Dual wave bolus

[RWright]

Would someone give me an example of how they use the dual wave bolus feature on their pump?

[jimhuck]

Whenever I eat pizza, I notice that my blood sugar goes up a little bit initially, but REALLY goes up about 1 to 3 hours later. That's the result of the fat in pizza slowing the digestion of the carbs. A dual wave allows you to take an initial bolus, say 2 units, and then spread another 3 units over a 2 hour period.

This prevents your BG from spiking, but also prevents you from going too low.

I use the dual wave alot. I like to bring my BG down gently, and sometimes a normal bolus is just too much all at once.

[Mindstorm]

What ^ said. I used to use it in college when I'd eat a box of mac & cheese because a straight bolus for the amount of carbs in the meal would just cause my sugars to crash and then soar a couple hours later. Now if I eat something like that I give myself a bolus for 60% of the carbs in the meal and an extended bolus for 40% of the carbs in the meal over the course of an hour and fifteen minutes. Has worked out great so far.

It basically enables me to eat some of the super starchy high-fat bad for you food that used to send my sugars all over the place.

[poodlebone]

I use it for high fat meals, all restaurant meals and I also use it for my lunch bolus almost every day. I go for a brisk walk after lunch at work every day and if I took all of the insulin at once I'd drop low 10 minutes into my walk.

[RWright]

Thank you! My sugar always goes up about 3 hours after eating pizza. I will try this next time.

[poodlebone]

Thank you! My sugar always goes up about 3 hours after eating pizza. I will try this next time.

Pizza is a very common problem food for most diabetics and using a dual wave bolus is the best way to deal with it. You'll find you probably need more insulin that you would think by just counting the carbs. Everyone is different so just experiment with the amounts and times to find what works best. Some people will give a 50/50 bolus, 50% right away and 50% over X hours. Some people do as little as 2 hours, some do it for 4 or 6. Some people give 70% right away, or 30%.

[networkguy]

I just started back on a pump (Omnipod, my third pump in 24 years hehe) and parrot what others have said. My rule of thumb is whenever I eat out...pretty much anywhere...50-60% up front, the remainder over 3 hours for all the reasons explained.

[Clint]

I dual wave for pizza like some of the others but I also do it for pastas or anything with lots of fat (very rarely do I have it though). The reason is bad fats can have a lasting effect on BG long after its ingested.

[kgm0612]

I use this feature whenever I eat pizza or Chinese food, only I give 60% up front and 40% over 4 hours.

Karen

[David]

Like almost everyone else said: pizza. For me it's 80% now, the remainder over 3 hrs. I also use it for a large amount (more than 4 ounces) of meat, for instance a big sirloin steak. I usually wing it but the remaining bolus will then run for about 6 hours.

david

[Subby]

I use it for pretty much each and every bolus I take on the pump, as my body appears to absorp insulin a great deal better (talking a difference of onset in terms of hours, even) when the instant part is small and the rest is a short square bolus.

Yes, I am different. But you did ask for examples, that's mine.

[RWright]

You all are so helpful. I love this forum! Just to clarify how to do this...I just turned the dual wave bolus feature on. So when I bolus again, will it give me the option to use this feature? What % would be good to start out with? I know it probably will be trial and error, but any suggestions?

[xMenace]

I use it for pretty much each and every bolus I take on the pump, as my body appears to absorp insulin a great deal better (talking a difference of onset in terms of hours, even) when the instant part is small and the rest is a short square bolus.

Yes, I am different. But you did ask for examples, that's mine.


My minimed rep has suggested I try this. She says they are recommending it often for your very reason.

I find myself doing it more and more with my low carb food plan.

[Subby]

Thanks for sharing that John, good to hear the concept is catching on somewhere in the medical world. I was treated like an idiot when I tried to explain it to my endo at the time.

You all are so helpful. I love this forum! Just to clarify how to do this...I just turned the dual wave bolus feature on. So when I bolus again, will it give me the option to use this feature? What % would be good to start out with? I know it probably will be trial and error, but any suggestions?

Yes, you get the option. Yep, it's just trial and error. Getting involved with finding out what works for you with certain foods, is the best course of action. To do so you must simply experiment.

To do that without much grief, I'd stick with leaving a decent amount either side for the time being (from 30/70 to 50/50 to 70/30) and try a square from 30 min to 3 hours. Once you work out what is working better or worse, you might be led to use more extreme parameters.

