Accu-chek combo Multiwave bolus

[ebony321]

Hi all,

I've started to try break out of my instinct to always choose extended bolus when i bolus for food.

I've started to use the multiwave bolus for food when i need a correction on high BG's, this is so the high BG is addressed immediately and then i still have the extended afterwards to deal with my meal. As it dawned on me that when using extended, especially for long periods of time it'd be a while before my full dose is given.

I hope this makes sense so far

SO, my question is, does anyone else use this pump and this bolus? because the pump 'suggests' an initial dose of insulin to be given immediately, and i am completely confused as to what it's reasoning is behind this.

Is it anyway based on any information that you programme into the pump?

I can certainly say i've been noting the doses seperately to see if it is working to a certain percentage but it's certainly not doing that.

For example, i just did a test run and put in enough carbs to give me an even amount of bolus which was 10u, i selected multiwave and it suggested 2.3u immediate delivery. Eh?

Either i'm missing something really simple here or my pump has a mind of it's own, as i'm sure the pump should default to 50/50?

:?:

 

[jopar]

Hi Ebony

The mulit-wave is my most used bolus..

If it's the first time you've got to the multi-wave that will be the factory setting I can't remember what settings it's working from, but it will give a smaller percentage for the first wave/bolus then the rest will be the rest of it..

But you can change this to suit your needs and your chosen just high-light in blue, then press the ok button, and use the up and down scroll to determin what does you want.. Same with the duration as well.

What percentage split you need and how long to extend it for, is a bit of a trial and error..

But I determine my split, by my BG reading if it's low 4's then I will reduce the first wave/part to slightly lower than usual..

If I am eating an high fat content meal, then I will have a lower first wave, larger back wave..

I normally work with a split of between 40/65% for the first wave and an hour extended, but this does very though again dependant on BG and whether high fat or not..

But remember the next time you use the multi-wave the figures it will give you will be determined by what spilt you used the last time..

The first time I used the mulit-wave got a bit of a shock, When it starts delivering you will see the whole dose figure counting down, and you wonder if it's going to stop or not :shock: But it does stop when it's deliverd the first wave, and then leaves the remianing extended wave figure!

 

[ebony321]

Hi Ebony

The mulit-wave is my most used bolus..

If it's the first time you've got to the multi-wave that will be the factory setting I can't remember what settings it's working from, but it will give a smaller percentage for the first wave/bolus then the rest will be the rest of it..

But you can change this to suit your needs and your chosen just high-light in blue, then press the ok button, and use the up and down scroll to determin what does you want.. Same with the duration as well.

What percentage split you need and how long to extend it for, is a bit of a trial and error..

But I determine my split, by my BG reading if it's low 4's then I will reduce the first wave/part to slightly lower than usual..

If I am eating an high fat content meal, then I will have a lower first wave, larger back wave..

I normally work with a split of between 40/65% for the first wave and an hour extended, but this does very though again dependant on BG and whether high fat or not..

But remember the next time you use the multi-wave the figures it will give you will be determined by what spilt you used the last time..

The first time I used the mulit-wave got a bit of a shock, When it starts delivering you will see the whole dose figure counting down, and you wonder if it's going to stop or not :shock: But it does stop when it's deliverd the first wave, and then leaves the remianing extended wave figure!

Thanks Jopar!

My nurse started me off on standard, and then extended. I feel pretty confident in using the multiwave and have been experimenting and changing the amounts myself judging on what i'm eating and wether i need a correction or not.

I just though it very odd that it suggested such a strange amount. Imay have to drag the manual out under the bed to see what the default settings are as i'm sure i've read/heard it's 50/50 but i may be wrong.

First time i did one i did panic as it counts the immediate bolus down from the whole thing, but i trusted the pump knew what it was doing and sure enough the extended bolus popped up on the pump. phew

i first used the multiwave when eating pizza after the extended just seemed to fail at covering it. I only like one pizza from pizza hut so i've pretty much got that one nailed now, tricky though!

I've been thinking more when i eat food since starting the multiwave, fatty foods and quick carbs, slow carbs etc.

My pump definately knows how to keep me on my toes thats for sure!

thanks again.

