Extended bolus for pasta meals

[SophiaW]

Can anyone give me some advice on what would be a good starting point for an extended bolus to cover high carbs like a pasta meal.

Last night we had spaghetti bolognaise. Jess had 200g pasta with some sauce. I did a 50% 50% split with the second 50% being delivered over 3 hours. She went too low 1.5 hours after the meal (2.8 mmol/L) which we treated with 8g of glucose sweets and 10g carbs of orange juice. 3 hours after the meal she was 5.5 mmol/L (bear in mind she'd had quite a large correction when she went hypo 1.5 hours earlier). 5 hours after the meal she was 3.9 mmol/L which we treated with another glucose sweet. 9 hours after the meal her reading had climbed to 8.9 mmol/L which we did a bolus correction for and then 12 hours later she was back up again at 9.9 mmol/L which again we corrected for by which time it was breakfast time and her readings since have been in the 5's.

So I know the 50% 50% split is too strong to start with. Can anyone help me to make a guesstimate on what I should try next based on the readings I got last night?

 

[louiseb]

sorry I cant help I have no experience of insulin but hoping by gmping this back up to the top maybe somebody else might be able to help.

 

[MushyPeaBrain]

My pump recommends a starting combo of 30% and then the other 70% split over 4 hours.

I haven't had to use a combo yet as I don't eat much in the way of pizza and my pasta portions are too small to warrant it but hope this helps a bit!

 

[MushyPeaBrain]

Here you go looked up my notes:

When I started using the Animas 2020 I was told they usually tell people to use combo for anything over 5 units unless you're insulin sensitive

If I remember rightly it was suggested I use the combo the bolus in the following way:

30/70 over half an hour for bread and plain potatoes (baked boiled)

100% extended over an hour for porridge (as it's very high fibre)

A 30/70 split extended over an 1-4 hours for pasta. This bolus was also suggested by my nurse for rice.

30/70 bolus extended for an hour, or an hour and a half, or up to four hours (trial and error) for high fat foods (like pizza). You start by extending the bolus for an hour and increase the extended bit of the bolus a little each time you eat high fat food, till you get the desired result.

For high GI foods (which break down into sugars quickly) I was told to think about using more of the dose in the first portion of the Combo bolus. (I.e. 40/60 or 70/30)

I was also told to consider the following when calculating a bolus:

carb content
BG level
fibre content
fat content
protein content
GI rating

However it's all very individual and you need to see what works for you.

 

[SophiaW]

That's great, thank you for taking the time to type that all out. I'll try it next at 30% 70% extended over 4 hours. It will probably need to be tweaked further but gives me a good starting point.

 

[donnellysdogs]

Wow Mushy, I was never told anything about extended or multi wave, fantastic to read and thank you very much, I have had to guess mine and had a few 'hiccups' along the way-so to speak!!

Thanks for the info....

 

[donnellysdogs]

Discussed different bolus regimes with my DSN today, and found Mushys details listed brilliant.

I am now looking more at changing from the straight forward bolus to multiwave or extended for all foods that are low in glycaemic index value. The vast majority of my food is low GI, so I wonder whether altering the type of bolus I am giving may tweak my figures rathe than adjusting the carb ratio's?

Do other members just change their bolus type for pasta and rice, or do other pumpers change more regularly for low glycaemic foods?

Do most pumpers just give straight forward bolus's?

As my eating habits are so routine, I am going to try different bolus's and monitor how I react....does anybody have other foods that they change their bolus for....I know I did for Christmas pud!!!

Any help very much appreciated......

 

[SophiaW]

We're very much still in the experimenting stage but any foods that seem to give less than ideal readings I'll try the extended bolus on to see if I can improve them. It's going to be a long process I expect.

The types of food we eat and I expect will need extended bolusing are paella, risotto, take away fish and chips, pasta and pizza. I also think pastry like cornish pasties or pies may need an extended bolus and I'm yet to see what porridge does.

Last night we had take away fish and chips as I wasn't feeling well and hubby organised the supper. I'm hoping someone might suggest what combination to try next time as we didn't get an ideal result. Here are the readings taken:

7pm: 5.4 mmol - Fish & Chips, no sugar drink. 66g total carbs. 30% 70% split over 3 hours.
8pm: 8.8 mmol
9pm: 7.3 mmol
10pm: 4.0 mmol
10:30pm: 3.7 mmol - treated with 1x 4g glucose sweet
3am: 14.5 mmol - bolus correction
7:30am 5.8 mmol

I don't think the glucose at 10:30pm caused the high at 3am, one glucose usually raises her BG by 2-3 mmol. I feel the 30% initially was probably about right, perhaps it could go to 35%, but maybe the remainder needs to be extended over a longer period of time. What do you other pumpers think?

 

[Hazza]

Hi Sophia, I think that you are right about the 35% at the start and maybe try 2hr extended instead of 3hrs. We tend to use 2 hours for Lily as she goes low if we use 3. We also use a multiwave for chocolate cake.
It's all trial and error and different foods need different bolusing.

Harry