guidence on multi-wave please

[aceone]

Hi. My son has been a diabetic since he was 5y (he is 12 now). He started on the spirit pump in april and went onto the new combo in august. I must admit, all diadetics should be on a pump for reasons i will explain at a later time.

My question is........My son is going to start using multi-wave, instead of using standard all the time, but i don't know how long to multi-wave foods for.

For example, i know rice need a long multi-wave but i cannot find how long i would do it for. Is there a guide for how long you multi-wave foods (not just rice)

I hope i have explained myself ok.

Thanks in advance. Ian

 

[kegstore]

Ian

I agree with you on the "pump for every diabetic"!

Your son's reaction to different foods will be unique to him, so the only option is trial and error with lots of testing in between, but as a rough guide here is what I use to start you off:

pasta - 4 hours; rice - 2 hours; fatty foods - 1 hour; pulses - 1 hour

Anything else I tend to bolus instantly, but do sometimes make new discoveries. Essentially it's down to what GI value each food has, so there's plenty of scope for fine-tuning, at least that's the way it works for me. Further information on GI is available at http://www.glycemicindex.com/

I can eat (what I think is) a large plate of pasta in absolute confidence, knowing my bg will stay almost completely flat throughout and afterwards. Hope that helps.

 

[phoenix]

I think this is difficult to get right, I'm always wary of too long a time period so it's interesting to read that Kegstore uses 4 hours fo pizza.
I've just used a 2 hour square wave for tartiflette, a really high fat mixture with cheese and potato ( a meal acceptable to neither docs nor low carbers!) I calculated the carbs, added on a unit because it didn't seem enough and did a square wave over 2 hours. It was hardly scientific, more like a game of think of a number, but at 2 hours my level is 6.3mmol. I'll look again in a couple of hours.
What would be a good idea is to record the experiment, it's a meal I might have 3 times a year so it's hard to remember what happened last time.

EDIT: BGL at bed 6.2mmol so didn't really change
fasting level 5.7mmol (a bit higher than usual but I normally go to bed at nearer 5mmol)

 

[meela83]

Sounds lovely Phoenix might need to ask you for the recipe!!

 

[kegstore]

I have to add that I have a distinct advantage with CGM, so I get a new sensor reading every 5 minutes. Provided the sensor is calibrated correctly (still waiting to nail this... :evil, means I can track exactly what happens to my bg over the hours following a meal.

I think this is difficult to get right, I'm always wary of too long a time period so it's interesting to read that Kegstore uses 4 hours fo pizza.

Interpretation of how different GI foods work with you is crucial. Pizza is actually a 3 hour bolus with me, but for rice "the rules" say that you only need to worry about basmati, all other varieties just use a normal bolus. If I did that I can guarantee a whopping hypo; trial and lots of errors (plus collateral damage like lacerations/bruises) made me settle at 2 hours. Better to start too long than too short, the occasional high is worth it if you can establish the correct rate of bolus for future use with a particular food.

(I love Tartiflette , but Reblochon hard to source in the UK?)

 

[phoenix]

Reblochon: I saw it in Tescos last time I was there
I'm going to have to do some more experimenting with multiwave, I quite often go too low an hour or so after dinner and am reluctant to treat because I know it will go up later. I need to remember to set the pump back to normal when dosing for the next meal. I had to suspend and start again this morning, when I realised I was doing a square wave for my breakfast,

 

[aceone]

Thank-you for all yor replies. I wish i could do the testing instead of my son. You know what kids are like if you interupt them while watching tv of playing on the DS.
I am very greatful for all the advice you give me on this matter.

I am from liverpool and we were only told about standard bolus. One of the nurses at the clinic said that another hospital (did not say were) just use multi-wave or extended. They dont us standard at all.

Any comments please..............

 

[kegstore]

I am from liverpool and we were only told about standard bolus. One of the nurses at the clinic said that another hospital (did not say were) just use multi-wave or extended. They dont us standard at all.

Again I think it depends on what you're eating, the type of insulin in the pump and how quickly your bg changes in reaction to them, but I use all bolus modes throughout a given week, and normal/standard bolus is probably the most common for me. The different modes of delivery are not there just to show how clever the pump can be, but to mimic as best it can the delivery of insulin by the pancreas in a non-diabetic, albeit in the manner of an automaton...

 

[phoenix]

There is an interesting discussion on dual wave boluses on Tu diabetes. (google Tu diabetes, TAG, dual wave.)
One interesting comment made was that a pump trainer called the normal bolus a 'skittle bolus',ie the bolus that you'd use to eat a bag of skittles, the dual wave was a far more appropriate method of insulin delivery for mixed meals
Some of the posters are working with the idea of TAG, total availalble glucose. This assumes that not only the carbs turn to glucose but also a proportion of the protein(58%) and fat (10%) but these take a longer time to convert
As far as I understand it bolusing involves bolusing for the carbs up front and then accounting for the glucose produced by the fat and protein.
What it doesn't seem to take into account is the gi of the carbs and unless I've read it wrongly it must mean decreasing the carb/insulin ratio (otherwise total insulin for the bolus would be increased). It also means a lot more maths! Some claim to be getting better control.