 

[donnellysdogs]

Jopar

Can you answer me a daft question probably....regarding multiwave...

When you get the machine to say give 3 units multiwaving over 3 hours...
1) how does it deliver it...i.e. does it drip feed every 3 minutes or does it give say 1 unit at the top of the first hour and then another full unit the top of the next hour?
2) does the first hour stat straight away, so that you are actually giving yourself more than you think in that first hour...or does it start after an hour?

Sorry, I have been thinking about this for some while and thought you might know....

Thanks
S

 

[jopar]

1, The dose is split evenly over the hour (or period chosen) then it delivers at 3 minute interviews.

2, yes the hour starts from when you start the multi-wave boluse, your 1st dose will be delivered 3 mintues after the first wave has been delivered..

I would love it if you could do a multi-wave that you could put the first wave in, then delay the start of the second extended wave..

Some people use what is a super bolus, where they add the background insulin to their the bolus total.. It sounds pretty complicated when you see if written down, and those who use it do say it's easier doing it than reading about it.. But this is mainly used when meal spikes are a problem, which I don't experiece so hadn't had the need to look into too deeply

 

[donnellysdogs]

Hi Jopar

thanks for response...I too when have used multiwave would have liked the 2nd part to be delivered at at time when I specified later..that would be good.

I rarely multiwave as most of my food is less than 5 units and this is what I was informed..to do a standard bolus unless over 5 units.....do you multiwave for less than 5 units or is it solely biased towards the type of food and your levels....

Just wondering whether to play around more...I don't eat cheese...most of my food currently is chicken or some sort of meat with salads, with a few nuts and a selction of fruit...currently 1/2 orange/1/2 kiwi, with some strawberries with a bit of no fat yogurt.... and lunchtimes ryvitas with some topping..but again lunchtime my dosage is due to walking dogs is rarely above 1 for that.

Can I ask what type of bolus you would do for that sort of food??

PS...I just like fresh food...I don't intentionally stay away from other types of food and do have bread, occasional creamcake etc...but just meat, veg, fruit and salad...

 

[ebony321]

Thats a good point DD, i was also advised to standard bolus anything under 5 units, but i have to be eating under 20-25g to be getting under there, and thats quite rare to be honest.

If i'm testing and i need a correction and i have no live insulin remaining i will standard bolus that.

I think you probably could extend or multiwave a small bolus but..

If the pump cannot give a dose every 3 minutes because the dose is too small to split into 0.1units over the set time? would it give it in a larger space of time? would it say give it every six minutes or would it just run out of insulin to give before the alotted time is over?

I'm really starting to think multiwave is the way foward as surely a small dose at the beginning to get things going would give you better 2 hours results and the second wave will deal with the slow release of carbs?

Unless of course your meal was very fatty so your better off having a delayed bolus like you suggest, i like the idea of a super bolus, it sounds pretty super just by its name

 

[donnellysdogs]

I know I was asked to try multiwave/extended for my 3 ryvitas at lunch time...and my levels shot up as high as a balloon..so I have not tried it for smaller amounts such as ryvita (21g CHO for the type I have) as a normal bolus seems to deal with ok.

I multiwave for bolgnese if I choose to have pasta with it, which is rarely...as this time of year I prefer asparagus, mangetout and leeks with it instead. Last time I tried a multiwave for bolg with past my levels went up to after 2 hours 8.9 from 5.7 and machine suggested a bolus..I did it...but directly afterwards I went in to look at the pump menu and saw that I still had 1.1 to go in me!!!!! So inevitably I started to go lower and ended up eating a piece of bread to sort out and was ok...obviously I didn't have everything just right that night...but the time before I had the same standard default settings and my levels stayed under 6 consistently....I do want to try again...but with me, I needed to know just how and when the pump put in that 2nd wave to know more of what I should do...

Thanks for the help Jopar..and Ebony

 

[jopar]

Most of my bolus's are under 4 units a little goes a long way for me..

Tonight I had a quiche (home made) and salad which worked out about 47g's of carbs...

My BG was 4.1mmol/l before tea so the wizard reduced my dose to 4.1 units so I had 2.8 units first bolus, the rest over an hour.. Not tested yet, won't until 2 hour mark so I let you know then..

