I feel like I remember getting the suggestion somewhere to add a unit to the dose when you stretch it out this way. Anyone ever heard this anywhere? I did a one week CGM study and they said when I eat out I have a late peak so I should dual or square it.
I havenāt heard this specifically, but I think there is something to taking more than you would take if you were bolusing all up front. For me at least, I think I have a āChinese restaurant effectā (if Iām using that term correctly) with every meal where my liver dumps glucose the minute food touches my mouth, whether or not I eat fast or very slow-acting carbs. Thus, if I were to extend out my bolus too much I would not have enough insulin up front and would have a huge spike. I have no idea if this is true for most people though.
Dual wave is really two things in one action. You tell the pump to give you a bolus now, say 2.5U followed by an additional amount of insulin over a specified time period, say 3.0U over the next 4 hours. FWIW, this is similar to my plan for two slices of pizza.
A square wave is really the second half of the Dual Wave. In the example above, you would bolus 3.0U over 4 hours.
I use the Dual Wave pretty regularly when I have a meal that has some carbs that I will digest ānormallyā along with some fat/protein or a lower glycemic food that takes longer to get into my system.
As far as adding a unit just because youāre stretching out the delivery? Nope, havenāt heard it. It could be someoneās rule of thumb for a particular food/meal.
I used dual wave bolusing for many years. Due to eating a carb-limited diet I found I had to add a square wave to cover for protein and fat. It takes personal experimentation to customize it for your self. Some of the pumps permit you to decide the insulin split between the immediate bolus and the extended one as a percentage. I found this more difficult to analyze and execute. I just delivered an immediate bolus based on the quantity of carbs and then the square wave for the protein and fat. My square waves varied in length from two to five hours. A steak dinner with its high protein could justify a five hour extended (square wave) bolus.
I have done this as well - essentially, itās āmanuallyā doing a dual wave. In practice, it can be easier because there might be fewer button to press than the dual wave process.
I also use the square wave sometimes in place of an increased temporary basal rate for two reasons.
1 - the math is easier if I know that I want āxā amount of additional insulin over āyā time, versus figuring out the percentages.
2 - My pump alarms at the end of a temporary basal rate. The alarm is especially annoying if it is going to happen when Iām in a meeting or at night while Iām sleeping. I also donāt like the TBR alarm philosophy, but Iām sure it was mandated by the FDA.
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I use the Dual or Square bolus on 2 occasions.
If I eat something of the 4 Pās then I use a square bolus.
If I have to bolus more the 20 units then I use a Dual bolus. This is because when I bolus a lot the insulin will come up along the catheter so it leaks.
So this sounds like the extended bolus. I use the OmniPod but havenāt really gotten used to that Frasier. Iām thinking to replace my existing profile basal which I triple for the hours 6-9 pm with this since it seems safer. I didnāt know low glycemic foods take longer to digest. That may be the reason I get spikes 3+ hours after eating dinner, and hence my increase in the basal. Does the extended bolus act the same way as a basal? I mean physically is it the same rate of the slow drip of insulin being injected so that the insulin injected is distributed evenly over the time period?
Essentially, yes. If you program your pump to deliver 3 units over three hours, it wouldnāt matter if you did this via a TBR or an extended bolus. On the Omnipod, you can set an increased TBR as either a percentage or set amount of insulin. Of course, thereās a bit more math involved if you want to use the TBR to deliver 3 units over three hours because you have to make sure youāre adding the extra insulin on top of your regular basal amount.
Sounds like you might have an experiment to try out. Let us know how it goes.
That is exactly what I want to do though, use the extended bolus or TBR to deliver an extra 3 units or three hours, and then be able to cancel that in case I am going low. I think my OmniPod is set for percentage for temps.
Iām fasting again today, so I wonāt try the extended bolus out 'til I start eating again. I will update you to let you know how it goes:)
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If you want to be able to suspend it if you go low I think it will be better to go extended bolus. Fewer steps, rather than having to go in and tweak the basal again.
Thanks. That makes sense. I have decided to switch to the extended bolus. It just seems safer.