[RWright]

Thanks Subby! When I actually use it, I'll post the results...

[xMenace]

Thanks for sharing that John, good to hear the concept is catching on somewhere in the medical world. I was treated like an idiot when I tried to explain it to my endo at the time.

I personally think it's a load of bunk, but hey, I can't argue with results.

[Subby]

If you can't argue with results, I have no idea why you would think it's a load of bunk! Completely irrational position, to me. And, may I add, a rather negative position when it comes to trying different tactics that may improve the individual ways our bodies absorb insulin. An issue that's been established as a potential problem right back since Bernstein picked up his typewriter.

[Delphinus]

Ok, rookie question alert.

Is dual wave bolusing just for pumpers?

Well, I guess non-pumpers could.

It's just doing what the pump does to dual wave bolus, but you do it manually.

Right?

[xMenace]

If you can't argue with results, I have no idea why you would think it's a load of bunk! Completely irrational position, to me. And, may I add, a rather negative position when it comes to trying different tactics that may improve the individual ways our bodies absorb insulin. An issue that's been established as a potential problem right back since Bernstein picked up his typewriter.

"Counter-intuitive" then.

[xMenace]

Ok, rookie question alert.

Is dual wave bolusing just for pumpers?

Well, I guess non-pumpers could.

It's just doing what the pump does to dual wave bolus, but you do it manually.

Right?


It's just for pumpers.

I suppose you could try injecting very small doses every half hour for three hours, but it's hardly practical.

[Subby]

"Counter-intuitive" then.

I can see that... but, just to make it clear, when I decided to give this a go (based only on observation that dual waves worked a lot better for me than even small instant boluses), I had such great results in squaring everything, that I tested a lot with no carbs or food involved (as it turns out, very similar to Walshes method for determining rapid action... take it, test every 30 mins, observe BG trend). A repeated huge difference between all instant vs squared/dueled, from that food-free testing.

Seeing this as some kind of holdup, or pooling issues, it also made sense of why on injection, I would need to take an injection, then test every 30 min, and wait for up to 3 hours to see a downward movement before I ate anything, as a virtual rule (holdup would really be between 1 hour and 3 hours, making it even more frustrating).

I'd say it only applies to a small percentage of people, something to do with the nature of their body and subq tissue perhaps, that I have not found an explanation for. My impression is, most people seem to get pretty good action for an instant delivery.

So, I am glad that there it is being suggested - (if suggested as an option, nothing more) - because I'm sure there would be a few more people around who would benefit from the technique to some degree. The rest in their troubleshooting efforts, can if they like try it, shrug and dismiss it as an issue.

[Subby]

Ok, rookie question alert.

Is dual wave bolusing just for pumpers?

Well, I guess non-pumpers could.

It's just doing what the pump does to dual wave bolus, but you do it manually.

Right?

With the pump and basal or square boluses, think "drip feed".

To do that you'd need to hold a syringe in you for hours and slowly and accurately deliver micro amounts. So, no, not really.

But, as John said you could replicate it to some degree with mini injections spaced out. I think some MDIers around here split their dose around some meals, a similar concept.

[xMenace]

If you can't argue with results, I have no idea why you would think it's a load of bunk! Completely irrational position, to me. And, may I add, a rather negative position when it comes to trying different tactics that may improve the individual ways our bodies absorb insulin. An issue that's been established as a potential problem right back since Bernstein picked up his typewriter.

I've been thinking about this and actually trying it for the past week. I have to say I do think it's bunk, but I also think it works. Let me explain.

I was told to try it to address my high post-prandials "because it closely emulates how our bodies deliver insulin". This is the part I think is bunk. Our bodies release insulin directly into the blood stream. Injected insulin goes into subcataneous tissue. These are two big differences. Injected insulin is still slower than natural insulin no matter how you deliver it. It won't and didn't address my high PPs. The best ways to address high post prandials are to 1. eat fewer carbs and 2. inject your insulin earlier. I will also add 3. release your insulin slowly with a square or dual wave.

I have tried square waving and am now doing it all the time. I don't have numbers to compare, but I do feel an improvement in performance. The kicker came this morning when my set change resulted in a high of 14+ mmol/l. I squared my large correction and two hours later I was 9 and dropping. Typically when I get a high like that I can count on a good 6 to 8 hours of trouble.

