Stupid Pump Tricks Vol MLXVIII - Extended Bolus Rollovers

[Spiker]

The summary of Wolpert 2012 is that for a 10gf low fat (LF) meal compared to a 60gf high fat (HF) meal, in T1 subjects, same gpr and gch, similar GI, crossover study, the high fat meals needed 50% more insulin per unit of carb, and were still showing higher BG than the low fat meals. So that's an acute effect in T1s, and a significant one.

Maybe what's happening is I'm going hypo when the fat wears off and my insulin:carb ratio reverts to normal.
Except I would expect the action of the fat to be 8-10 hours and the action of the insulin to be 4-5 hours so that doesn't make sense.
Maybe the ratio reducing action of the fat (in T1s) is much shorter, shorter than the action time of the insulin.
That would mean I go hypo shortly after I stop having butter coffees. That kind of matches... I'm going hypo a couple of hours after leaving the places where I am able to make butter coffees.

Edit:
I'm cross-posting (http://www.diabetes.co.uk/forum/threads/slim-and-save.74191/page-4#post-812367) with myself here, still a bit whacked from the hypo earlier today. But it looks like something - possibly the high fat diet, possibly not - has broken the magic IOB capability of my pump, which previously shielded me from the hazards of insulin stacking.

 

[ElyDave]

Don't use extended or multiwave. Just whack on a high tbr if needed.
Went out with parents n hubby tonight. Just the pudding had 110g in it. The dinner 59g and the starter guestimated at 40g. So over 200g in one meal!!!!!

So bolused for that and then stuck on a tbr of 250% for 4 hours.

As this is actually 4 times the qty of my whole days food then even this 200% tbr is not going to cope with the inbalance between of my 50/50 basal/bolus ratio. So at end of 4 hours will do another tbr probably of another 4 hours, depending on levels though.

The pudding of millionaires shortbread sundae wasn't worth 110g carbs though!!

That one meal is about twice my daily average.

I thought I was throwing the boat out with my homemade chocolate fondants at 30g apiece

 

[donnellysdogs]

DD I don't understand your reason for doing a massive TBR on top of bolusing for the carbs. Is the TBR just for the fat in the food?

Solely because my body I guess works very differently.

If I have that much "food" -it doesn't matter what it is from my daily totals of 27units split about 13.5 equal.. It then puts me to at least 17 for bolus... If Idon't add on the extra basal in back ground I'm jiggered.

 

[donnellysdogs]

That one meal is about twice my daily average.

I thought I was throwing the boat out with my homemade chocolate fondants at 30g apiece

It was the equiv of 4 days of food for me at least!!! thats why I think I need to have extra basal cos my body is just not used to it.

Brewers fayre grub I always google to look at carbs on their menu first..... It total carb overload!! Would have had more! Mum offered me half her pud.. Had to turn it down although I wanted it as 110g carbfor the pud was enough!!

 

[noblehead]

@Spiker, the Joslin Study conducted some research into dietary fat and how it effects bg levels and insulin usage in type 1 diabetics:

http://www.sciencedaily.com/releases/2013/03/130327190328.htm

 

[donnellysdogs]

Was 5.6 at 2.30am and 7.8 at 8.30am so unless I had the extra basal running through the night I would have had horrendous highs. I don't think it was the extra fat.. As millionares shortbread sundae was huge everything at 110g carbs!! Let alone the rest!!
It works for me as multiwave or extended just doesn't cope in my body.. We all different though.

 

[Spiker]

It works for me as multiwave or extended just doesn't cope in my body.. We all different though.

I am curious though. What doesn't work about extended bolus for you? What happens when you tried to use it?

In principle I can't see the difference between say a 4 hr TBR and a 4 hr extended bolus?

 

[Spiker]

@Spiker, the Joslin Study conducted some research into dietary fat and how it effects bg levels and insulin usage in type 1 diabetics:

http://www.sciencedaily.com/releases/2013/03/130327190328.htm

Ah that's a write up of the same Wolpert 2012 study I linked to earlier. Thank you though.

 

[Riri]

OMG - reading this thread over and over again just makes me realise how little I know/understand about food, TBRs, extended boluses V insulin. I have to say most of the time my 'wing it' and gut feeling response, having had diabetes for over 16 years now, seems to work on the whole. I use a TBR quite often but only for illness, time of the month and every other mysterious high blood sugar periods I get - never thought to use it for different foods. You certainly learn new things every day in this game.

 

[donnellysdogs]

I am curious though. What doesn't work about extended bolus for you? What happens when you tried to use it?

In principle I can't see the difference between say a 4 hr TBR and a 4 hr extended bolus?

I get immediate highs (2 hours after) and all during the night and I will have to correct all the time...a TBR is giving extra basal as well as the extra bolus for the carbs. The extended bolus just flat lines the bolus delivery (which is increased obviously) but doesn't allow for the extra digestion etc going on in my stomach I guess... I was diagnossd with slow colonic transit anyway which thanks to flax and chia seed keeps my stomach working nicely and normally nowadays. Perhaps its my stomach actions with 4 / 5 times my normal food that impacts on my bloods and my reason for extended not working?? Multi wave would have been the ideal choice not extended but neuther work. I just rake ut that as the food qty us so much extra bolus that my basal goes out of sync and thats why I have to do it my way.

