I hate taking my insulin before i eat because i worry i won't eat all my food etc (i usually eat a lot)
Is it safe to cover about half my food before and half the food after? My pump trainer told me that insulin would stack which i don't understand because I'd be covering the carbs.
I do this all the time--every day, actually. I'm often hungrier than I realize! It's basically like a dual-wave or square-wave bolus (or combo-bolus, depending on what type of pump you have). You just have to be super vigilant and not forget the second bolus! (which of course, can be known to happen to me!)
I agree with Sophie that splitting a single bolus doesn't stack anything. I always defer about 1.25 units of my breakfast insulin for two full hours to better match the time the food hits my bloodstream. I would be cautious eating very high glycemic foods if you are splitting your bolus since that might cause a bad spike.
Maurie
You can do this, but the preferred way would be to use a dual wave or extended bolus as Alan recommends. I believe the problem is that the current generation of pumps does not correctly incorporate insulin on board and carb on board into the calculations. Most pumps account for insulin stacking in correction calculations, but most don't handle accounting for it in carb boluses, and none as far as I know handle carb stacking. This means that depending on the pump, you will a variety of different carb bolus calculations, none of which properly account for stacking.
+1 for dual wave/extended bolusing on a pump.
I agree adding an extention on to your bolus also helps to cover the fat or protein in the meal, while this is out there i have been wanting to add a question. how important do you think it is to bolus 15 mintue pre meal with a pump, i have been more vigilent about making my son test while i'm cooking so he can bolus before the meal, esp if he is higher i think this really helps, though when i am not home i'm sure my husband and son are not doing this. any thoughts? thanks and good luck tom, sometimes the best info comes from fellow pumpers! amy
I think it depends on whether your son tends to spike or dip in the first hour or two. I have more trouble with 2 hour lows than 2 hour highs and almost never bolus more than 5 minutes before I eat. Others have a different pattern and tend to do very well with a pre-bolus. I'd say experiment a bit and let experience be your guide.
Maurie
thanks! he tends to creep up the first 2 hours especially in the morning,
(cereal) all input is appreciated, so many variables.... amy
I'm on MDI and only use insulin for meals because my fasting BG is pretty good, so far, and my endocrinologist doesn't think I need a basal insulin yet.
I divide meal boluses all the time, especially in the morning when I eat mostly protein and almost no carbohydrate for breakfast. I find I have to cover for protein and fat, so I calculate the insulin based on 58% of the protein and 10% of the fat, then take about 2/3 of the bolus when I finish the meal and the remaining 1/3 about 90 minutes later. This keeps my PP BG from spiking and also helps with the slower digestion of protein. When I have carbohydrates in my meal--usually for dinner--I calculate the insulin needed for the carbs as well as for the protein and fat. I take 2/3 of the bolus just before the meal, and the remainder about an hour later. If it happens that I don't eat everything I expected to eat, or decide to eat more than I'd originally planned, I can make adjustments, reducing or increasing the top-up bolus. This has worked very well for me so far.
So how should i do an extended bolus for my regular meals? I've never used the extended feature before.
Hi tom, i'm assuming you are still an omnipoder? we ussually do and extended bolus for a fatty meal or maybe one with alot of protein, you have to make sure the exetend feature is on, if you are confused you can check with omnipod support but it is really just a matter of turning it on, once it is on everytime you do a bolus you have to option at the bottom of the screen to extend, if you press it is asks how much you want to deliver now say 50% then how long, we ussually extend for a 1/2 or one if it is really fatty, restaurant food or icecream out, then if you dont eat everything you can cancel the extention if necessary.. i'm by no means an expert, jacob has been podding for a year, we ussuaaly just give his whole bolus at once and if he wants more we add on, ussually more than what the recomendation is because the pdm is thinking i just gave a big bolus why whould i want to give much more... so many variables, who knew pumping would be so difficult but it beats shots and the flexibility is wonderful... good luck! amy
See no reason why you can't split your bolus...you just may not achieve the best results...
I usually will not bolus ahead of time at a strange restaurant but if it is a place that I'm very familiar with I do and I will always use the most appropriate type of bolus for the type of food I'm going to consume in the end I must cover every carb with insulin or cover insulin with a carb. Your pump assumes that all of your settings are correct and the carb portion of your bolus is 100% correct. If everything is correct including your carb count you never stack insulin that's covered by carbs.
