I was wondering what % other moms are using for their TAG formulas. If you don’t mind sharing I think it could help us all!
I love TAG! I don’t quite have it perfected yet, but my gosh it really puts some rhyme to the reason. I could not make sense of so many of our highs until I found TAG. I would increase my DD’s basal rates since I knew my carb counts were good, and that just created a mess.
Here’s my scoop:
Age: DD is almost 14, T1 for 3+ years
TAG Formula: All Carbs up front, Then 40% of protein and 20% of fat dosed in an extended bolus over 2 hours.
Challenges: This formula seems to work well for us on combo foods such as pizza and chinese food…Yes!!! Sometimes she will run a little low with this, so we watch carefully.
**Our formula doesn’t work as well for us on foods that are only high in Fat OR Protein (but not both) such as nuts or plain grilled chicken. It is not enough insulin in these cases…not sure what I am missing.
I’d love to hear any advice or feedback. I’m trying to just use one universal TAG formula to keep things doable for my DD. I’m asking a lot of her already, LOL
This is how we do it… your child may need something completely different 
Hi Midwest Mommy!
Isn’t TAG wonderful! So, I would hope that Ricardo would reply to you as well because he is so amazing in understanding the science of all this. But I am thinking the issue might be one of timing. For myself, when it is very high protein or high fat, I have to extend to 2.5 or 3 hours respectively (high fat requires more time for me).
As for the lows, you might try lowering the 20% fat dosing to say, 15% and see how that works.
Regards,
Cheri
Hi Midwest Mommy,
TAG has its own complexities and if you couple it with the hormonal changes that teenagers undergo, you may find many mysterious challenges.
If DD is going low early in a TAG session, it would suggest that the immediate carb bolus is too high and some of that insulin should be shifted to the extended bolus. If she is dropping low late in the TAG session, it would suggest that either there is too much extended bolus or the rate of delivery for the extended bolus was too fast.
Depending on which of the above scenarios holds true for your daughter, Cheri has an excellent suggestion of cutting back on the fat %, if she is dropping low late in the TAG session.
My understanding is that for protein only meals, the body may have to convert a higher % of protein to carbs since there were no carbs in the meal. The body prioritizes fueling itself to maintain BG for brain function.
Again, depending on the hormones of your teenager and her activity level, from your description it seems DD may be converting a higher % of proteins to glucose, which when using your standard TAG % would cause her BG to go high for protein only meals (teenagers need their fuel). For some TAGgers, high fat meals tend to increase insulin resistance which would lessen the effectiveness of your TAG %.
You may have to have a separate TAG % for the high protein and high fat meals. Remember that TAG is a personalized algorithm, which is why we vary in our TAG %.
In the case of the grilled chicken, the next time she eats it, note the amount of insulin she took for the extended bolus and also note the total amount of insulin she took for corrections. The total of these 2 will give you an idea of what her body needs to metabolize the grilled chicken meal and if you extend it for the proper amount of time, she should arrive at her BG target without dropping too low or spiking too high.
Ricardo who is not a doctor
Thanks Dear Ricardo (who is not a doctor - LOL)
Nevertheless, you provide such clear possibilities on both sides of the spectrum - I never thought to ask whether the low was early or late in the TAG.
FYI to Midwest Mommy - My personal algorithm puts me at 40% proteins, 10% fats - and I am highly insulin resistant.
This whole system, by the way, assumes that both basal rates and insulin to carb ratios are where they need to be.
Thanks to both of you!
The lows always come late…towards the end of the extended bolus period. This is just for a combo food though…something high in both fat and protein like pizza. It’s not a huge deal, we cgms and I watch for it. A little juice and it’s fixed…so much better than trying to correct a 300 late into the night.
Yes, teen hormones are always fun. Her’s have been easier this year than last, fortunately, and I hear around 15 things become much more predictable.
Interesting note about the protein only meals - and it kind of makes sense. I’ll try to keep some notes and see what we can do. Honestly, I’d rather have ONE not so perfect formula then two perfect formulas. Your probably wondering why in the world I would say that but I don’t want her getting confused with manually calculating insulin - she is the type that needs one consistent formula. Gosh I’d love it if the pump makers adopted TAG some day. I can dream, right?
Would the body also convert more fat to glucose if the carbs are minimal and there is no protein? Wondering if the same principal is at play here. Nuts for example, pretty low in carbs but crazy high in fat - we still get a spike with TAG so I’m sure we need more insulin. If you haven’t guessed yet she is quite fond of nuts! I’m just wanting to understand the theory,
Tag is awesome. Thank you for finally turning the lighbulb on for us. No wonder our Free foods were never really free.
Am so glad things are going well and I do understand the need to have one not-so-perfect formula.
About the nuts…for me, it is not a matter of more insulin, it’s a matter of extending it for a longer period of time. Again, for me, I have experimented and extending it across a longer period of time is what worked - if the combo ends before my body is done processing that fat, then I will get a spike, regardless of what I pumped earlier - but then, I am insulin resistant.
If the only variable is the time of the bolus, depending on the food, I think that’s a pretty great thing!
Hi MidwestMommy,
I have a 13 yr old son with T1 for 18 months and pumping (with OmniPod) for the past 6 months. Although pumping has made life MUCH more convenient, his A1C’s are still too high. After his last endo visit a month ago, I decided to get methodical about it and identify one problem each week to tackle. Thanks to the folks on TuDiabetes we are off to good start. I think this TAG concept may be a huge help. I have definitely seen the late spikes with fast food like burgers/fries and pizza. We have tried extending the bolus for high fat foods but just counting the carbs, not the protein or fat. I am excited to try this, but I will also need a simplified rule of thumb that he will remember to use when he eats away from home.
