/60, I do 50/and spread out 50.
The TAG group is way too complicated for me.

Thanks Laura. I agree on TAG, I’m not planning on starting to also count protein anytime soon; I feel I’m at my limit of how much time I want to spend thinking about diabetes and if in the end I can’t eat pizza, well it will just join the list. And I think the long rise with pizza is the combo of fat and carbs, not necessarily fat and protein, but whatever works for people is great!

you could be ruthless about it and pick a time when you don’t have to do anything, be anywhere or sleep. then on an empty stomach eat a slice of pizza. don’t bolus. check your glucose every 15 minutes and write it down. it could be several hours for pizza, maybe even most of a day.
it’s uncomfortable but it tells you how your body handles the pizza, how long it takes, etc.
it’s also not the smartest idea, and hard to explain to most doctors why that one crazy spike happened. but it will answer your lingering questions.
[i do these experiments myself with a CGMS so it’s much easier, but still makes you feel like you’ve been hit by a truck]

Thanks for the suggestion, Marti. I actually think I’d rather just try various combinations of percentages and doses that are higher than I would normally use for those amount of carbs, that way I’ll see what (if anything) actually works! But I can see it would be useful to know exactly when the spike happens. I find it interesting that when we’ve had discussions on the forum, I think I remember people talking about square wave boluses (which in ping speak is 0%/100% and nobody’s suggested that. I did actually try that and spiked at the two hour mark which for me was a step backwards. Trial and error.

I’m lucky that I don’t have to explain my numbers to anyone (my doctor knows he wouldn’t have a clue, and I don’t see an endo). I only have myself to explain them to and that’s hard enough!

Boy me too.
That’s why I dont care about the new software deal.
I have to think through all my choices, and think them through again and again, and no one looks at my numbers anyway. My endo will randomly pull something out of the hat, and put me on the spot and I have to work really hard to get him to understand my reasoning.
My situation is very customized and my choices cant be explained easily.

Yep, that’s why I say that my favorite kind of doctor is one who will leave me alone! (Except for writing prescriptions of course!) That’s what I have now and it suits me fine. Unfortunately I plan to switch from my PPO to Kaiser in the fall to save money and it’s going to be a stretch to find someone as hands off as I like!

Zoe - have you checked out the TAG group?

That’s what I would use for your pizza.

I think they take things way beyond what some of us have time for!

Interesting…I have a very busy life and after a week or so of learning, I’m able to handle it just fine. And, bottom line is, success speaks for itself.

My A1c is very, very low and I rarely get spikes anymore. And, TAG is especially great for covering things like pizza.

Thanks, Cheri, but it seems like too much investment for one or two foods. The rest of the time I do fine with just bolusing for carbs. My goal is to spend less time thinking about diabetes, not more…lol. But thanks for the suggestion!