Due to holiday eating, my growing maturity and adventure (if you could call it that) with my medtronic pump, I’m trying the Square wave and Dual wave bolus settings more after starting my pump a little over 2 years ago. I’ve had great success with the Dual wave bolus but I’ve failed miserably with the Square wave, especially on Thanksgiving. It was a total flop, I mean total flop. So I need some guidance. I have talked to my local medtronic rep about how to use these boluses. She said its more or less trial and error. I have the hand outs too. What I think its more or less a trial and error is how many hours typically do y’all use for a thanksgiving and/or Christmas meals? The carbs I can count but how many hours?? Help. I have looked back at older discussions and posts but I’m not really finding the help I need. I don’t have any gastrointestonal slowing. I have good control, last alc about a month ago was 5.9. The issue is, when I go to parties with my husband and/or have large holiday meals, I feel like I more or less check my pump at the door and control is but a faint memory. Then I’m sad and discouraged.
This is what I did that didn’t work: Set the Square wave for 3 hours and 90 carbs. Should i use more carbs or more/less hours?
I’m usually an educated pumper but what the heck, this setting really throws me.
I have been using dual wave bolus when ever I know it is an amount of insulin that will actually cause a bit of pain if injected all at once. I usually take about 2/3’rds of it up front and spread the rest out over half to full hour. For occasions like you’re talking about I also set a temp. basil rate. Basically for the length of the party if my basil rate for that time of day is .95 unit per hour I’ll bump it up to 1.10 or a little more for say 3 hours (thus getting .15 units more per hour). Mind you, it will never be perfect but it will get you closer to the readings you want when you get home. It introduces the insulin in a slower manor that you probably will not get a sudden low even if your pretty far of counting the carb intake and or fat content.
I am also dabbling with this function. It is confusing but 90 carbs doesn’t sound like much to me so I would maybe have just done a dual if maybe eating a lot of fat at one time. I am using them for lows now when I am taking in more carbs than necessary to bring up my sugar and it worked beautifully. My trainer also says she uses it when she eats a salad with little carbs then dual waves for the dressing over the course of an hour. I haven’t tried it yet, but am totally going to next time I just eat a salad.
Thank you all so much! This really helps.
From my education, which could contradict experience
Square wave is for grazing, party meals and large blocks of time when a diabetic might find himself/herself eating a large meal. Thanks @Lori31, I think you are right, too little carbs. I had a lot of turkey and ham so I tend to lower carbs when I have a lot of protein due to a BG lowering affect I’ve noticed that occurs with me. There was a lot of fat though. Maybe for Christmas, I will try 1.5 to 2.0 hours and increase the carbs.
The Dual Wave is actually for diabetics starting a meal with high BGs, that’s the reason for the increase at the beginning then the trailing off at the end. BUT, the Dual wave can account for normal or low BGs in the beginning, ie. the reason the the percentage changes 60/40, 30/70, etc, etc. I have found generally speaking, on the Dual wave I do well with 60/40 or 50/50.
Dual wave from medtronic’s sheet is for the 4-P’s. Totally agree though with all of what you have said. I’ve also heard a lot of diabetics use the Dual wave and never use the square. I would like to excel at both.
I feel more prepared to try again. Big Thanks!
Busybee
I successfully use the dual wave (combination) bolus for almost every meal. Unfortunately, I think most “rules” of diabetes get thrown out the window when you’re talking about a holiday feast involving hundreds of carbs, lots of protein, and a boatload of fat. And combine that delicious plate of food with a “who’s-kidding-who” SWAG on the actual nutritional content.
I think it’s risky dosing in these situations. The highest likelihood is that you’ll either overdose or underdose – by a lot. The best advice I can offer is to enjoy your meal, make your best guess, closely watch the post-meal numbers, and respond with appropriate action. I would encourage delaying sleep until the IOB comes down to a sane level or set an alarm to do a mid-sleep correction. Any alcohol consumed makes things even more unstable 5-6 hours out.
I know I’m a party-pooper but I’ve been-there-done-that so many times with an always hopeful expectation before the ultimate failure. I say enjoy life, try to be safe and move on.
Thanks @Terry4, I appreciate the comedy and encouragement! Holiday meals are pretty much a crap shoot! Unfortunately, I’m a first born child and must work hard to attempt success! If I don’t quite get it after multiple attempts, I will throw caution to the wind! If for the first couple times you don’t succeed, throw it out the window and enjoy life, right?
