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using extended bolus

cally

cally

Well-Known Member
Messages
232
Location
United Kingdom
Type of diabetes
Type 1
Treatment type
Pump
I would like some tips on eating out and using extended boluses.
I try to eat on a low carb basis most of the time, but I do find it difficult if there are meals out on holiday or special family occasion and I want to eat more normally for a change.
I do try to use an extended bolus with an immediate bolus followed by an extended bolus over 4-6 hours and this seems to work until the 6 hours are up but I still find that my blood sugar rises as high as 15mmols in the middle of the night and often even in to the next day sometimes. Even if i'm sure I have calculated the carbs properly.

Eating late at night is a particular problem and obviously I don't want to go hypo during the night. I'm a bit worried about how long to extend the bolus for and by which ratio.

I have tried many combinations and am fed up with it now. Do i have to accept that my body just can't cope with large amounts of carbs?
Any tips on how any of you cope would be most welcome.

I'm using an Animas vibe
 
i think if you have tried many angles with regards these occasions with no success its unlikely you will find the perfect formula to deal with it..........

keep at it though.........

trying to avoid spikes between meals can usually be tackled with the timing of your bolus, so you could try getting more in at the start of the meal and also leave more time between the bolus and the actual eating.....

I have found that one party to the next is always different no matter how hard I try, however these occasions only come along every so often, so its not doing too much harm letting your hair down from time to time....

:)
 
look up TAG total available glucose as well, if you low carb, from what has been said, everyone is unique and you have to work out your own ratio
http://kellywpa.com/2010/11/10/total-available-glucose-tag-2/

http://www.tudiabetes.org/group/tagers
I´ve just read "Your diabetes science experiment" by Ginger Vieira and the comments here and wonder if I´ve got it right.
Carbs that convert to glucose is 90-100%
Peak is 30 min - 1 hour
Protein that converts into glucose is about 50% but only if the protein serving is over 20 grams
Peak is 2-4 hours
Fat that converts into glucose is about 10% but only if the meal has more tha 20 grams of fat
Peak is 8-10 hours
Example with protein from Vieiras book:
"If a 12-ounce (340 grams) filet mignon has about 90 grams of protein, there are 70 grams of protein that are over 20 grams. Therefore 50% of 70 grams is 35 grams of added glucose to the total carbohydrates of that meal."
Example with fat from the book:
"1 cup og Ben & Jerry´s Cherry Garcia ice cream contains 52 grams of original carbohydrates and 28 grams of fat. That is about 10 grams over 20 grams, therefore I would add 1/2 or .5 units of insulin to my insulin dose after calculating teh dose for teh 52 grams of carbphydrates". (This is her personal ratio not a given 1/2 unit)
How to bolus:
Add upp the total available glucose form carbs, protein and fat and bolus 50-75% up front and the rest for and extended period of 1,5 - 4,5,6 hours depending on the meal and the fact that only you are you.
Have I got the TAG-thinking right?
 
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Thanks novorapidboi26 and jack412
I have tried all kinds of different bolus and then extended bolus but I can usually remain on target for the first four hours or so of a six hour extended bolus but then my blood sugars start to rise.

So I don't think the immediate part of the meal bolus is wrong. Its the later rise that concerns me. At the moment I deal with it by getting up at about 03:00 and testing and correcting.
I don't think extending the bolus for longer will help either.
As I said I don't have this problem if I stick to lowish carb meals which is what I do most of the time.
It is only if I try to eat 'normal' food on holiday and special occasions that it all goes wrong.
 
For me I only need extended bolus for protein heavy meals and fat heavy meals. I would have expected you to need extended bolus LESS when coming off low carb for a day or a meal. What kinds of things are you eating? Pizza and ice cream? Those do need extended bolus, because of the fat.
 
cally said:
I can usually remain on target for the first four hours or so of a six hour extended bolus but then my blood sugars start to rise.
Click to expand...
This suggests the immediate bolus (4 hr action) is basically right, but the extended part needs to be a larger dose. And reduce the immediate bolus accordingly when increasing the extended bolus.
 
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Spiker said:
Cally are you sure you don't just need an increase in basal?
Click to expand...

On very rare occasions of a takeaway I always bolus for meal as usual and then whack my basal rates up to 200% until the 3-4am dose is finished. This is just my way of handling, I've done extended but it not work so good for me, or the multiwave because my body is just not used to carbs. At xmas (used to be all of December) I used to run 24 hours at a time on 200 or 250% because this happens with me:-

If I eat double (at least) the qty of carbs I always eat...effectively that is knocking my basal/bolus ratio's out of sync..so having to have higher qtys of bolus for my food means I also have to alter the basal...as fat and protein etc also comes in to play with takeaways as well as humongous carbs then I just accept that from 4hours after my meals if takeaways I will put on a tbr for another 4 hours....
For xmas day only this year (not all of December) my pump will stay probably on 200-250% as I know I will be eating at least double my carbs.

Extending and multiwaves do not allow really for me to work, when I'm eating rare takeaways etc because its the same amount of insulin delivered differently. My body dods not like its basal/bolus ratios going out of sync...

Just my way of accounting for odd days of extra carbs...
 
Thanks spiker and donnellysdogs,
I have tried increasing the extended part of the bolus and that didn't help, but maybe I didn't increase it enough!
I think I will try increasing the amount and the length of the extended bit next.
A bit more experimentation is called for I think. I like your temp basal idea and think I will try that also.
I do have several basal patterns already, and think it wouldn't be possible to do another one for high carb days and holidays as the details and timings are always different.

I think my body just can't cope well with carbs and wonder if I have a bit of delayed digestion going on?
 
The trouble with extending over a longer length of time is that it just makes your 5 units say stretch to 5hours rather than say 4 hours, so it is effectively delivering less insulin each hour... If its this scenario as an example over 5hours you would then only get 1 unit an hour rather than 1.25 an hour if it was 4 hours. So you could just end up higher for longer...
 
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