New on Omnipod

Diabetes Technology Insulin Pumps
1

Hi everyone just started my omnipod 1 week ago. Got my basal test done from midnight to noon. Taking à little break from fasting and trying to fine-tune morning breakfast I:C ratio. Befor on mdi i was 1:10 lately at breakfast now the endo started me on a 1:14 carb ratio. M’y question is concerning extended bolus. I use to grab à tim breakfast sandwich every morning (33 carbs and 25 gr of fat per sandwich) i use to give 3 units and be fine. Now i tryed the 2.1 units and end up low or border line at 2 hours mark. Is it possible that i need an extented for that? How would you try this. AT what point do you start using extended (when fat représente how much of total carb in meal).

Thanks

2

Hello to another fellow Canadian! We're all a little different when it comes to how we handle the foods that we eat, but most of the time it comes down to a bit of trial and error to see what works for you. Especially for foods that are high in protein or fat because they tend to take longer to break down.

As a new pumper, what I would do first is to first do a basal rate test through breakfast by skipping the meal and checking about once an hour. If your bg stays level, you know your basal is good. If it climbs, it needs to be increased. If it drops, it needs to be decreased.

Once you've ensured that your basal rate isn't coming into play, now you can start to watch how you handle the food. If you test before you eat, then periodically after you eat at one hour increments, you can watch to see how you're reacting to the food. What you're interested in here is how long it takes you to reach peak.

Once you've determined this you can start to play with the extended bolus options, and split your bolus over time. This way you give yourself enough insulin to cover the peak, but also temporarily increase your basal to cover the slow digestion of the food you just ate. This will require you to play with how much to split and over what time duration as we're all unique, but I typically start with a 50/50 split over the length of time it takes to process the food and work from there.

3

I know like i said that my basal from midnight to noon is ok ive tested with my endo the two time périodes twice to confirm. Got a dexcom G4 also i see the trend. Bg before meal 7 mmol. 2 hours after 8.5 mmol. 3 hours 10 mmol after 3 hours going back down. Ill seewhen iob is finish were i am at. But my question is Why is it that before on mdi i could bolus all upfront and now i would have to do an extended. Like i said it was à tim breakfast sandwich. 33 carbs and has 25 grammes of total fat.

4

Ah, well I wasn't aware of the G4 so that certainly helps you figure things out.

Insulin needs tend to change as a result of the migration from MDI to pump. I had to relearn several of the foods I ate on a regular basis as a result of the switch.

I also found that overall I needed less insulin, and my TDD went down. It took a bit to figure out the new I:C Ratios.

5

What kind of bolus do you personnaly use when eating à tim breakfast sandwich. Do you ever use the extended bolus? If so when?

6

I usually only use extended bolus if i eat very cheesy things like fondue/raclette… other than that i often even prebolus for food.

7

I try to consume about 50 grams of carbs per day. With this eating routine my body does convert some of the protein (I use 50%) and I believe some of the fat (I use 10%) to an equivalent amount of carbs. With my eating style, I use the extended bolus for every meal. You will need to determine which meals in your diet need an extended bolus. The best answer for you can only be discovered through trial and error. The most likely meals to need this are the ones with a large % protein and fat, like 20%+ and 50%+ respectively.

Using your pre-pod I:C ratio of 1:10, a 33 gram carb breakfast needed 3.3 units of insulin to metabolize it well. Now that you've transitioned to pump therapy, you've found that one unit of bolus insulin is actually covering more carbs than MDI therapy did. Do I have that right?

Perhaps under MDI, your basal insulin was covering some of your meal or bolus needs. You now know that 2.1 units given for your 33 gram carb breakfast is a bit too much. Whether you need to use the pump's extended bolus feature would require some fingerstick readings out to about 5 hours.

I would test at hours 3, 4, and 5 to get an idea if any of the protein (or fat) is being converted to glucose in your case. If you BG rises at the 3, 4, and 5 hour marks then you can experiment with a small amount of insulin delivery extended over about 3 hours. Perhaps you could use 0.5 units per hour. The extended amount that you experiment with will need to make use of the 3, 4, and 5 hour data that you collect.

If I were faced with your situation, I would decrease the 2.1 unit bolus to about 1.8 and then measure your BGs at mealtime, 2, 3, 4, and 5 hours.

I sometimes eat a sausage and egg breakfast sandwich at Starbucks. It's served on an English muffin. I only eat one piece of the muffin; it contains 21 grams of carbs. The sandwich also contains 28 grams of fat and 19 grams of protein.

My breakfast I:C ratio is 1:4. I give myself 5.25 units of insulin to cover the carbs (21/4) and 4.8 units over 4 hours to metabolize the protein and the fat. That's an extended rate of 1.2 units/hour. I arrived at that extended bolus rate with personal experimentation. I started with a 1:4 I:C ratio but my experimentation led me to a lower rate, about 1:2.6.

I also know that my control is best when I walk for about 20-30 minutes at the one hour post-insulin mark.

Recording your results will leave to better analysis and decision-making. Once you have your breakfast sandwich meal dialed-in, you can move on to other meal challenges. I would encourage you to complete your basal tests for the rest of the day before you draw any conclusions regarding meal doses, extended and otherwise.