Good to know about alcohol, kind of forgot about that. I’m 26 weeks pregnant so no alcohol right now. I do like to drink when I’m not pregnant/breastfeeding.
Busybee
Holiday meals! I wonder why that phrase isn’t in the BAD WORDS filter?
Had an end o appointment this morning - my weekend was bad enough that I gave my endo reports that ended last Wednesday! No need to spend time discussing the obvious, right?
As for alcohol, if there’s a meal that I expect to consume any significant amount of alcohol (as in, enough to impair my judgement), I make whatever pre-meal decisions regarding my insulin, then lay off making ANY decisions, corrections, etc., until I’m clear-headed enough to be safe!
I think if you actually had all the ingredient info and could carefully weigh and calculate then you might have a shot at a dose in the “right neighborhood.” Who ever went to a holiday party with a food scale??!
For me, all my ratios become useless when I eat over 30 or 40 grams of carbs in a meal. It’s like a whole 'nother set of rules and I don’t know what they are. It’s like going through the worm-hole to the adjacent metabolic universe.
I haven’t used either of those boluses in a looooong time and I have been on a pump for 16 years. I discovered that I respond better to a temporary basal for whatever reason. For example if I am eating pizza I will bolus 4-6 units for pizza and then turn on a temp bolus at 120% for 6 hours. Try it next time you have pizza or Chinese food. I don’t snack enough at holiday events to warrant a square bolus. I just bolus for more than I expect to nibble on and it works out.
I don’t use them much but have a local buddy @Phyl, who proposed 75%/25% split, w/ the 25% over 4 hours adding maybe 20 carbs for “sauce, etc.” for stuff like pasta and pizza and it works very well. But I am always up against bedtime for late dinners, etc. too and am a much bigger fan of cranking my basal up to 200% (Medtronic) to get the coverage. That way if my BG starts to crash out, I can turn it off and “untake” some of it. Which I suppose you could do with a combo bolus too. I don’t find them at all useful for stuff like holiday debauchery and will just sort of eyeball the appetizers and go "hmmm, I can find say 25G of carbs there, eat until it goes up, bolus for 15 more G and keep on rockin’!
I agree Terry I try to keep my carbs too between 40-60 otherwise I just don’t seem to be able to tolerate more. But this is my regular routine holiday meals all goes out the window. I was proud of myself this year no second helpings and just a small taste of all the goodies.
In my case, simple carb counting does not work for complex meals. I use extended boluses for all meals that include significant amounts of protein and fat. This can be done in 3 different ways: (1) temp basal, (2) square-wave, or (3) insulin stacking. Options (1) and (2) are really the same, except (2) allows more flexibility in how large the extended bolus can be. It is impossible to come up with fixed rules about extended boluses (or anything else related to D) - one has to try, learn from mistakes, and make adjustments on the fly. In general, one can be a bit more aggressive with extended boluses since they can be aborted if need be, i.e. if you see your bg curve bending down too soon or to fast.
Here is an example of what I did today, including a square-wave bolus followed by some stacking (because the square-wave was slightly too small and too short). Note that it took me around 6 hours to digest a ‘normal’ lunch. I have also included a few hypothetical scenarios - what I think would have happened had I not made various decisions. If nothing else, the example can surely be taken as a proof that there are some crazy geeks among PWD
I included your quote above because those five words perfectly demonstrate the value of a CGM and also a pump (in that order).
I try to impress upon my sugar-normal friends that life is different every day, so is our bodies’ reaction to the activity, meals and stresses. For them, all this hormone activity just magically happens. For D-types of all stripes, we have to consciously step up - whew(!).
Very good comprehensive example of how insulin dosing is done well. Bottom line, you had a normal blood glucose for 24-hours. That flatline taken by itself seems to imply you found some magic static formula but instead you were making dynamic adjustments all day long. The CGM provides valuable visibility and feedback while your brain is constantly weighing, what’s next? You use a variety of tactics and know when to employ each of them. You do this very well.
Thanks. I also need to thank you for the ‘brisk walk after meal’ suggestions I’ve picked up from your posts elsewhere on TuD: even relatively brief 15-20 min walks can be much more effective (and are certainly healthier overall) then attempts to throw larger corrections on postprandial spikes.
If for the first couple times you don’t succeed, throw it out the window and enjoy life, right?