We know it's not a perfect world and our pump settings are not correct for every situation so many of us consider our IOB if we have some at the time of a bolus, IOB and our BG data at the time of a bolus can help us determine if we are overloaded with insulin and need to change our bolus wizard recommendation.
I don't think the omnipod will show you how much active insulin is in your system.
Thanks Amy- yep i'm still on omnipod. You usually extend for an half hour or one hour? And do you ever extend on non fat/protein meals?/ what happens?
lots of trial and error, but if it is really fatty foods, like most restaurant food or icecream we would extend and hour usually 50/50 more up front if his blood sugar is higher to start, i would do a 1/2 hour for less fatty food, we honestly dont use the feature as much as we had been, we usually dont extend for a normal meal, maybe if your issue is you are not sure how much you are going to eat you can at least bolus for part of the meal and definitely the correction, in this situation when you are later calculating how much insulin to give, input your bs at 100 so you are not getting the correction again if you are high, there are so many variables and everyone is different, are you overall happy with the omnipod? we have had our ups and downs but at least we have fine tuned a little better and have figured out how to work around pod change highs, if you are struggling with this i can tell you what works for us. good luck and keep asking we all learn from each other it helps when you don't feel alone in this. amy
I'll have to play around- trial and error. My problem isn't not knowing my carbs- it's just that I HATE taking a bolus before I eat- because i usually eat a ton of food and sometimes worry i won't be able to eat all my food and have insulin on board- I've gotten low a few times in the past. An omnipod rep told me to try splitting my dose or using the extended but i'm not sure about timing extended boluses.
I have my ups and downs with the omnipod as well- I'm still getting my settings correct- and dealing with this bolus issue (had this on MDIs as well) My average sugars have gone up since pumping- but trial and error. The biggest issues with the pod itself is that I can only wear it mostly on my sides and lower back. I've tried all the other sites but it is too uncomfortable- I had some reps examine my body and sites and told me I'm too muscular for most sites because and the muscles bend them up... but i'll take that as a compliment. I've gotten occlusions every time i tried wearing it on my butt. Have you had occlusion errors? The butt is a place i'd like to wear it but haven't found a sweet spot.
I also have some reactions from the adhesive- i'm ripping off a layer of skin every time i take my pod of. I started using baby oil -it's helping some.
Sorry for the long message =]
i have gastroparesis so i split the bolus 2u. before meal & 1.5 after.more or less.manually.it works better that way for me.also if i don't feel well i eat first & then bolus.
hi tom, jacobs fav spot is his sides like you, arms are a distant second he wears it way up close to his arm pit he has a little bit to pinch there, i have wanted him to try his low back but he his hesitant, with legs and rare instance arms we have had occlusions so i am fearful of legs now although we will try again in the summer, better with a bathing suit! if you have two good sites you are probably doing ok because you can turn the pod to make two sites out of one so to speak so you really have 8 sites if you can finangle it! the butt site seems tricky but if you are making the low back area work i'd say you are doing good. don't appologize for the long message that is how we get things out around here, good luck with everything, we are all learning to deal the best we can and lets face it visits with the endo ussually dont cover it all and they are not in the trenches everyday so ask away we are here! have a good weekend amy
My son does this virtually every day. Just as he sits down to dinner, he boluses for what he thinks he’ll eat the first go around. If he goes back for 2nds (which, being a teenage boy, he does most days), he’ll bolus for those carbs when he eats them. If he ever gets full before he finishes what he’s bolused for, he’ll usually make up the difference with a glass of milk.
I believe stacking refers to correction boluses and not to bolusing to cover carbs, so I think you’re fine. The only issue could be whether your timing of food/insulin matches. That’s different for everyone and seems to be a very inexact science. If your postprandial numbers are where you’d like them to be, your method must be working for you.
Good luck!
I tend to drop really low within 2 hours as well if I'm not careful, I never bolus more than just a few minutes before I eat. This usually works out pretty good for me, but everyone varies. I agree with Maurie experiment and let experience be your guide.