Its all experimenting as individuals really until we find things that work for us.

I don't normally eat any such **** food, no potaties, pasta, rice etc so this is also probably a reason too. My levels are pretty stagnant and so fine tuned to my normal living and day to day foods...With very little variance (by my own choice...) that extra just completely messed me up on normal multiwave and extended.

 

[donnellysdogs]

Illness and stress I always have to shove on a tbr of 200-250% too!! Perhaps my fault though as my normal living is so relaxed with work, food, activities and is so fine tuned with the basal and bolus that I cause my need for extra TBR for odd occasions...

We're all different...

 

[jack412]

Interesting. I'll have to reread that. I can see how it could be good to have a "third arm" - TBR to deal with fat, extended bolus for protein, normal bolus for carbs. (Maybe in a few years we will have pumps or dose calculators that will just let us explicitly enter the three values.)

I still worry that the TBR doesn't have any way of corresponding to the amount of fat or carbs or protein ingested. The TBR isn't the inverse of insulin resistance, after all. So I can see how an increased TBR could compensate for an increase in basal requirements caused by transient insulin resistance, which is useful, but how could it also compensate for increased insulin resistance vs the carb and protein bolus?

Anyway thanks, and I may give it a try, because what I am doing now ain't working.

this tag'er wrote some programs that might be worth looking at and googling to get to the author
https://twitter.com/ten3six
V3... 2013
http://jdrinc.webatu.com/iD-Cal.html


list of progs
http://jdrinc.webatu.com/

 

[noblehead]

OMG - reading this thread over and over again just makes me realise how little I know/understand about food, TBRs, extended boluses V insulin. I have to say most of the time my 'wing it' and gut feeling response, having had diabetes for over 16 years now, seems to work on the whole. I use a TBR quite often but only for illness, time of the month and every other mysterious high blood sugar periods I get - never thought to use it for different foods. You certainly learn new things every day in this game.

Riri, if you purchase the book Pumping Insulin by John Walsh & Ruth Roberts they go into great detail how you can get the best from your pump, when I first read it some of it just didn't make sense, but now I'm pumping insulin its all much clearer now.

 

[iHs]

Like @Riri I dont really bother with the waves and just keep to normal bolus but then again, I try to keep my meals balanced up with low carb vegetables, protein and fat and normal bolus works ok for me. If I had to calculate the fat, protein and carb in my meals, I wouldnt want to have a pump anymore but its everyone to their own

 

[donnellysdogs]

I dont count anything except 4g for an egg really. Also lower carb. Just had to learn my own way for rare excesses!

 

[RuthW]

The summary of Wolpert 2012 is that for a 10gf low fat (LF) meal compared to a 60gf high fat (HF) meal, in T1 subjects, same gpr and gch, similar GI, crossover study, the high fat meals needed 50% more insulin per unit of carb, and were still showing higher BG than the low fat meals. So that's an acute effect in T1s, and a significant one.

.

So, as a Type 1, new pumper and interested in the LCHF info on these boards, can I ask (politely because this is not rhetorical - I really would like to know the answer) what are the benefits of long term LCHF diets for Type 1s if it doesn't allow you to reduce your total intake of insulin? ( I am not contrasting with high carb here - just a more moderate carb/fat/protein approach). Or are you not talking about LCHF - more about protein intake and effects on insulin? (The benefits of LCHF for Type 2s seem very clear - just wondering about Type 1s).

 

[Spiker]

this tag'er wrote some programs that might be worth looking at and googling to get to the author
https://twitter.com/ten3six
V3... 2013
http://jdrinc.webatu.com/iD-Cal.html


list of progs
http://jdrinc.webatu.com/

Very interesting TAG links, thanks.

 

[Spiker]

So, as a Type 1, new pumper and interested in the LCHF info on these boards, can I ask (politely because this is not rhetorical - I really would like to know the answer) what are the benefits of long term LCHF diets for Type 1s if it doesn't allow you to reduce your total intake of insulin? ( I am not contrasting with high carb here - just a more moderate carb/fat/protein approach). Or are you not talking about LCHF - more about protein intake and effects on insulin? (The benefits of LCHF for Type 2s seem very clear - just wondering about Type 1s).

Well a 50% or even 100% increase in carb ratio still means less total insulin if you reduce your carbs by more than half, vs whatever baseline diet.

But yes I think one of the most consistently reported findings from the front line of LCHF is that you can't get your insulin dose below a certain floor level, no matter how much you juggle the nutrient composition.

 

[donnellysdogs]

I agree with Spiker but the benefits are- less carbs, less insulin, less errors on guestimating any foods....
Also some of the older pumps when you get over 1 unit an hour of basal...only had increments at 0.05. If you decrease bolus's from carbs gradually you will lower your basal to only the necessary amounts.... And then if you needed over 1 unit an hour you may find you need to drop to less than 1 unit an hour.. And then you can get better control as the rates on some pumps adjust by 0.01. So allowing better tighter changes in basals to be made.
From my personal data and how my body handles carbs...If I ate say an average of 150 carbs a day my basals would also need to be doubled at least to keep them in line with the 50/50 basal bolus ratio that consultants like to see you on...

 

[Spiker]

I don't believe in using the 50/50 basal to bolus ratio as a prescription. In my view that should only be used as a starting point in the absence of any other information.