i am a pumper and i use a CGM from Dexcom. i think of myself as a very neurotic control freak. my most recent A1cs have been 6.5. i work hard for this. years ago i didnt care so much about my control over D. BUT, recently i got my Dexcom CGM. i like to try and keep my BG control as steady as possible in between my "healthy" range (80 - 180). I use Novolog insulin
which peaks after 2 - 2 1/2 hours and stays in my system for about 4 hours.
I don't want to insulin stack, but i would like to snack between meal boluses. i am skinny but i eat a lot.(dont hate me)i get hungry between my basic meals.
the point is this: do others snack between meal-time boluses, and do they
rely upon the bolus "WIZARD" feature on their pump?
Unfortunately, I don't have a simple yes or no answer for you. I'd say yes...mostly. I take a lot of things into consideration if I'm "snacking" or grabbing a coffee or doing anything that requires a change in my insulin. I'll usually look at my blood sugar and where the trend graph is heading, how much insulin I have on board from the previous bolus, and what the wizard suggests. Once I've looked at everything, I make a decision. I'm also not far from glucose or more insulin so I usually know that if I make a mistake it won't take much to fix it/take long to discover it.
After typing all of this out, it looks like a lot, but it becomes sort of second nature and I don't normally spend a huge amount of time fretting over my insulin doses. And to compare, I also usually have a1c's ranging from 6.1-6.5.
the point is this: do others snack between meal-time boluses, and do they rely upon the bolus "WIZARD" feature on their pump?
Yes, I do.
Although since starting to use CGM I think I snack less frequently. There is something about knowing I'll see the effect of whatever I eat on my CGM monitor trend line which gives me pause, at least some of the time.
One thing about relying on a pump's "Wizard" is that the values for your insulin sensitivities, carb ratios, basal rates, and insulin activity time all have to be fairly accurate for it to all mesh together properly.
I keep intending to check all my values methodically & get them sorted. But doing so requires not eating for extended periods of time which I'm always postponing for a "better" time in some vague, unspecified future.
Stacking doesn't matter if you're able to keep track of insulin on board and compensate appropriately.
Current rapid-acting insulin lasts between 4.5-6.5 hours, so you need to do some combination of consuming sufficient fat/protein to extend digestion, eating a later snack/dessert, and temporarily reducing/killing basal insulin to make your food match your insulin.
Given the complicated relationship between carbs consumed and insulin, I find the insulin on board feature, and bolus wizard function, only modestly useful. It's actually never been clear to me why some people find it more useful--until my pump can be told what I've eaten, and can estimate the BG impacts of that for me, IOB is of only limited utility, albeit still somewhat useful.
If you're already doing this for whatever you've eaten, then additional bolus insulin and additional food, also doing what's necessary to make them match, is no issue. But it starts to get a bit complicated to keep track of it all. So I find I end up snacking on nuts or other low-carb options much of the time.
I never quite understood the elevated emphasis that doctors and CDEs warn about "stacking insulin." In theory, if one accurately carb counts and matches a well-calibrated insulin to carb ratio, then stacking insulin doses would not matter.
I think the environment where stacking does matter is when making high BG corrections. If I make a second correction, I will usually permit the wizard to subtract the current IOB from the recommended second correction.
Unfortunately, in the real world, even perfectly matched meals and insulin doses will mismatch die to reason beyond our control: perhaps a little more exercise today, or more stress, or a little less insulin sensitivity. Maybe the medicos are worried that analyzing one insulin curve on top of another one will just confuse us.
The one truth that I always come back to is that smaller insulin doses (fewer carbs) leads to smaller mistakes, whether you stack or not.
Yes, I do depend on the carb bolus wizard to calculate my dose. If I add a snack, I'll usually accept the wizard's offer except if my BG line is trending lower earlier than I thought it would from the previous meal. Then I might subtract a little insulin from the snack bolus.