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Extended Bolus or TBR

noblehead

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A quick question, how do people adjust their insulin for high-fat meals, do you use an extended bolus or do you set a TBR?

I was reading Think Like a Pancreas last night and Scheiner says he recommends you use a TBR for such meals, saying increase it to 50-60% over 8 hours and monitor thereafter, any thoughts?
 
I use the extended bolus - e.g. fish and chips is about 120g of carbs. I do a 30/70 split over 2 hours. Or if my bg level is verging on the low side before the meal I'll do a square wave
 
a TBR is definitely a worthy option............

I have tended to use an extended bolus in the past though with varying success as the insulin dose still matches the meal carbs but is just delivery over the extended time. You could say the absorption of glucose from this meal takes on a similar profile...........

whats the science behind choosing a TBR? would this be TBR instead of any bolus or in addition to a bolus.......?
 
novorapidboi26 said:
whats the science behind choosing a TBR? would this be TBR instead of any bolus or in addition to a bolus.......?
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There's a good question, I'm taking it to be in addition and you bolus for the carbs and the TBR is for the insulin resistance that takes place hours after finishing the meal, I'm not sure at the moment and don't have the book to hand.
 
50-60% sounds a lot - not that I've tried it. Always interested to hear how others get on with things like this as I just tend to avoid these types of foods which is the wrong way round really.
 
I've always extended the bolus but never really thought about the TBR option.

What does it say about the Bolus, should you still take the same amount for the carbs in the meal?
 
Thanks very much for the replies, much appreciated

@dtennant9, doesn't seem to say for some strange reason but I'd imagine you would still have to bolus some insulin, I've also got the book Pumping Insulin so will have a look later and see if there's any mention in there.

tbh its probably trial & error like everything else, I've not long started on a pump so still getting to grips with things, but finally nailed my basal rates (for now) after a lot of testing, sore fingers and missed meals
 
Thats great that you have managed to get your Basal Rates sorted so quickly!
I'm still a bit away from that and haven't been able to do much for the last couple of months as I keep getting the cold.
 
dtennant9 said:
Thats great that you have managed to get your Basal Rates sorted so quickly!
I'm still a bit away from that and haven't been able to do much for the last couple of months as I keep getting the cold.
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Thanks Dtennant9, I had a cold about 5 days after starting on the pump so know where your coming from, once the colds gone get down to some basal testing as it s worth the inconvenience that it causes, I'm on 5 different basal rates at the moment although my pump allows up to 7.Good luck and best wishes.
 
Yeah it's not good but at least I have the TBR which I've never used before other than for exercise.
I'm currently on 140% all day and seems to be taking the edge off it. The literture I have says keep your TBR on until your results go back to normal. Either that or I'll have a massive Hypo.
 
I know I'm old but, I know extended and wave bolus but what's a TBR out of interest?
 
Oh yes definitely
 

If I have a larger meal than normal say an odd rare takeaway or a meal out I do not extend or multi wave.

My reason is:
My normal carb value intake is between 12-50g per day.
If I am then going to have 100-150g depending upon the food and company.... Then that is putting my basal ratio to bolus ratio out of alignment for that period of digestion.
So I whack on a TBR of 200% or 250%.
Multiwaving in this scenario just does not work for me and My levels will start climbing all during the night and I would end up in the 10-15 bg levels.

This is probably 1 meal on average in 3 months and for me ut works brilliantly.
 
noblehead said:
Thanks DD, over what time-scale do you whack on the TBR?
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I'll whack mine on straight after I have ate... Which may be 2 hrs if going out for a meal and about 1-2hrs after a takeaway.
I then test at 3am on these nights and can switch off then according to the results I see. If I'm above 7 I will leave running until I get up which would be about 8am. If below 7 I turn off.

It is a more complicated route than doing a multi wave but that for me just gets me nowhere at all for eating more.
 

Thanks again DD, that's helpful although I do know that's just your own experience, I'll experiment and see how I get on
 
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