pump virgin, I have a ?

[willie4004]

Just started 3 days ago and i am a snacker. Lets say for example, I eat Bfast, snack, lunch, 2 snacks, dinner, and then another snack. Thats 7 times I should give myself a bolus. Is that normal to give yourself 7 bolus' in a day? I am just making sure that is normal since some of the time I have some insulin on board from lunch, bfast, etc.Thats part of the freedom of the pump right...

Also I cannot thank you people enough, i have had much comfort in this site and has been very educational and supportive. It is easy when you have diabetes to get lonely and feel like you are the only one going through this. I dont know what I would do if I could not get advice and experiences from actual pumpers. The internet is great. Thanks

[steamfan261]

Yeah, it's pretty normal. If you're using a Medtronic pump the Bolus Wizard will allow for insulin-on-board when it calculates your bolus.

[Gary_W]

Hi Bob,

I'm only 3 weeks in with pumping so my advice may not be as valid as some of the old timers here on the pump. Also, I'm using an Animas not a Medtronic. They all work out insulin on board in a slightly different way. The Animas lays out for you how it does the maths; not sure the Medtronic does?

IMO, you need to figure out HOW it is doing the maths and until you fully understand how it does it, you need to be careful of the advice that 'insulin on board' gives you. Doing 7 bolus' in a day is fine, but the Animas can occasionally tell you that you don't need to bolus due to IoB. If you are confident that you got the carb counting right from the last thing you ate then in theory all the IoB you have is already 'spoken for' with the meal or snack you last ate. If you eat more, you still need to cover it.

As an example, imagine a carb ratio of 1:10 and you eat 100g of carbs for a main meal. 10u of insulin goes in. A couple of hours later, you decide to eat a 40g carbs desert. Your pump tells you that you still have 4u of insulin on board. Does that mean you can eat the desert scot free and not bolus? In my opinion, no it doesn't.

I'll get down from my soap-box now. It's just a little personal niggle of mine as I think that IoB is poorly explained in the Aninmas manual and until I discussed it on here and had a serious amount of circular brainstorming I just didn't get it. I will bet that it gets a lot of people into trouble and has the capacity to cause seemingly inexplicable highs (why am I high after eating that desert? I had 4u of insulin still active...).

Gary

[RobiJo]

The Animas lays out for you how it does the maths; not sure the Medtronic does?

IMO, you need to figure out HOW it is doing the maths and until you fully understand how it does it, you need to be careful of the advice that 'insulin on board' gives you. Doing 7 bolus' in a day is fine, but the Animas can occasionally tell you that you don't need to bolus due to IoB. If you are confident that you got the carb counting right from the last thing you ate then in theory all the IoB you have is already 'spoken for' with the meal or snack you last ate. If you eat more, you still need to cover it.

As an example, imagine a carb ratio of 1:10 and you eat 100g of carbs for a main meal. 10u of insulin goes in. A couple of hours later, you decide to eat a 40g carbs desert. Your pump tells you that you still have 4u of insulin on board. Does that mean you can eat the desert scot free and not bolus? In my opinion, no it doesn't.

I will bet that it gets a lot of people into trouble and has the capacity to cause seemingly inexplicable highs (why am I high after eating that desert? I had 4u of insulin still active...).


The MM bolus wizard doesn't calculate NEW carbs into IoB, it will give you the full amount. It only subtracts insulin if bg is low, which you would have already put in the first bolus. So it WOULD tell you to bolus later when you decided to eat the dessert.

[pumpman]

Hi Bob,
Doing 7 bolus' in a day is fine, but the Animas can occasionally tell you that you don't need to bolus due to IoB.

As said above, IoB only counts towards BGL corrections. If you just had a meal and put in a bolus, your blood sugar is naturally going to spike up for a while. If you tried to correct this "fake" high, you'd go low later.

So if you have desert 20min later, test you BGL, see you are high (~10mmol/l), you put in a correction AND carbs bolus, the pump will ignore the required amount of "correction" insulin (since there is already insulin in your body bringing down your BGL) and just put in the carbs bolus.

[Gordonm]

Yesterday I had 10 boluses. I had a few small meals and some snacks throughout the day. My average Bg was 91 for 11 BS tests. It was a pretty good day on the pump. I bolus for everything I eat unless I am correcting for a low or going out for a 2 hour+ bike ride.

[solox316]

So if you have desert 20min later, test you BGL, see you are high (~10mmol/l), you put in a correction AND carbs bolus, the pump will ignore the required amount of "correction" insulin (since there is already insulin in your body bringing down your BGL) and just put in the carbs bolus.

This is true, but after only 20 minutes, I wouldn't even test my BGL again, just bolus for the food only.

As most are saying, the IOB only plays a part if you are dealing with a BGL reading as well. Unless you are dropping low, you should cover your snacks with the proper insulin. I would say though, to do some 2, 3, and 4 hour tests after eating (without snacks) to see if you IC ratio is accurate.

[kstreeter513]

I eat several small meals throughout the day. So, ya, bolusing 6-7 times a day is just fine, and imo more healthy.:)

[Subby]

There was some saying I saw a while back that was "smaller numbers, smaller risk", when it comes to insulin. I think that's really true... and I think it's a useful saying with this question:

Lower carb is good. If you are used to eating whole lots of carbs, try keeping it under control each day, eg 0g or 15g or 25g at a meal/snack, rather than 30 - 70g. (You can always take the "real" low carb option, too).

Breaking up your energy intake and having lots of boluses can be really helpful to control (for me, and probably quite a few others) if the doses are a little wrong the risk is smaller, the impact on your BG is smaller, the better off you are.

The time NOT to bolus many times through the day IMHO, is those times/days/weeks when you are tweaking. IE, really trying to get your I:C or sensitivity correct, or keeping an eye on your basal (or basal testing). No useful information can really be got for these two if you keep breaking the insulin action up with new carbs/boluses. So if your ratios etc need work and you want more meaningful data with you BG tests, remember to simplify the picture again and cut down the snacking (or stick to no carb snacks!)

[Gary_W]

As said above, IoB only counts towards BGL corrections. If you just had a meal and put in a bolus, your blood sugar is naturally going to spike up for a while. If you tried to correct this "fake" high, you'd go low later.

So if you have desert 20min later, test you BGL, see you are high (~10mmol/l), you put in a correction AND carbs bolus, the pump will ignore the required amount of "correction" insulin (since there is already insulin in your body bringing down your BGL) and just put in the carbs bolus.

Hello Pumpman,

I can't speak for the Animas 1200 that you are on, but with the 2020 it certainly DOES take IoB into account for carb bolus' in certain situations. Read up my other threads on the subject in this part of the forum for an explanation of how the 2020 does it.

Gary

[pumpman]

Hello Pumpman,

I can't speak for the Animas 1200 that you are on, but with the 2020 it certainly DOES take IoB into account for carb bolus' in certain situations. Read up my other threads on the subject in this part of the forum for an explanation of how the 2020 does it.

Gary

Just did and yes, this pump does have the strange "within target range so no IOB calc" feature. I do find it very silly.