I have yet to try this kind of bolus. Will it keep track of IOB as well?
Yes it will. But it will continue to deliver what you programmed for the duration.
I tend to prefer the square wave. I use it for Chinese or high fat food, or a meal of several hours. It delivers the set bolus equally over the time period you chose.
A dual wave delivers two boluses--at the time you programmed and again at the end of the programmed time period.
They are useful tools for difficult foods.
dual wave works well for pizza (at least for me--not that I eat it very often any more). I do roughly 70% immediate bolus, and the rest over 3-4 hours. It's not perfect but beats remembering to give little "mini boluses" for the next few hours. :)
For simplicity sake, I like to deliver the immediate bolus and the extended bolus separately. I don't like the percentage split choice. I like to deliver "x.x" amount for carbs and "y.y" amount over so many hours for the protein/fat bolus.
I use extended boluses for every meal. They're a key part of my dosing regimen. I eat a low carb high fat diet.
My pump keeps track of everything I bolus, if I inject I bolus with the set detached to keep a record of it. I wish it would also keep track of temp rate adjustments in iob. I have to ask my cde about that because if you're only on fast acting and you increase the basal that needs to be factored in to iob imo.
So far I have only done a percentage split bolus on my pump- I'm not sure if that is square wave, dual wave or whatever. One of them seemed to work but I felt like I was kind of weak and going to go hypo for the percentage delivered later part. Another I did failed with me spiking, so that time I needed more insulin upfront. I can never tell honestly- the last two nights I thought I was ok to bolus right when I ate but then I went hypo- a lot of the time I don't bolus until I've eaten the first portion of my dinner and or I see a rise depending on starting bg and on how I'm feeling and activity levels.
i would like to know more about your bolus method. i can’t really get away w/ carbs, more particularly simple ones. i have been on a low carb/high fat diet for a while now, and i know that the high fat content slows down the digestion of everything that goes into my mouth. i am very lean and try and eat as much fatty foods as i can, i.e. : peanut butter, eggs, nuts in general, cheese, butter, chicken w/ the skin on it…i have no idea how to do my boluses for these foods. i have tried and experimented w/ diff dual boluses, diff splits, different time periods; i just can’t get down any formula. my cde says i just have to continue experimenting until i find the most successful way. i am exhausted. any tips?
I deliver an immediate bolus for carbs using my insulin to carb ratio. I then deliver an extended bolus (x number of insulin units over y period of time) based on the protein and fat in my meal. My system works best for people that limit the amount of carbs they eat. This method falls apart for me when I consume about over 30 grams of carbs in a meal. I usually consume less than 50 grams of carbs per day, not counting my glucose tab corrections.
I count 50% of protein grams and 10% the fat grams as “equivalent carbs.” I add those two together and divide by my Insulin to carb ratio to calculate the protein/fat bolus. I then extend that protein/fat bolus over time such that I don’t exceed more than 1.2 units per hour. This system works well for me and may serve as a reasonable starting place for your own personal experimentation to confirm its usefulness to you.
Any insulin dosing changes like this should be carefully done with your safety carbs near at hand. Frequent BG testing and CGM monitoring are prudent controls. I have found this extended bolusing technique to be forgiving, however, since it’s delivering the dose over several hours time.
my problem w/ this system is this: for whatever reason, i always need to bolus; coffee, tea, chicken, fish, turkey, cheese, nuts, eggs, veggies (even the low GI ones). if i look at food i need to bolus, despite there not being any “real” carbs present. so my breakfast might go something like this: 3 scrambled eggs and 1 small cup of coffee. i require coverage of 30 gms of carbs for this simple meal. when i go over my “daily totals” for the day, how much insulin i have had to use (including my basal units) for a 24 hr period, it never exceeds 20 to 25 units. my basal totals for the day are minimal; just 12 units. what i like from eating things like peanut butter, is that it seems to keep my BG steady. no spikes, no dips, no insulin. its very reliable for me.
So, you are saying that even though the scrambled egg meal does not contain 30 grams of carbs, you’ve found you have to dose as if it did. I’ve found it helpful to me to consider the fat and protein, too.
This is how I would consider an initial dose for scrambled eggs. Three large eggs mixed with two ounces of heavy cream for scrambled eggs contains:
1.7 grams carbohydrates
19.5 grams of protein
27 grams of fat
If your I:C (insulin to carb) ratio was 1:10, then you could bolus 1.7/10 = 0.17 units immediately. Then if you take 50% of the protein grams, that’s 19.5 x 50% = 9.75 and the add that to 10% of the fat grams, 27 x 10% = 2.7. 9.75 + 2.7 = 12.45 equivalent carb grams. Divide that by 10 (an assumed I:C ratio just for illustration), 12.45/10 = 1.25. For the protein/fat bolus deliver an extended bolus of 1.25 units over 1.5 hours.
As I said earlier, this is a personal experiment that could allow you to learn what works for you. It may take a few trials to learn what works.
Having said that, I don’t believe that there is any static formula that yields the perfect insulin dose. What I seek is to find a dose that will put me within reach of my target and then I will use exercise, a nudge more insulin, or a part of a glucose tab post meal to home in on my blood sugar range target.
No two meals are exact, even if they are the same food and portion size. Our bodies’ absorption of food and insulin varies, from meal to meal and from day to day. It’s a dynamic game we play and there is no one rule book or formula that will always work.
I like peanut butter, too. I found, however, is that it does take insulin to metabolize it. You may need the peanut butter to compensate for some of your basal dose, particularly in the late afternoon when most people’s basal requirements go down. Ot perhaps your pancreas kicks out some home-grown insulin from time to time. It’s complicated. You know what works for you.
The extended bolus based on protein and fat has worked very well for me and a few others that have tried it.
I usually take about 32 or 33 units total of insulin per day. I weigh 162 pounds.
That;'s incorrect, at least for Medtronic and Animas pumps (where it is called a combo bolus). The first part of the bolus is delivered immediately and the second part is delivered as a square wave over the specified period.
I use dual wave/combo boluses routinely.
i cannot count all of your formulas. its too much work; i would feel like a chemist. i have tried doing this too some extent, but i would rather NOT eat something if it is too complicated. for whatever reason, small amounts of peanut butter seem to keep my BG stable throughout the day. no idea why.
I understand. You know what’s best for yourself. Fortunately for all of us, there are many roads to the same place. I’ve found some things that works for me; you’ve found some tactics that work for you. Good luck!