Frustrated with dual wave bolus!!!

[poper77]

I know that everyone is different when it comes to how much and when, but can anyone offer any advice on the dual wave function? I have it figured out for eating really high fat meals, but can't seem to get the hang of it for lower fat meals (5-10 grams). I have been trying to do almost 1/2 the bolus over 1/2 hour - I turn out high. If I try the same thing over an hour I am still high!! Are there any guidelines for this? :mad:

[RLK]

I have been trying to do almost 1/2 the bolus over 1/2 hour - I turn out high. If I try the same thing over an hour I am still high!! Are there any guidelines for this? :mad:

I usually take half of the bolus up front and spread the other half out over something like 2 or 3 hours. Sometimes I get it right, sometimes I miss by a mile. 3 hours seems to be close for me. You may also need to account for protein because that can drive your numbers up (though to a lesser extent than carbs) and therefore should be bolused for, especially with pizza and the like. Do a search on these boards for "TAG" or "Total Affect on Glucose"- there were some really good discussions not too long ago.
Hope this helps and good luck!

Edit: I just re-read your post. I don't think I've ever used the DW bolus for a meal with only 10 grams of fat. Is it possible that your bolus rates aren't quite high enough? Sorry for not picking up on this in my original reply!

[spike]

ah, why not stop using a dual wave for anything EXCEPT high fat meals? a well balanced meal should use a normal bolus. try it and keep tabs on your bg's. of course u will be high if you delay your bolus for 30 minutes. many foods hit fast. TRUST ME! :)

[spike]

for pizza what works for me is 60/40 over 4 hours.

[Cyborg]

I use the combo bolus quite often. I've never used it for high fat meals, but I do use it for protein. I almost always bolus for protein seperately from the carbs. I do also combo bolus for pizza, but it is high fat and high protein.

For protein, I do a 30/70 combo bolus over 3 hours. I calculate "equivalent carbs" as 75% of the actual protein content.

I also do a combo bolus if I take Symlin with a meal. 50/50 combo over 2 hours and bolusing for the entire carb content seems to work best for me in that case.

Trail and error, hopefully without too much error... Good luck. :)

[KAnderson]

I use the dual wave with pizza, etc - 50/50 - 2 hrs. Works great for me - also if I eat a Costco "Rot dog" - I use the DW to account for the fat/protien. When you say "high" - how high do you mean? What time frame?
Ken

[xMenace]

I guess I must be perfect:- I've never found they do anything for me. I go straight up all the time.

[poper77]

When I say "high" I am usually 200+ about 2 hours later...but still have active insulin....I think I will just do as Spike suggested and not use the dual wave unless it is a super fatty meal. The minimed nurse had suggested to use it with most meals as a normal pancreas would secrete a little insulin in beginning of a meal and then a larger dose a little while later. It is good to hear what other people do though.

[spike]

When I say "high" I am usually 200+ about 2 hours later...but still have active insulin....I think I will just do as Spike suggested and not use the dual wave unless it is a super fatty meal. The minimed nurse had suggested to use it with most meals as a normal pancreas would secrete a little insulin in beginning of a meal and then a larger dose a little while later. It is good to hear what other people do though.

The beauty of Humalog/Novolog is that they cover a "normal" meal pretty darn well, if taken at the start of the meal. They never were intended to be "doled out" over time for a non-fatty meal, contrary to what the MM gal suggested to you. Once again, the combo bolus is for fatty meals; not for carby ones.

Let us know your results, please.

[KAnderson]

Wow - 200 + @ 2 hrs isn't good...what was your BG when you started your meal? You can expect up to a 50 pt gain at the 2 hr mark...so if you were 150 + you could expect that kind of a reading - however with a 6.8 A1c - that doesn't sound likely..Remember that everyone is different and it can take a bit of experimenting to figure out how the DW works for you.
According to my manual, the DW is also for slow absorbing carbs as well as for treating a pre-meal high.
Ken

[spike]

Wow - 200 + @ 2 hrs isn't good...what was your BG when you started your meal? You can expect up to a 50 pt gain at the 2 hr mark...so if you were 150 + you could expect that kind of a reading - however with a 6.8 A1c - that doesn't sound likely..Remember that everyone is different and it can take a bit of experimenting to figure out how the DW works for you.
According to my manual, the DW is also for slow absorbing carbs as well as for treating a pre-meal high.
Ken

The dual wave might be in some manual as a means of treating a pre-meal high, but I don't do that. If I'm high right at meal time, I take a normal bolus to cover the carbs, plus the high, start it, and try to delay my meal for a little while. I'd like someone with experience here to please explain the rationale behind treating a premeal high with a dual wave, and what results they get from doing so. (Assuming that the meal is NOT fatty)

[KAnderson]

Spike - I don't have experience with it - I do as you described - I just commented on what my MM manual says...
Ken

[Cyborg]

The dual wave might be in some manual as a means of treating a pre-meal high, but I don't do that. If I'm high right at meal time, I take a normal bolus to cover the carbs, plus the high, start it, and try to delay my meal for a little while. I'd like someone with experience here to please explain the rationale behind treating a premeal high with a dual wave, and what results they get from doing so. (Assuming that the meal is NOT fatty)


I do the same. I also have never used a combo bolus to treat high bg.

[kgm0612]

I use the dual wave feature when I eat Chinese, Pizza, or foods high in fat & protein. I usually take half up front and the other half over a 3 to 4 hour period.

Karen

[JanTx]

I'm clueless here, but have this question about being high before a meal and the mm pumps. THe bolus wizard works for that, right? You put in BG, carbs, and it figures out how much to give based on both those numbers. Do I have that right? Sometimes it lowers the bolus if I'm low and others it increases the bolus if I'm running higher.

I'm not even thinking about the dual and square waves until 11/11 - I'm going to an advanced pumping class then. That's exactly 4 weeks after I started pumping so that seemed about right for that kind of fine tuning.

[Cyborg]

I'm clueless here, but have this question about being high before a meal and the mm pumps. THe bolus wizard works for that, right? You put in BG, carbs, and it figures out how much to give based on both those numbers. Do I have that right? Sometimes it lowers the bolus if I'm low and others it increases the bolus if I'm running higher.


Assuming the MM works like the Animas, yes you are correct.

[spike]

I'm clueless here, but have this question about being high before a meal and the mm pumps. THe bolus wizard works for that, right? .

Are u asking someone in particular, or all of us?

[JanTx]

It was a general question to whomever knew enough to answer. Thanks, Cyborg. Spike, your comments about treating a high before a meal made me wonder if I was doing that, then realized that maybe the Wizard on the mm pump was doing it for me. Seems like it.

[Cyborg]

No problem... You'll be a pro in a few months. :)

[poper77]

I think the bolus wizard accounts for when your high as to what percentage to take immediately and what to take over time. This weekend was a good test for not doing the dual wave, unless for a fatty meal and it is working better! I did do a dual wave for dinner saturday because I went to my in-laws and we had alot of food and cake, and it all went well.
Thanks!