Super bolus question

[Gary_W]

Hello everyone,

I'm really enjoying my pump (perverse to enjoy a medical device that you insert with a steel spike but you know what I mean).

I seem to have good success with post-meal walks / mild excercise by using the extended bolus to slow the Apidra down. I'm going hypo a whole lot less lately which is great :D

I still spike quite badly in the mornings, but have improved this using the super bolus. I'm still experimenting with a few different combinations and breakfasts before I consider I've got it right. I'm just interested to know how others do it?

So for those that use it, do you ALWAYS choose the same length of time to kill the basal? And do you kill it completely?

To date, I've always stolen either 2 or 3 hours from the basal and added it to the up-front bolus. The three hour one seems to work best for me and means I can eat regular cereals for breakfast. Which I like doing; I just cannot face all the bacon and eggs stuff in the mornings....

The only disadvantage I've found so far is that it fouls up the IoB reading quite nicely. I've heard of people doing super bolus with the 'fill canula' part of the prime menu as this won't then show up on the IoB. Sounds a little dodgy to me; I'm sure it's fine but I'm just nervous of the prime menu whilst I'm attached!

Gary

[Eddy]

Not to hijack the thread... but, after reading of your trials and tribulations with Lantus, I wanna know what in the *bleep* kind of basal you have.

[Subby]

I've heard of people doing super bolus with the 'fill canula' part of the prime menu as this won't then show up on the IoB. Sounds a little dodgy to me; I'm sure it's fine but I'm just nervous of the prime menu whilst I'm attached!

I'm no help with super bolusing, but I must say I would feel the same trepidation mucking around in the prime menu and fixed primes, myself. If you aren't comfortable with it, don't do it.

What's the reference to bacon and eggs... fat to slow your absorption? As options, have you tried specific low-gi options as well? There are a couple of cereals and breads that spike me much less severely. I'm in another country but I'll say them anyway: Helga's soy and linseed bread gives a wonderfully low response. Vogel's Low GI muesli does pretty well for me too. (and it's really nice).

I don't know how exhaustively you've tried low GI stuff. I find that some of it works great, other times it can be officially "low GI" and still spike me right up (repeatedly). I partly put this down to GI being tested on non-diabetics, with their full, natural insulin capability intact and probably a little different to diabetics (or just me).

In other words, for me Low GI foods represent a good target of things to try, and I sometimes find stuff that is "low GI" that really does give me a good slow energy release. But some just do not work as low GI for my body: so a lot of checking and experimenting per food, is required.

[Gary_W]

Subby - Thanks for that. I am aware of GI and try to go with foods that are kinder if I can. I don't always manage that :) There is a German rye bread that I do well with, but I tend to be OK with most stuff at meals other than breakfast. Evening meal is open season and it seems I can eat anything without spiking too badly. Long may that continue... The bacon and egg reference was purely in terms of low carb breakfasts. Lots of folks here seem to go with cheese / bacon / eggs etc. Whilst I enjoy all of these things, breakfast to me tends to be cereals, breads and fruit. All of the things that spike you worst at the time of day when you are most resistant to insulin so I realise I'm my own worst enemy. Knowing how diabetes changes, there may come a day where I can't eat these things anymore but until then I'll try and figure a way to get around the cornflakes :)

Eddy - I'm really still working out the basal. My night-time and morning seem about right now (though my BG has risen VERY slightly in the night for the last couple so it may be changing again already....). Afternoons still need taking back further. I haven't got those right and haven't got time / opportunity to basal test without life getting in the way. With that in mind, I am currently taking a grand total of 9.08U per day in basal. Which isn't much... It is split through the day as follows:

12am 0.100
1am 0.075
4am 0.500
6.30 0.525
9am 0.475
11am 0.400
4pm 0.450
10pm 0.275

As stated, the afternoons still tend to result in a 3.30 - 4.30pm hypo so I'm taking the early afternoon back a little as of tomorrow and seeing how it goes. I've only done a couple of actual basal tests during the day since pumping; the rest has been adjusting based on when I seem to dip / rise inexplicably and as I blood test at least every 2 hours I'm not far out. Apart from the mid to late PM, I'm pretty good now. Nights were tested extensively in the begining with 2 hourly bloodtests as everything was going to pot on MDI.

As you can see, the 7-fold increase in early hours to dawn was no fun on Lantus. If you do the maths on 14u of Lantus, that equates to around 0.58u per hour if you take it as being genuinely flat. Of course it doesn't work like that but you can see how this gave problems. I would sometimes drop by 5mmol in the night and again if you do the maths there is a couple of spare units of insulin floating around in those early hours comparing Lantus with pumping. That's more than enough to drop me down there.

Gary

[xMenace]

I usually decide at 9am, my 2hr pp. I set a 2 hr temp based on my number and activity and lunch plans. My critical time is 11am to noon.

[Eddy]

I am currently taking a grand total of 9.08U per day in basal.



As you can see, the 7-fold increase in early hours to dawn was no fun on Lantus. If you do the maths on 14u of Lantus, that equates to around 0.58u per hour if you take it as being genuinely flat. Of course it doesn't work like that but you can see how this gave problems.


No wonder you were having such a rough time with Lantus. What puzzles me is how you went from being a flatliner to your current basal pattern. What causes such changes? (Or is this just another case of "stuff happens"?)

[Subby]

Gary, I have a big drop in insulin requirements 4 - 6pm. My amateur guess is that this may be some kind of daily liver exhaustion (my needs rise very steadily, up to that point).

Regardless why, I really found that putting more intermediary steps in my basal and easing it down towards that time, helps alot for minimising my "crunch time". My gut at looking at your basals is you could try putting another basal in at 12 - 2pm or something, then try stepping it down, ease down towards your "crunch time". May be worth a shot.

[Gary_W]

Eddy - I can't be sure what caused it. From a history point of view, I only learned to basal test etc in January 2007! At that point, I needed 20u of Lantus per day and putting it all in at night worked.

Weight then started coming off (which was good, as it was the Lantus overdose of yesteryear that had caused it to go on in the first place). As more and more weight came off, I gradually had to reduce the Lantus. IIRC, all was well at 16u per day. I then had to reduce it further. Once I took it down to the 14u per day (what I needed) something just flipped and the problems came on in spades. These days, almost 70% of my daily insulin comes from bolus. I'm not a complete carb monster either. Imagine how I kept in the old days when I used to be on 35u per day of Lantus and around 20u of Novorapid.... No fun at all for most folks but with my body's preferences it is no wonder I bounced off the end stops for years :eek:

Subby - Thanks for that. I have indeed done something along these lines and the PM seems fixed. If anything I drifted a little higher today in the PM but that could have been the ice cream I had earlier finally getting in.

You've got to love that about a pump; if your problem is in one bit of the day, you can fix that little bit without having to louse up the rest.

Gary

[xMenace]

Imagine how I kept in the old days when I used to be on 35u per day of Lantus and around 20u of Novorapid.... No fun at all for most folks but with my body's preferences it is no wonder I bounced off the end stops for years :eek:

Brings me back to my endo visits when he'd flip a coin: heads is raise the basals and tails is lower them. Gawd!

Great work Gary!