“Dual-Wave Danny”. I have continued to have splendid results with the 70/30 dual wave. My bg’s have never been better. So I must reiterate, Thank you DWD! 
Danny, I’m laughing. Bananas send my blood sugars through the roof - in fact most fruit does. I’m insanely jealous of people for whom fruit is just another food with exactly the carbs it says. I can mostly go without fruit (I eat lots of healthy non-root vegetables) but we’re coming into summer in Australia and all the lovely stone fruit are just hitting the stores. And mangoes! Yum. I managed last summer with only 2 small mangoes. No idea how I did it. Even eating it with a protein, fruit still makes my BGs go crazy.
So, yes, we’re definitely all different. If a banana is 20 carbs, I bolus for 25 or 30 (depending on size). I also can’t bolus way before a meal because I’ll go low. My problem is 3-4 hours after a meal. If you only took my numbers 2 hours after - perfect! ! I also have to bolus if I have a protein-only snack or meal. Just 2 eggs will send me out of range. Totally unfair! LOL
I’m still struggling with different types of meals. My 70/30 doesn’t always work. If I have something steamed with almost no fat, then a 60/40 works better. If I have something with more fat, then I can do the 70/30, but I have to do a small extra bolus at the 2 hour mark. And despite all that, I sometimes completely miss the mark and can’t figure out why. It’s all experience and the more I do it, the more I get what works and what doesn’t.
After two weeks of trying this method, my average daily BG came down from 182 mg/dL to 155, and my standard deviation came down from 77 to 67 mg/dL. I want to start fine tuning the method with more careful documentation now that I’ve proven to myself that it works.
The most surprising thing is that the same amount of insulin actually hits me harder from a 30-minute square bolus than in a normal bolus. This must be related to absorption. This is counterintuitive using the insulin timing curves, but for me its true. I have also tested positive for insulin antibodies; I wonder if the absorption issue is related to that?
I tried correlating my blood sugars to a number of things in the attached graphs, just trying to make sense of it all.
Danny, CDE’s always look at me funny when I estimate 10g CHO for a banana - they’re alomst a free food for me too!
I created a TAG method square bolus worksheet. Unlike Danny’s method, this gives 100% of the carb bolus up front and only squares the fat and protein content. I’m still testing both methods but the TAG method was just complicated enough that I needed a spreadsheet!
That’s it Grace! Totally jealous! LOL
Danny, This discussion has helped me more than any CDE or endo ever has. Thanks!
Hi Grace,
Great job on the spreadsheet.
It looks like you based your spreadsheet on the percentages I gave in my original post. The 40% may not work for you and you may have to tweak the percentages. You may also have to tweak the rate of delivery for the square/ extended bolus, since your body may digest fats and proteins at a different rate.
TAG is definitely more complicated, but our bodies are complicated. Many of the posts I have seen in this thread are just dual waving the carbs, whereas TAG accounts for the effect that proteins and fats will have on your BG.
I read about TAG in Total Available Glucose - A Diabetic Food System, by Mary Joan
Oexmann MS RD, ISBN 0-688-10004-X
It appears the book is out of print. It was published in 1989 and 1990.
The book only had about 2 pages that talked about TAG, so it is not even worth getting. If you understand the principle, you can make TAG work for you.
If you insist on reading it for yourself, used copies are available at Amazon.com for a penny plus shipping.
The dual wave bolus works in a way that you get x amount of insulin up front and then over the next 1/2 hour to hour (or what ever you pick as your time) it gives you the remaining dose in very small incriments. Kinda of like your pump giving you your basal through out the day. Hope this makes some sense
Hi Danny,
Thanks for keeping this thread going.
Some in this thread are using the method of dual waving based on carbs only. Others, such as myself are using the method referred to as TAG to dual wave based on carbs, fats and proteins.
I thought it would be helpful to mention a little test that anyone can do to see if they would benefit from the TAG method.
Assuming a person has their basals properly set to keep them at an even BG when not eating:
- pick a time where your BG is in normal range and stable
- eat a small steak or piece of chicken or fish (high protein meal). I use about an 8 ounce piece of meat.
- do not eat anything else (especially carbs)
- do not bolus for the high protein meal
- watch you BG over the next 3 - 8 hours
Essentially, you are doing a basal test with a non-carb food, just to make sure that you only need to bolus for carbs.
If your BG stays flat, TAG will not help you. A type 2 diabetic may still have good second phase insulin release and can prevent the meat from raising their BG via gluconeogenesis.
If you notice your BG starting to increase over time, it means your body is converting some of the protein in the meal to glucose (via gluconeogenesis) and you may benefit from TAG.
I learned this lesson the hard way after a Ruth Chris steak. My BG kept rising for the next 8 hours
Hi Danny,
From the example you gave, it appears TAG could help you.
I am assuming you counted the carbs in the chicken wings and sauce and calculated the bolus based on the carbs only , using a dual wave bolus. If this is the case, you used the grams of carbs with your i:c ratio to come up with how much insulin you needed to cover the meal
If you added up all the insulin you needed to cover this meal over the 8 hour span (initial up front bolus + square wave + corrections), you will see that it is a quantity of insulin that exceeds what you would have calculated based on the carb count and your i:c. TAG explains it by saying that you only counted the direct carbs without accounting for carbs produced by the proteins and fats in your food.
The standard TAG formula says that approximately 50% of the protein in a meal will be converted to glucose and about 25% of the fat will be converted. I tweaked those numbers for my metabolism. Carbs coming from the conversion of proteins and fats to glucose is a slow process and will affect you hours after the meal.
