I hope I have this right - can anyone confirm?

I’m figuring out a bolus for a pizza hot pocket and this is my very first time to TAG.

This thing has 37 carbs, 17 grams fat and 10 grams protein

Using the starting formula I figured I would bolus for the 37 carb grams upfront, of course.
Then bolus 10% of fat = 1.7 and 50% of protein = 5, so another 6.7 grams over about 6 hours.

Does that sound right or am I completely lost?

a little more info now that I have finished figuring.
J is on a 1:8 I:C ratio right now so he would get
4.60 units now and .85 for the next six hours.

I got six hours because of reading someone's post about doing about 1 unit per hour, which of course I screwed up into thinking six hours because I'm bolusing for 6 grams. Instead I think it should be .85 for the next hour. But that sounds like not nearly enough.....?

That sounds like it would make him go low since it is so much more upfront than over time. Sounds like not enough to cover the fat spike. ???

Hi kimcannally,

It sounds like you are not really sure that counting only 10% of the fat grams will be adequate. There are some TAGgers that do well with 10% fat coverage. Some use a higher fat percentage if they are really affected by fat calories. In addition, for some of us, the fat calories will slow the metabolism of the carbs and as you mentioned, a person may go low early with so much insulin upfront.

From what you wrote, you did the math correctly. You would bolus for the 4.6 units for the carbs, and then follow with .85 units over an hour if you are trying to set the rate at about 1 unit per hour. Only you know the details for J’s metabolism. If J may drop low early, you could consider moving a portion of the 4.6 units into the extended bolus and extending for the length of time needed to maintain 1 units per hour. If J is really affected by spikes due to fat, you may consider increasing your fat % and extending for more than 1 hour.

Consider starting conservatively until you know how J’s metabolism reacts. Then slowly increase your percentages and/ or extension times until you can get the desired results.

Thank you. I’ve tried this twice now and both times he has dropped to the 50’s after several hours. I am trying a new “formula” next time by only bolusing for 30% of the protein and only giving 0.5u per hour for the extended portion.
It was really nice that he didn’t spike after eating and I would love to get this way of bolusing working for us.
Next time I plan to actually test him at hour 1, 2, 3 and 4 instead of just watching his Dex.

It would be a lot easier to work with if he would eat then not eat again for several hours. He tends to eat constantly for a period of time, which makes that extended bolus really hard to figure and work with. (The Ping won’t let us start a combo bolus when another one is already under way. I have to see how much is left of the current one, cancel it and add that amount left to the new one)

Hi Again kimmcannally,

Based on J going so low, your plan of backing off the carb bolus sounds like a good approach. Once you get his TAG formula correct, you should be able to control how much he spikes due to carbs, proteins & fat and minimize the amount of time he spends out of BG range. I had a very good day yesterday with TAG, spiking only about 20 points after a 60 gram carb meal before returning to my target range. When you get the formula down, TAG can be your best friend

As you mentioned, it will be hard to evaluate if your TAG protocol is working if he constantly eats. Based on this, you might consider his last meal before bedtime the best period of time to evaluate a TAG protocol. Just remember to factor in that if you use the bedtime TAG during the day, he will probably be more active and this can modify your results. Also, depending on his age, you may also have to consider the hormonal influences that can affect BG. You may be on the right track with only bolusing for 30% protein since J is a growing boy and needs to use most of his protein as protein instead of converting it to glucose. Watch his protein % as his growth slows.

I also agree with you on the Animas. I do exactly as you do when I want to add an extended bolus to an already running extended bolus.

Our best to you with TAG and do keep us informed of your progress.

oy I don’t know if this is going to work for us. J went up to 335 after eating today - no lows but i don’t know how to keep him from eating so erratically. I think the donut did it, even though I TAGged it. He started to eat the thing before I got the bolus done. Then I turned around and ate breakfast. I got to prebolus for that, at least. Since he is special needs, it’s really hard to get him to wait to eat. It’s hard to get him to do anything I want (he needs) to do.
Oh, thinking back, I did subtract the fiber from his breakfast - 5 grams of it was the same as his protein and fat so I ended up not TAGging it, just bolusing for carbs. Maybe that was it - next time I won’t subtract the fiber. I was just afraid he would go low. That’s a laugh! Ugh. Off to check him again. If you have any suggestions or ideas, please feel free to let me know!

Hi kimmcannally,

Some TAGgers subtract for fiber. I personally don’t subtract since my metabolism seems unaffected by the fiber. The missing bolus from subtracting the fiber, plus the addition of a fast acting carb like a donut would contribute to the 335 BG. As you are already doing, pre-bolusing for carb heavy meals will help the carb spike. For the extended bolus, I typically use a rate of delivery of about 1 unit per hour. For carb heavy meals. I sometimes deliver the extended bolus at a rate of 1.5 - 2 units per hour to moderate the carb spike.

You said earlier that a 50% protein bolus made him low and this time 30% made him high. Would 40% be a better fit?

It will be hard to figure your TAG if you adjust too many variables at once. Was it the fiber you subtracted that caused the 335 BG or was it the decrease to a 30% protein bolus. Try adjusting one variable at a time until you can get consistent and predictable results. When I started TAGging, it took me a while to figure out the % that worked for me and after about 5 years of TAGging I am still adjusting my TAG as my body changes.

Thanks Ricardo. Yes, you are right. Too many variables being adjusted at once. And I do believe his cartridge of insulin ended up going bad today too. He stayed in the 300’s for HOURS and developed 0.5 ketones. I was throwing insulin at him all day long, til I finally changed the cartridge and now he is coming down nicely. I also changed the site several hours before I changed the cartridge, thinking the site needed changing, but nothing lowered him until I got that insulin changed out. What a day!