Super bolus help

[tigger]

I've been trying to do this on the occasions I eat cereal in the morning and am not sure I'm getting it right. Basically I take 10% of the next 2 hours add it to my bolus and do a temp basal at 90% and each time I am going low very badly around 2 hours later. What am I getting wrong? Do I need to start the temp basal earlier? I use porcine insulin so use 2 hrs as my set time for adjusting anything basal related.

 

[Deleted Account]

Hey @tigger
That sounds complex.
Can you remind us which pump you have?
Other users of the same pump may have a simpler solution such as using combo-boluses and not altering basal.

 

[Binary]

Pretty much every cereal will spike. If you don't get a spike then you will hypo around 2 hours and even if you do spike you can still hypo around 2 hrs.

I assume you are using a super bolus to stop/reduce a spike? Two hours in and I would expect your initially insulin to still be working. You could reduce your temp further without increasing your super bolus but that may affect your BG's a few hours later.

Do you eat your cereal immediately after bolus? If you do and only if you are a good number 5 - 7 then you may consider waiting so many minutes before eating. Try waiting 10 minutes then eating and see how you get on. You BG's should start dropping but when it rises it starts rising from a lower number and the spike should be lower as the insulin has had longer and is working better. It may enable you to reduce you bolus slightly which would help reduce your drop around 2 hours.

 

[tigger]

I'm on a 640g.

I usually wait 30 mins after bolusing before eating.

 

[Binary]

Ok, I wouldn't wait any longer than 30 minutes, are you spiking then dropping? If you are hypoing around two hours either you are taking to much insulin or its too strong at that time.

I would suggest you either try reducing you insulin (assumming you count carbs then you can bring out your carb ratio for breakfast) or you drop your waiting time to 20 - 25 minutes.

My understanding of a super bolus is that you take some of your basal and lump it on with your bolus and therefore reducing you basal for 1 - 2 hours which is what you are doing but in terms of percentages it is the smallest super basal that I have heard off.

My understand of a super bolus was more like transferring 50 - 100 percent of your basal to you bolus but this is the last thing you want to do if you are having bad hypos around two hours. You should only consider this if reduce your insulin which causes a large spike but 3 hours later you figure is back where it started and stable.

 

[donnellysdogs]

Without breakfast and bolus's are your basal tests ok?

 

[tigger]

Yes basal test has been fine and I've been using libres a lot recently so can see whether I'm waiting too long and hypoing. I'll just have to think of something else. If I do it my usual way I have a massive spike.

 

[Binary]

You could try reducing your basal for the first hour say 50% without loading it onto your bolus, alternatively if you don't want to change anything then you can always try eating/drinking extra carbs prior to hypoing maybe half an hour before expected hypo.

 

[Bluey1]

I have stopped having breakfast, it's just too difficult. My problem is I don't hypo. Without eating I go up in the morning (I have to adjust the pump) anyway, but 4 weetbix and I'm hitting 16 and it eventually comes down just before lunch. I find I have to wait at least 45 min before eating otherwise I can hit 20+

 

[catapillar]

I think you're super bolusing wrong. A super bolus is supposed to involve stopping basal completely, or significantly reducing it and adding the lost basal onto the bolus. You are only reducing your basal by 10%, which is, frankly, pointless.

If you're going low 2 hours later, you might need to consider reducing the basal for longer before eating, but not adding all of the basal lost onto the bolus.

Or just find something other than cereal, or choose a lower GI cereal, or try it with whole milk to see if that reduces the spike.