What does a successful extended bolus look like?

[StewM]

One of the things you hear a lot of with Extended Boluses is "it's trial and error", which I don't dispute there's no way round that. The thing is to determine if something is an error and the cause of that error you have to know what success looks like and that's something, as I refine my Extended Bolus technique, I've realised I don't know what a 'perfect Extended Bolus' would look like. So does anyone who's got a good technique down want to share, what happens when your Extended Bolus works?

Observations from my own trial and error.

1) Too Much Insulin Up Front, or the Extension is Too Short

This is fairly easy to recognise. Your Blood sugar dips below your starting point without even the hint of a spike from the food. You treat the hypo (even preemptively at above 4.0mmol/l) and then the treatment sends your Blood Sugar into the stratosphere because the Food Spike hadn't actually hit yet, and the Insulin you intended to deal with that Spike was essentially eliminated by the Hypo treatment.

2) Too Much Insulin in the Tail, or the Extension is Extended for Too Long

This one initially looks like you haven't taken enough Insulin. Your Blood Sugar starts climbing and climbing, if you correct your blood sugar drops like a rock because you did set the correct dose, it just hasn't arrived yet, and when it does arrive it makes the Correction you just took unnecessary*. Let's say you were patient and didn't correct. Instead, your blood sugar would climb and climb until suddenly dropping off a cliff when the required Insulin finally arrives (obviously this will vary a lot depending on how in sync your carb and correction ratios are).

*I know hypothetically your Bolus Calculator should prevent this from happening, but I find the Bolus Calculator, in general, less reliable when Extended Bolus miscalculations have occurred.

 

[Soplewis12]

One of the things you hear a lot of with Extended Boluses is "it's trial and error", which I don't dispute there's no way round that. The thing is to determine if something is an error and the cause of that error you have to know what success looks like and that's something, as I refine my Extended Bolus technique, I've realised I don't know what a 'perfect Extended Bolus' would look like. So does anyone who's got a good technique down want to share, what happens when your Extended Bolus works?

Observations from my own trial and error.

1) Too Much Insulin Up Front, or the Extension is Too Short

This is fairly easy to recognise. Your Blood sugar dips below your starting point without even the hint of a spike from the food. You treat the hypo (even preemptively at above 4.0mmol/l) and then the treatment sends your Blood Sugar into the stratosphere because the Food Spike hadn't actually hit yet, and the Insulin you intended to deal with that Spike was essentially eliminated by the Hypo treatment.

2) Too Much Insulin in the Tail, or the Extension is Extended for Too Long

This one initially looks like you haven't taken enough Insulin. Your Blood Sugar starts climbing and climbing, if you correct your blood sugar drops like a rock because you did set the correct dose, it just hasn't arrived yet, and when it does arrive it makes the Correction you just took unnecessary*. Let's say you were patient and didn't correct. Instead, your blood sugar would climb and climb until suddenly dropping off a cliff when the required Insulin finally arrives (obviously this will vary a lot depending on how in sync your carb and correction ratios are).

*I know hypothetically your Bolus Calculator should prevent this from happening, but I find the Bolus Calculator, in general, less reliable when Extended Bolus miscalculations have occurred.

Morning,
I have had a few successes, I view my successes as a small peak after eating with no significant dips or peaks in the period after eating.
To be honest on paper it sounds marvellous but practicality is another story.
Best of luck.

 

[Soplewis12]

One of the things you hear a lot of with Extended Boluses is "it's trial and error", which I don't dispute there's no way round that. The thing is to determine if something is an error and the cause of that error you have to know what success looks like and that's something, as I refine my Extended Bolus technique, I've realised I don't know what a 'perfect Extended Bolus' would look like. So does anyone who's got a good technique down want to share, what happens when your Extended Bolus works?

Observations from my own trial and error.

1) Too Much Insulin Up Front, or the Extension is Too Short

This is fairly easy to recognise. Your Blood sugar dips below your starting point without even the hint of a spike from the food. You treat the hypo (even preemptively at above 4.0mmol/l) and then the treatment sends your Blood Sugar into the stratosphere because the Food Spike hadn't actually hit yet, and the Insulin you intended to deal with that Spike was essentially eliminated by the Hypo treatment.

2) Too Much Insulin in the Tail, or the Extension is Extended for Too Long

This one initially looks like you haven't taken enough Insulin. Your Blood Sugar starts climbing and climbing, if you correct your blood sugar drops like a rock because you did set the correct dose, it just hasn't arrived yet, and when it does arrive it makes the Correction you just took unnecessary*. Let's say you were patient and didn't correct. Instead, your blood sugar would climb and climb until suddenly dropping off a cliff when the required Insulin finally arrives (obviously this will vary a lot depending on how in sync your carb and correction ratios are).

*I know hypothetically your Bolus Calculator should prevent this from happening, but I find the Bolus Calculator, in general, less reliable when Extended Bolus miscalculations have occurred.

As teatime dinner is always my largest meal with protein & carb mix I always extend the Bolus of this meal.mostly 60/40 release over an hour or 1.5 hour if pasta.

 

[Chas C]

Generally if its normal food for me then I'm standard 30% upfront and 70% over 75 mins, usually taken 20 mins before eating but time prior I adjust depending upon my BG at the time, if high then much earlier if low then much later or none at all.

If I'm eating pasta or pizza then I normally extend the time for the 70% out to 90 mins, if its a curry then sometimes 120 mins.

If I'm eating over long time then I don't extend but just top up on the way, if I'm caught out by meal time extending unexpectedly then I'll cancel the extended bolus, make a note of the undelivered amount then top up along the way also adding the undelivered.

It is trial and error, I do my best to try and stay below 10 for meal peaks, but its not always possible. I would add do what fits your lifestyle best and try not to get it perfect as there is always something else in the background that having an impact on your BG's.

 

[StewM]

Morning,
I have had a few successes, I view my successes as a small peak after eating with no significant dips or peaks in the period after eating.
To be honest on paper it sounds marvellous but practicality is another story.
Best of luck.

Yeah could you explain a bit more? Cause like you say that does sound good, so what’s issues with that?

 

[Soplewis12]

Yeah could you explain a bit more? Cause like you say that does sound good, so what’s issues with that?

Just all the guesstimate of what you are eating and how it affects you. Might be better if you are a person who eats the same meals week in week out but I regularly eat different meals Al the time.