Thanks for all the good info, everyone!
–Cynthia
Hi Cynthia –
I hope TAG is helpful for you guys! I know lot of families can just extend out their bolus and be fine, but it’s never worked for us. I am so glad to have found TAG! I tested it quite a while before I shared my formula with my dd. I would just enter the extended part into the pump for her. She recently asked me to share it with her – I thought she’d really be mad at having to do this extra step but she’s been pretty good about it.
I used TAG recently for eating at a Japanese Steak House - Fried Rice, Terriyaki Chicken and even a cupcake afterwards (family Bday)…and it worked!!! No spike. I have practically pulled all nighters before to deal with meals from the Japanese steak house, so I was thrilled. It was also really nice to use the Pod remote and be able to do all of this without bugging my DD to give me her tethered pump (we used to be on MM). Dex was also a big help in deciding when to dose for the different courses.
Good stuff!
P.S. Don’t you love the Omnipod?
Cheri –
Thanks…that’s interesting.
I’ve found with combo foods (not nuts) that we go low at the end if we extend out longer than 2 hours, which seems kind of backwards since it’s less insulin/hour but the body is a complicated machine isn’t it?
How long do you extend the bolus for nuts?
I ordered the Salter 1450 scale last night to help us with TAG. It has a database of 1000? foods and shows you the carbs, proteins and fats for your serving size. We have a scale already but convert everything manually with Calorie King and a calculator. I’m hoping this will be easier for my daughter and she’ll like having a “gadget”, LOL>
Midwest Mommy,
Yes – I love the OmniPod. It has been a bit of a learning curve, but getting better all the time and SO much easier to live with than MDI.
I have also spent many nights managing highs or lows that I didn’t understand. So frustrating! I may teach myself about TAG first with the dinner meal, since its usually at home and I’m the cook, and it may result in better sleep for me:)
BTW, how do use the data on the omnipod? I am trying to use the reports on CoPilot to learn about trends. So far, I mainly use the Daily Combination report. Any suggestions?
Hi Cynthia -
I’m a little embarrassed to admit I don’t know my way around the CoPilot repts. We just switched to the Omnipod in early Feb (from MM). We also swtiched to the Dexcom cgms, and since that has more data, I use that instead. Dex is very accurate for us (we used MM cgms for 3 years and the difference is night and day), just in case you ever want to go that route.
Good idea to try TAG at home first. You might see lows so keep a close eye. I hope it works for you – let us know what you think.
Thanks for the info. I have been fiddling around with TAG throughout the day, but my son also has the flu, so (silly me!) not getting the results we hoped for. I’ll keep trying – it seems like taking protein and fat into account would explain a lot.
do you use TAG on every meal or just ones that are high in fat/protein or both? just started this with my 5 yr old. I figure the earlier we get started with this the easier it will be by the time she’s 13…
I started tag with our problem foods like pizza. For other meals, it kind of depends on how insulin sensitive/resistant she is running and what the food is (I’m still working on this). I wish I could give you a more concrete answer…so much of T1 is flying by the seat of your pants!
Let us know how it works for you!
It seems to be working well so far. I’ve been using it on every meal, even cereal. I learned tonight though that if you suspend the omnipod to make a change in lets say the basal rate the extended bolus doesn’t restart when you resume. I’m pretty sure it gave me two choices when I hit suspend, either cancel the extended bolus or suspend all insulin delivery. I picked the latter thinking when I resumed the pump the current running “program” would also resume. Also, when she finished her meal she asked for a frosty which she NEVER does and I got it for her. Pump won’t run an additional or add on to the current extended bolus so I just figured it up and gave her the entire TAG in one bolus. Not sure if that was the way to go but with the above fiasco she only got 0.05 of her 0.30 extended anyway. So, the Wendy’s meal experiment went up in smoke…
I’ve read here that adults when using TAG approach give all the carb amount up front and use extended bolus for fats and proteins only… But I noticed with my son that he always goes low in the first hour if I do that, today he had a pizza which was 38g carbs about 25g fat and 20g protein, I covered the carbs with normal bolus and then did 40% for fat and 50% for protein extended over 4 hours, he was 53 an hour later, treated the low. After that he stayed between 90 and 110 for 4 hours.
I was just wondering if anybody else noticed that giving all the carbs up front causes a low? It’s not the first time it happened to us… next time Im going to do maybe 70-80% upfront and the rest included in extended bolus.
Just checked him, 6 hours after dinner he is at 172, the pump didn’t give correction, havet to wait and see if he keeps rising…
I use 20% for protein and 10% for fat then divide the bolus amt for carbs by the total TAG and that usually adds up to about 90-95% up front and the rest I extend over 2-3 hours. She tends to run low about the third hour if she is going to so I have been playing with her I/C ratio and basal rate a bit. All in all, this is working out really well and she’s been several days where her highest bg is 140!! I do check her more often though especially at night and had to treat a 65 at 12:30 a.m. two nights ago…
I have heard other parents saying that. In fact, I think I hear that more often than not. The fat may be delaying the carbs from hitting, so you have a low in the first hour. For some reason my DD needs all the carbs up front plus the extended bolus for fat and protein.
I’m not sure you need to add anything into the extended since you are using 40% and 50% already. Maybe the first time try it without adding it into the extended??