boluses

[ebony321]

Hey guys,

Just wondering, what sort of boluses do you use and when?

my pump does the following;

Standard bolus : all insulin deliver immediately in one go

Extended bolus : all insulin delivered over a chosen period of time (15mins-X amount of hours)

Multiwave bolus : part of insulin dose delivered immediately and the rest over a chosen period of time.

So, my wondering is that my nurse first said to use standard bolus whilst i was getting to grips with things.

then she said to use the extended bolus if the dose was higher then 5units.

Now she has said that it's recommended to always use the multiwave bolus when over 5 units.

I currently use all three, standard bolus if a small amount of insulin, an extended bolus if its more or has a high fat content. I use the multiwave bolus if my meal has a complex carb.

But thinking about it, i should probably use the multiwave bolus if i need a correction, so i can deliver this immediately and the rest is an extended, because i want that to be corrected asap.

Just wondering if my thinkings are along the right lines and im curious what other people do?

Thaaaaaaanks as always

 

[donnellysdogs]

Hi Ebony

Can't understand your reasoning to want to give a multiwave as a correction bolus?? If you are needing a correction bolus, it would be because of being outside the limits on a high basis...so why would you want to give some now, and some later, surely...only by my reckoning the machine is telling to give it all straight away to get the levels down sooner rather than later....

I always use standard bolus for correction, you have your correction bolus set up to give you so much to bring you down as normal, depending on your sensitivity, and your acting time, and this is meant to bring you down within 5 hours without sending you hypo, if you have your settings correct.

I do normal standard for over 5 units, but think that is because I very, very rarely have anything with high fat content. I used a mutliwave for the one occasion I have had a slice of pizza...

It would be interesting to know what others do, because I was actually asked to try extended bolus for low gi foods (no lower limit of how many grams), and I had to give up doing it within 2 days, because it sent my levels so, so, so high.....

I just can't see any reasoning as to giving a multiwave for a correction bolus....

 

[ebony321]

Hi Ebony

Can't understand your reasoning to want to give a multiwave as a correction bolus?? If you are needing a correction bolus, it would be because of being outside the limits on a high basis...so why would you want to give some now, and some later, surely...only by my reckoning the machine is telling to give it all straight away to get the levels down sooner rather than later....

I always use standard bolus for correction, you have your correction bolus set up to give you so much to bring you down as normal, depending on your sensitivity, and your acting time, and this is meant to bring you down within 5 hours without sending you hypo, if you have your settings correct.

I do normal standard for over 5 units, but think that is because I very, very rarely have anything with high fat content. I used a mutliwave for the one occasion I have had a slice of pizza...

It would be interesting to know what others do, because I was actually asked to try extended bolus for low gi foods (no lower limit of how many grams), and I had to give up doing it within 2 days, because it sent my levels so, so, so high.....

I just can't see any reasoning as to giving a multiwave for a correction bolus....

Hi DD,

what i meant was a correction alongside food.

So i have an immediate dose of insulin (for the correction) and then the extended bolus after (for the food).

Extended boluses work really well for me, as i have a high ratio it also helps with comfort issues too.

But i just though if i need a correction at a meal time, if i'm using the extended bolus which could be for a while then i'm not really getting that correction quick enough?

If i need a correction and i'm not eating anything i bolus that as a standard bolus.

I dont think maybe i worded my first post so well

 

[donnellysdogs]

Aaah, now I can possibly see your reckoning...However, I have never tried it. I see the reasoning behind it.

Again, 99.9% of my bolus are all done by standard bolus, so I would be interested in hearing from others as well that use the other variations...

 

[SophiaW]

I get what you're trying to say Ebony. If Jess has a high reading at a meal time, and we're not doing a standard bolus with the meal but rather an extended bolus, then we will do two separate deliveries. First one as a blood glucose correction as a standard delivery, second delivery as the meal bolus and extended according to the type of food, we won't put in a BG reading with the second delivery. You are right that if you include the whole lot in an extended bolus it will only mean that your BG takes longer to be corrected which is not what you want.

 

[ebony321]

Aaah, now I can possibly see your reckoning...However, I have never tried it. I see the reasoning behind it.

Again, 99.9% of my bolus are all done by standard bolus, so I would be interested in hearing from others as well that use the other variations...

Ah good

just a thought, i mean either way i would be getting the same amount of insulin, i'm just wondering if i would get better two hour readings maybe which would improve my hba1c a little?. I may have to experiment, a day of just extended and a day of multiwave maybe.

I know other people use a different pump so it would be interesting to know what the other pumps are able to do bolus wise...

 

[ebony321]

I get what you're trying to say Ebony. If Jess has a high reading at a meal time, and we're not doing a standard bolus with the meal but rather an extended bolus, then we will do two separate deliveries. First one as a blood glucose correction as a standard delivery, second delivery as the meal bolus and extended according to the type of food, we won't put in a BG reading with the second delivery. You are right that if you include the whole lot in an extended bolus it will only mean that your BG takes longer to be corrected which is not what you want.

ahh..

