Treating gastroparesis with a square wave bolus?

Diabetes Technology Insulin Pumps
#1

I have been using a square wave bolus with my dinner to treat (self-diagnosed) gastroparesis, and it is usually very effective. However, the last few evenings I have gone back getting low 2-3 hours after my meal.

How long should I set the square wave? I was using 1.5 hours and that seemed effective. The last couple of evenings because of the lows, I went to two hours and still had problems prior to bedtime.

Suggestions? This only occurs in the evening; I have no problems with breakfast or lunch.

#2

Hi Spock. You might find something on the gastroparesis group: http://www.tudiabetes.org/group/gastroparesis, or maybe you could ask a question there. I have slow digestion rather than full-blown gastroparesis, and am on MDI. I take half my bolus before a big meal, the other half after, but I know that's not an answer to your question. In truth, when I was on my pump I often used the same method since I never quite trusted the square wave.

#3

I have gastroparesis too, I square wave mine over 2 and half hours. That's been working pretty good for me. I go to gastro on Friday, and most likely getting back on Reglan again. I also use a lot of Glucerna, and I don't bolus for them, and that tends to keep me pretty stable.

#4

Thoughts about the fact that this only happens in the evening? I don't understand that.

#5

I have no clue...and actually I don't square wave mine,I dual wave mine over 2 1/2 hours, but I seem to have more trouble with this problem in the evening too. I know mine is definetely gastroparesis. Gastric emptying test two times has confirmed it, but mine comes and goes.

#6

Perhaps things are different in the evening. While you may well be eating very similar dinner meals your activity level may make a big difference. If you regularly walk around during the day, but are more sedentary after dinner that could make a big difference in how the meals are digested. Bernstein actually recommends a stomach exercise to aid digestion. Are there other differences you can think of in your evening/dinner context?

#7

I eat very lightly during the day. Usually cottage cheese for breakfast and a small sandwich (25-30 carbs) at lunch. As a result, the eveing meal is the biggest of the day, but low carb. And I usually have a glass of wine with dinner.

Additionally, I have been reducing my insulin amounts in an attempt to alleviate the number of hypos I have been having. I lowered my I/C from 1/10 to 1/15 and it has been working well. I am beginning to think that maybe I just need a lower I/C in the evening. I just changed it and will see if that helps.

#8

The big meal may be the problem. In gastroparesis the vagus nerve is damaged. It controls the signals to your stomach to contract and push your stomach contents into your digestive tract. Normally, with a large meal, you will signal your stomach to regulate and slow the release of food into the digestive tract. But with gastroparesis this signaling doesn't work well and the stomach contents are just stuck. This can result in a hypo as your insulin hits you before your food has an effect. And you probably go high later. So a common recommendation is to eat smaller meals more frequently.

Beyond that, the stomach exercises which are described by Bernstein may help. He also recommends chewing gum and using Super Papaya Enzyme.

#9

I also have Gp, dxed this year. The problem you have at night I too have that problem but I also have kidney disease, stage 3. I was told by my Endo that with kidney disease I don't need as much insulin. So what I do at night for dinner is not to count all of my carbs. I sometimes subtract 10g and not bolus for that. I also changed insulin sensitivity and insulin to carb ratio. When I set bolus either dual or square I set sometimes for 2 or 3 hours depending on where my bs is before eating. I tend to explore in finding out what works for me...hope some of my suggestions will help you.

P.S. I recently changed my basal rate from .8 to .7.

#10

I would tend to agree, the big meal even if low carb is probably a big part of the problem, its a delay of the stomach digesting and moving the food, if you are eating lighter meals, your probably not having as much of a problem with your blood sugars cause your stomach is digesting things with little trouble.

I agree the key to gastroparesis, is smaller more frequent meals. I use glucerna a lot too, to help keep my blood sugar levels even.

#11

One thing I've found with my GP is it doesn't follow the course that is described. As Spock said it's at night and no matter whether I eat light or heavy it doesn't matter. Sometimes I hit the nail on the head and don't have any lows but that's because I test constantly after eating dinner. That's why I said you might have kidney disease as I do. Since being told how to not eat any fibre and to eat what we're told not to eat I don't have any of GP symptoms except for food digesting slowly.

#12

I go tomorrow to get back on Reglan. At least I will be able to eat again.

#13

I have found, that it depends on how that day is going. sometimes, I do a dual wave for 1 hour, when I am not feeling bad,and others I have to do for 3,(when I am feeling bad. also percentage is tough. when I am bad I do 40/60 3 hours, (dependent on what I eat).I do use domperidone, which I get from somewhere near australia,