since i have been on my pump, i have been delighted by the ease w/ which i can bolus. it is only my current pump which has the WIZARD feature. i love it. what i also enjoy about being on the pump is the ability of using the DUAL WAVE bolus. after yrs and yrs, i am still figuring out how to bolus for fatty meats and pizza and grilled cheese sandwiches. but its all been trial and error. now to the point: how do you negotiate using your SQUARE bolus option? how much insulin do you assume that you will need? how do you know how long to set it for? how do you get through thanksgiving or other holidays that seem to take forever? and, what if the food isn’t something you can eat, but you bloused for it anyhow (beforehand) and now you are stuck w/ IOB that has no where to go? what if you decided you really like what you are eating and that you would like to eat more of it?
I was told you can use the square feature for things like parties where there’s a lot of finger food and bolusing for every canape that comes by is inconvenient and hard to keep track of. I’m not sure how useful it is, though. You kinda have to figure how many carbs you’re likely to have anyway–a total guess–or just pick some number out of a hat and try to stick to it, but the whole point is that the situation is inherently unpredictable. You can just try to eschew all carbs of course and I’ve done that, but it isn’t always easy–it’s a party after all.
But I think basically the square bolus is the same thing as setting a temp basal for the same period of time; it’s just easier to conceptualize. “I probably need 14 units over the next two hours” versus “I need to kick my basal up, um, how much? to cover some guess at what I’m going to eat over the next two hours.” Either way, I find parties the hardest because you just don’t know what they’re going to be offering, it’s really hard to keep track (“Hm, was that my 7th corn chip? If I have brie on that chunk of baguette do I forfeit a teeny bite of whatever’s coming up for dessert? And how many carbs were in that sauce?”), and it’s really hard to keep within whatever limit you’re trying to set yourself. Seems I always end up chasing a high or a low no matter what I do.
One of the worst was when I bolused for some cake, which I normally wouldn’t eat, even at a party, but it was a small group and I just didn’t want to make a fuss about it not being able to have it, insulin, blah blah blah–only to find out too late that it was a low-carb recipe. Wait, whaaaaat??? This was back when I was on MDI so there was no way to compensate by backing off my basal insulin or whatever. It’s actually been kind of a running joke with my friend who was hosting that night.
I understand the dual bolus. what i am very curious about is setting the square bolus for things like parties, i.e thanksgiving, birthday parties, etc. of course, dual bolusing for a party is just anyone’s best guess as well. as i said before: i still can’t get my “formula” right for beef, pizza, and grilled cheese sandwiches. and to top that off, while i am on the adjunct subject, i need to dual bolus for simple carbs like yogurt, english muffins…UGH. if i go low, then i spike ^. then i am chasing my tail for the rest of the day. i even have this problem w/ a simple cup of morning coffee.
MarieB-
thank you for your input. i realize that you are one of the Big Guys on this org. so i value your response and input to everything. do you have a formula for dual wave on pizza, which is a fast carb/slow carb. i can’t get my split right, and i don’t know how many hours to put the “square” part of my bolus for. how many hours do i count?
then, there are the foods like steak. how on earth do i bolus for that? i am so confused, still, and i’ve been on (3) pump for 14 yrs. you’d think i would have gotten it down already. i feel like an anxious idiot.
For an example, for pizza I would do a 60/40 split and go over 3 hours. I do this for anything that may contain wheat as wheat sends me up over 300. And it works out pretty for me.
personally, I find pizza very difficult to bolus for, no matter how I do it. sometimes it works ok, and other times not. I rather avoid pizza (but not completely, like French Fries). I don’t have any issues with steak. whenever we have it, we share one, so I might end up at most having 4 oz, and I don’t even count it towards a bolus.
Our new site has a great search function. click on the little magnifying glass in the upper right and enter key words. here are the results for “pizza” https://forum.tudiabetes.org/search?q=pizza
I’m not a big fan of the square. I will occasionally use dual waves but I eat more than the square uses. One interesting suggestion from “Sugar Surfing” was to use a square wave for correcting highs at bedtime, so you get the right amount of insulin but it doesn’t perhaps have quite the same risk of a nosediving low.