So you are manually doing what my pump offers as the 'multiwave bolus'?

All this time and its only just occured to me! (doh)

I definately think i'll try this as there's been times when i'm testing regularly to make sure i'm coming down nicely after a meal and it's taken a bit longer, which may coincide with sightly higher readings pre-meal.

hmm, the mind wanders. Thanks for that Sophia

 

[donnellysdogs]

Got to ask from this, how often do people use extended compared to standard?

I'm worried now that I should be altering more than I do.

For example tonight I had ham salad and 200g of strawberrys..would anybody use an extended or multiwave for that-oh and 3 plain ryvitas for lunch?

Tomorrow night I will have quiche and salad with 1 kiwi, 1/2 orange and 1/2 banana and the lowest carb strawberry no fat low fat yogurt....would anybody use extended or multiwave for that?

 

[ebony321]

Got to ask from this, how often do people use extended compared to standard?

I'm worried now that I should be altering more than I do.

For example tonight I had ham salad and 200g of strawberrys..would anybody use an extended or multiwave for that-oh and 3 plain ryvitas for lunch?

Tomorrow night I will have quiche and salad with 1 kiwi, 1/2 orange and 1/2 banana and the lowest carb strawberry no fat low fat yogurt....would anybody use extended or multiwave for that?

Because i have a ratio of 2.5u:13g unless i have a very low carb meal, my dose is usually above 5units, which means i use an extended bolus about 80/90% of the time i'd say.

In my case extended works better because i have to bolus a bit more insulin it means it's not sort of sat there, it works bit by bit as the glucose from my food is released if that makes sense?

so for example the ham salad (assuming its little or no carbs) 200g strawberries 1 kiwi, 1/2 orange and 1/2 banana and the lowest carb strawberry no fat low fat yogurt for me that would probably be over 5units for me so i would extend the bolus.

If i had the same amount of carbs, but the meal was high in fat, or the carbs were more complex, i would multiwave bolus.

Or for example if your snack/meal had some carbs in that was fast acting, teamed with longer acting carbs you could multiwave bolus, because the fast acting would shoot your BG's up before the insulin took effect.

When me and my nurse talked about the different boluses i asked if anyone stuck to one bolus, to which her reply was 'of course' and explained that while people use the same bolus which can work perfectly for some, she encourages people to play and practice with others incase it could be more efficient, or if the standard is no longer as effective.

Hope this makes sense, i have a feeling i'm not very good at explaining myself tonight! :lol:

 

[SophiaW]

Ebony, I'm not sure how your pump works but with the Animas if I wanted to say deliver 4.5 units with a 30% immediate delivery and 70% over 3 hours, plus deliver 1.30 units immediately as a BG correction I'd need to manually calculate what percentage split to deliver a total of 5.8 units. It's not a calculation I can do quickly and easily so that's why I take the route of correcting the BG first (100% of 1.30 units immediately) and then asking the pump to deliver 30% of 4.5 units immediately and 70% of 4.5 units over 3 hours to cover the food. Maybe your pump can crunch the numbers for you.

Donnellysdogs, the only meals we use extended or combo boluses for is pasta, pizza, rice dishes like paella and any high fat foods e.g. takeaway fish and chips, KFC etc. Otherwise a standard bolus seems to work okay for most other foods that we eat.

 

[ebony321]

Ebony, I'm not sure how your pump works but with the Animas if I wanted to say deliver 4.5 units with a 30% immediate delivery and 70% over 3 hours, plus deliver 1.30 units immediately as a BG correction I'd need to manually calculate what percentage split to deliver a total of 5.8 units. It's not a calculation I can do quickly and easily so that's why I take the route of correcting the BG first (100% of 1.30 units immediately) and then asking the pump to deliver 30% of 4.5 units immediately and 70% of 4.5 units over 3 hours to cover the food. Maybe your pump can crunch the numbers for you.

Donnellysdogs, the only meals we use extended or combo boluses for is pasta, pizza, rice dishes like paella and any high fat foods e.g. takeaway fish and chips, KFC etc. Otherwise a standard bolus seems to work okay for most other foods that we eat.

My pump is apparently meant to suggest a 50/50 but doesn't. I usually work out the split myself like you do, it doesn't work out by percentage. I've just never took the correction into account before. But i think from now on if i need a correction and plan to use an extended bolus, i'll use a multiwave and set the correction to be the immediate delivery.

Like you if i intend to use a multiwave but want to hav the correction immediatley too then i'll work out my usual split without the correction, then add the correction amount onto the imediate delivery.

thanks

 

[ams162]

we nearly always use the normal bolus and then a dual bolus for pasta and pizza which seems to work for us if we use a standard bolus for pasta esp dylan is low an hour after but high hours later a dual bolus deals with this well. never used the square wave bolus on his pump tho.

anna marie