Using your example of 1.5 units up front and 3 units over 3 hours meant that your square wave was set at a rate of delivery of 1 unit per hour (3 units/ 3 hours). This rate of delivery was great for you because it kept your BG stable. You were delivering the insulin at a rate that matched your body’s metabolism of the protein and fat in the meal. If you simply stretched those 3 units over a longer time, the rate of delivery would have been less and most likely you would have seen you BG increase.
It looks like you needed that 1 unit per hour delivered for a longer period of time than 3 hours. TAG would have told you you had some additional carbs to account for and would have had you extend the square wave for a longer period.
One way to figure it out would be to take the correction you took and add it to the square wave, while keeping the rate of delivery at 1 unit per hour.
Danny,
The 8 hour bolus can be a problem if it is stacked on top of an upcoming meal or exercise.
This is where you have to take into account the carb loading of the new meal or any upcoming activity.
For activity, you may have to cut or shut off the extended bolus. For a new meal, you would have to calculate a new dual wave which combines the new carb loading with the remainder of the unused portion of the previous extended bolus.
It gets complicated, but it works well when used correctly. The fact that it is complicated might be why TAG never really caught on and the book is now out of print.
Danny,
I am just bumping part of the post which mentioned the TAG book since some may have missed it and wonder where TAG came from.
TAG is definitely more complicated, but our bodies are complicated. Many of the posts I have seen in this thread are just dual waving the carbs, whereas TAG accounts for the effect that proteins and fats will have on your BG.
I read about TAG in Total Available Glucose - A Diabetic Food System, by Mary Joan
Oexmann MS RD, ISBN 0-688-10004-X
It appears the book is out of print. It was published in 1989 and 1990.
The book only had about 2 pages that talked about TAG, so it is not even worth getting. If you understand the principle, you can make TAG work for you.
If you insist on reading it for yourself, used copies are available at Amazon.com for a penny plus shipping.
http://www.amazon.com/gp/offer-listing/068810004X/ref=dp_olp_0?ie=U…
Danny,
Don’t forget to take into account that if the meal is considered high fat, it may slow the metabolism of the carbs. In this case I move a portion of the upfront bolus into the extended so that I don’t drop low early on.
It’s trial and error when you start TAG.
Ricardo & Danny,
You guys rock.
I’m loving this discussion; but I can’t help playing devil’s advocate for a second. WHAT IF… all of our i:c ratios are wrong because we do bolus testing on meals with some fat and protein. SO… the TAG method is working because it effectively increases our total insulin for the meal, and also stretches it out over time to mimic both second phase insulin release and slower digestion of carbs when they are “encased” in fats and proteins. The method works, not because 25, 40 or 50% of fats and proteins are actually converted to carbs, but because it mimics normal digestion much better and solves the accuracy problems inherent with bolus testing. Is this just another way of looking at it, or does this explanation miss some aspect of why these square boluses work so well?
Hi Grace,
You can test this theory very easily.
If the success of TAG is due to faulty i:c ratios, the TAG i:c ratio should still work if you ate a carb only meal. I know in my case it would be way too much insulin, even if I spread it out with a dual wave.
This is SO helpful. I have had great numbers for the past few days. I wonder if those of us doing lower-carb diets find the TAG more helpful - because maybe more of our protein and fats are being turned into glucose. I know I’ve been kind of frustrated by the 1500 and 1800 rule that don’t seem to apply to me at all and by the constant statements of “you only need to bolus for carbs” and “fats do not raise blood sugar.” So hearing that some of you, like me, have to bolus for protein and fat makes me believe that I"m more normal than I thought.
Maria
Hi Maria,
TAG makes a lot of sense, when you consider that the body cannot store excess protein when you eat, so it converts any excess protein, above and beyond what you need to repair your body, to glucose as an alternative energy source. It does the same with fat to a lesser extent.
Our brain needs carbs to function. Gluconeogenesis is a back up source of carbs, especially if we restrict them in our diets. For many of us, if we do not account for this in bolusing, we will tend to have a lot of unexplained highs.
I remember when carb counting came into vogue and my CDE mentioned I needed to dose only for the carbs! Hah!
With absolutely no self-insulin production as a type 1, I just don’t think this is solid science.
I’ve greatly simplified my TAG math by automatically including 1 unit of fast-acting for a “normal” protein meal (about 4-6 grams of protein from any source). This is my cheater way of doing it since I’m too lazy to do all that assessment of my metabolism (unlike Ricardo, who rocks).
Another thing that makes life (and our math) so complicated is that few of us eat a meal composed of only one type of nutrient. So those cashews that seem like mostly fat? They actually have 7 grams carb, too. And that much carb, although slower to act, is nearly equal to 2 glucose tabs.
Different is the new normal, right?!
Hi Kelly,
I am happy that you find some value in the TAG info.
I agree that carb only bolusing is not solid science, at least for some of us. Like you, I am a Type 1 with no first or second phase insulin release, so TAG is simulating that dual phase release for me.
Carb only bolusing fails to account for the interaction of nutrients in a food. The best example of this is pizza. If you just ate the crust of a pizza, for most of us, our BG would spike in a short period of time. Add a little tomato sauce and cheese to the crust and all of a sudden the carbs are absorbed slower and you may need extra insulin to cover the protein and fat. TAG is better at accounting for nutrient interactions than carb only bolusing.