I’m not sure I completely follow that logic. Is it to avoid giving a large bolus all at once and then having the ability to cancel a portion of the bolus if you start trending low?
I think it’s more for parents. I know some parents and you see them share things “he’s high, I corrected and he crashed…and now I’m up all night…” The square makes the “dive” less alarming I think. I am too lazy to have bothered with it.
if i want to keep my overnight BG higher, i just use the temp bolus. i like that feature a lot. also, i use that feature whenever i am sick w/ the flu or have had anything like a dental procedure. it keeps my sugars in check, and the percentage of the temp basal can also be lowered so it fends off lows during exercise.
Thanks MarieB. i got a ton of great info for your suggested pizza thread. i am solo excited to try some of the suggestions out. i think i will go to my favorite restaurant where they have thin crust pizza and do the 50/50% split over 3 hours. it seems reasonable. i will have 2 slices (but ooow, would i really like to have 3, as they are small), and i will see what happens. i will tweak as needed for the next time i go back. say a prayer for me!!!
Here in the Nederlands I use the square for Patat(=frence Frice),Pasta,Pancakes and Poffertjes(like your amarican pancakes but smaler).
Here they are cold the 5P’s and I use the square for a P of 2 houres.
I also use a dual if I max. may bolus of 20 Units in 1 time. Then I bolus about 15 Units in 1 time and the rest in a square of 30 minutes. If I don’t do that my set is going to leak.
Steven Ponder started that approach at diabetes camp. It allowed the kids to wake up in range with a lower risk of a low while they were sleeping. The tradeoff is that it doesn’t lower a high blood sugar as quickly, but in that environment, it’s probably a worthwhile tradeoff.
I’ve found that my son’s needs have changed over the years, but if he eats pizza, chinese, pasta or the like for dinner, he needs extra insulin for at least the next 8 hours. It’s different if the meal is lunch - more like three hours. It’s a perpetual trial and error situation for these types of meals.
Effectively it’s the same as just setting a higher basal rate, but easier to figure out (“just give me an extra 10 units over the next hour” instead of doing the math to determine by what fraction to raise your basal to get the same result). So I guess it would work for any circumstance under which you’d want to do a higher temp basal, which would include “grazing” situations like parties with a lot of snacks and finger food, where you’re eating a lot of small bits of carb spread over a few hours, as opposed to a single meal where the carb intake is all in one go. I’ve tried it for that purpose a couple of times but I’m not sure it’s been particularly effective–SO much guesswork involved. My impression is that it’s a Medtronic idiosyncrasy–does any other pump have this option? My Snap didn’t.
Slightly OT, but speaking of Medtronic idiosyncrasies and temp boluses, why oh why does Medtronic force you to specify the actual basal rate when doing these instead of letting you do it as a percentage of the rate, like other pumps (or at least the Snap, which is the only other one I have personal experience with). It’s SO much more in line with how I actually think about things. My brain is analog, dammit, not digital.
does your son wear the pump? i find that my pump is set for different “sensitivities” for throughout the day. and i have a multitude of basal rate settings also set for the different times of day.( the dexcom cgm has allowed me to see diff. trends so i have really been able to fine tune these) Do you use the dual bolus feature or the Wizard feature? or do you just add extra insulin post your immediate bolus? (which i have not ever tried but am very curious about.)
I have been making use of this lately for high fat meals that seem to sneak up on you later, even after normal readings. The medtonic temp basil is not that hard, if my normal .95 uph I up to 1.10 or a little more per hour, then bolus for the carbs. Been doing much better this way instead of suddenly waking in middle of night with a super high reading.
You can set temp basal types as either a selected rate or as a percent of basal. Main > Basal > Basal Setup > Temp Basal Type
Select Insulin Rate (U/H) or Percent of Basal