But if I had a roast dinner (taddies done in beef dripping) which my normal insulin for that is about 3.5 ish, I would put about 1.8 to start and the rest over 75 mins..

I find it hard to say how I split because a lot is so automatic, very dependant on several factors, such as BG, Meal type and what I'm doing afterwards to determine the split.

I've been pumping for quite a while now and started off on the Blue Spirit pump, a bit of a Skoda of it's time (before VW took them over) so with no wizard's you had to manual calculate your bolus! Don't regret having the spirit as it did teach me a lot, but it does have make using a wizard strange though

 

[donnellysdogs]

Thanks Jopar

It gives me more of an idea to perhaps experimenting more....I too will have quiche and salad..tomorrows meal actually..so I look forward to seeing what your results are...I am going to try altering to a dual tomorrow.....

Much appreciated....

 

[jopar]

DD

You'll gonna hate me for this one, just done my 2 hours test (I do enjoy the reminder)

4.1mmol/l spot on... Should get a tad raise though as pastry but this will remain under 5mmol/l

Experimenting can be scary more so if you likely to go one way or tuther... But if done with caution and extra checking to keep a good tab on things should be fine within reason..

 

[donnellysdogs]

I think that is brilliant..gives me more confidence in doing a MW...seeing that my machine is set up to a default of 3 hours I believe then it is good also to see that you change yours down to much less than the default. I know for one bolognese I was perfect with 3 hours, don't know why the same bol and same dosage didn't work the 2nd time.....

and the time I tried with my ryvitas I had to give up...my levels went to 15 all the 3 days I tried it...so now like today I was a bit low for my liking I was 4.4 had my ryvitas and 2 hours after was 4.6...so when I tried with MW it put me off...but...thinking back I probably used the default settings...will definitely try for my quiche and sald and fruit tomorrow...(depsite the quiche not being home made!!!!)

Just gives me a bit more confidence to play a little more with the MW function,,,Thanks J...S

 

[donnellysdogs]

Hi Jopar

Had same as you last night (quiche and salad, plus bowl of straberrys and yogurt though!!), and basically did 1/2 my units up front and the others multiwaved over 1 hour.....started off at 5.0 and 2 hours later 5.4... excellent...
Just got plain chicken tonight with salad so will keep to my standard...what a result though Jopar..really pleased and given me more confidence to experiment more with MW.....thanks S

 

[sugar2]

Really interesting, and thought provoking thread....thank you!

Inspired to experiment a bit more. i assumed, that if I managed to stay under 7, after 2 hours, all was well, so rarely do anything other than standard bolus, but the fact that you (Jopar) stayed around 4.1, without a hypo, ahas made me realise that I really could (try!) to do better.

Off to experiment..

 

[donnellysdogs]

I didn't like to see a swing of more than 1.7 in my levels after food, so a 0.4 is great. I now want quiche again tonight to try it again!!!! Having seen all the mangetout that need picking and the carrots to pull up...think going to have chicken and veg tonight though!!!! So as this is miniscule carbs, just thinking what carb treat I can have as a pudding to try the MW again!!!!!!

Jopar...can you give a bit more advice....if you were having pasta....how long in time would you do that over??? Just a rough idea of what you do would be great....I take that it would be a longer period of tiime-I did mine over 3 hours but got 2 differing results both times!!!!

Thanks J...very much appreciated...S

 

[ebony321]

What a result DD.

The multiwave is great but i find it takes some experimenting when it comes to different foods.

With pasta usually extend for 2-2.5 hours. I'm not fond of having too much of the same tasting foods (i like a bit of everything all at once) so i don't usually have too much of it..

When first doing pasta i did the usual 2 hours test but i tested every hour after that to see if i had a sneaky rise later on so i knew if i should extend it further next time but 2-2.5 hours seems to work for me!

My nurse always says theres all these wonderful things on pumps but some people only ever use what works, when they could be using something much better!! and i think it's true.

I really need to take that into practice and programme a weekend basal instead of temp basal rates :lol:

 

[vic hill]

whatever u use 50/50 40/60 always remember on NOVO ACTRAPID ITS A SIX HOUR WORKING TIME
So it will work longer not like normal bolus
stay safe vic