More testing is needed.

So yes I can see an improved absorption that makes up for some of the timing loss. A squared pre-bolus is probably going to be my regular method now, at least for awhile.

[Subby]

Fair enough. I don't necessarily agree with the theory that it better emulates the body's insulin processes, either ;) All I find is that the speed of onset increases a great deal if squared. And that increase in speed lines me up with the kind of outer limit of most people's "normal" boluses. Pure velocity issue - just for my body.

As I said I always had enormous troubles with an "instant" delivery. My MDI days involved sitting around and testing for up to 3 hours waiting for a bolus to work. Something abnormal goes on. I spent years trying to troubleshoot it - insulin, injection lengths, sites, exercise, blah blah. Nothing helped this absorption issue. Until I stumbled a bolus that actually worked something like typically expected of any bolus (something I only really learned by reading and chatting here, the docs were always in shrug mode, books are always innacurate so you don't know what to expect really) - through doing some squares.

So, for me it's not to emulate the body, but to get around what seem to be massive "capturing" or "pooling" problems that occur when I inject (or instant bolus) anything more than around 2u. Interestingly there have actually been one or two people post who sound like that have a similar chronic holdup. I don't know if squaring did/might help them. But one way or the other I am sure I am most definitely in a minority. It's just what physically occurs for me and helped kept my BG volatile for many years.

That's about as theoretical as I'd get with it... that it seems to be "pooling" related. I am sure many many people don't have the issue at all. For the others, I have no idea if people might get this a "bit" or a "lot". I like to mention it as it really is not on the radar yet knowledge and tactics might resolve people's instability drastically.

So, the mm person is really going a different track to me... but I guess I'm still happy that if it becomes more accepted/widespread to try squares and duals, for whatever reason, (and yes I do think they've got lots of potential application anyway) then someone out there like me just might get a glimmer of solution to a very tough, hidden problem.

[RWright]

So...I tried the dual wave bolus @ 50/50 %. I ate 2 slices of pizza Friday night. It usually sends my sugar up crazy after 3 hours. I checked at 3 and it was 136! Love this feature! Thanks for the help and info.

[kgm0612]

So...I tried the dual wave bolus @ 50/50 %. I ate 2 slices of pizza Friday night. It usually sends my sugar up crazy after 3 hours. I checked at 3 and it was 136! Love this feature! Thanks for the help and info.

Just curious.....Did you check at the 4 or 5 hour mark?

As I mentioned, I give 60% up front and spread the other 40% over the course of 4 hours. But........I find at the 5 hour mark, I'm higher than when I tested at the 4!

Karen

[RWright]

Just curious.....Did you check at the 4 or 5 hour mark?

As I mentioned, I give 60% up front and spread the other 40% over the course of 4 hours. But........I find at the 5 hour mark, I'm higher than when I tested at the 4!

Karen

I didn't check at 4 or 5 hours...I went to bed. I will be sure to do this next time.

[Russell A.]

I use dual wave or in Cozmo lingo "combination" 95% of the time. I find if I take 45-50% upfront and the rest over 30 minutes my blood sugars stay under 150. However i will use the straight extended over 4 hours for pizza since it effects my blood for several hours.

FYI: either way I bump my normal calculation up about 25% to compinsate for the duration.

For me I figure between 4-6 units per each large piece of ZA!

Russell

[Subby]

FYI: either way I bump my normal calculation up about 25% to compinsate for the duration.

Hey, that's a really good point, I will do that at times as well, with certain foods like pizza that just gives and gives and gives. I will often need to give more insulin than my normal I:C ratio would predict, especially considering it's a bit dissipated over long square.

Yep, lots of carbs, lots of fat, lots of insulin... one way or the other, pizza not called fattening for nothing...

[Russell A.]

**** Subby! All this talk about Pizza, it happens to be lunch time here and I am starving. Man could I go for eating a whole pizza!

Russell

Hey, that's a really good point, I will do that at times as well, with certain foods like pizza that just gives and gives and gives. I will often need to give more insulin than my normal I:C ratio would predict, especially considering it's a bit dissipated over long square.

Yep, lots of carbs, lots of fat, lots of insulin... one way or the other, pizza not called fattening for nothing...