Author Topic: "Super Bolus" to avoid the post meal high  (Read 1424 times)

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Offline gemsa

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"Super Bolus" to avoid the post meal high
« on: 18 October 2014, 06:58:49 AM »
My DSN came back from a conference/training and said the latest method to avoid those ridiculous pregnancy post meal highs instead of injecting for a later snack early like several of the ladies on here have tried (which they don't recommend) is to "Super Bolus" (sorry for pumpers only). So you do your normal ratio for breakfast (or the meal that's giving you the rise) and add on a couple units. Then over the next two hours set up a temporary basal rate that will remove half of those extra units from your basal profile. It does require quite a bit of maths but is doable. So, say you're Bolusing 5units for a bowl of cereal and your basal rate is 1unit per hour at that time, add on an extra 2units with the Bolus - 7units in total, then take 1unit (half of the extra) off the next two hours of basal by going on a 50% temporary basal rate of 0.5 for two hours. Obviously it gets confusing when your basal changes hourly and is something 'less rounded' like 0.64 but if you're good with maths its achievable. Unfortunately no suggestion for a formula/ratio for choosing how much extra to do, just trial and error. I've not tested it yet, something for Monday as my weekends are always different.

Hope that helps someone!
T1 diagnosed 1985, DAFNE Oct 2012 (HBA 9.2%), started pumping April 2013.
HBAs: Feb 2013 8.6%, Jan 2014 7.4%, June 2014 5.9%, Jan 2015 7.5%
Healthy baby delivered Nov 2014 predicted 97th+centile but actually 50th centile.

Offline himtoo

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Re: "Super Bolus" to avoid the post meal high
« Reply #1 on: 18 October 2014, 07:43:26 AM »
Hi Gemsa
just want to offer my thought on this even though i have not started pumping -- the idea sounds good from what i have read   


if you increase your testing as well to monitor the situation would that be feasible ?
could you get your strip supply increased to cater for this ?


it would seem perfectly reasonable to me to enquire along those lines.



T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline gemsa

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Re: "Super Bolus" to avoid the post meal high
« Reply #2 on: 18 October 2014, 08:26:05 AM »
Hi Paul. Yes you should test extra to find out what works and the hospital team would definitely support this. My GP has struggled to come to terms with the increase of testing from 5times a day pre pregnancy (which they struggled with even then) to 8 times a day during pregnancy (plus plus plus all those extras for hypos/driving etc). However, that is a different battle in itself and I think you could easily justify more strips to see what happens just like you can justify more strips to do a basal test/fasting every now and then.

Your hospital team will probably write to your GP when you are on the pump to explain your test strips needs have gone up and will do so even more whilst you get used to it. They will also explain the training you have received so that the GP can trust you actually know what to do with these strips and aren't just testing for the sake of testing. Whether the GP does anything as a result of this letter is a different story ;-)
T1 diagnosed 1985, DAFNE Oct 2012 (HBA 9.2%), started pumping April 2013.
HBAs: Feb 2013 8.6%, Jan 2014 7.4%, June 2014 5.9%, Jan 2015 7.5%
Healthy baby delivered Nov 2014 predicted 97th+centile but actually 50th centile.

Offline himtoo

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Re: "Super Bolus" to avoid the post meal high
« Reply #3 on: 18 October 2014, 08:39:45 AM »

Hi Gemsa
this sticky on the forum might be of some help.




I ran into problems with my GP a few years ago -- I ended up trying another GP in the surgery who was more amenable to an increase from 200 to 250 per month







http://www.diabetes.org.uk/Documents/Advocacy/test-strips-advocacy-pack-0613.pdf
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline sedge

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Re: "Super Bolus" to avoid the post meal high
« Reply #4 on: 19 October 2014, 10:11:03 PM »
Paul - when you go onto a pump, your DSN will send a letter to your doc saying you still need cartridges of long and fast acting (in case of pump going base over apex or some other emergency) AND vials of fast acting, and at least 200 strips a month, if you want more just say so to her and she'll put whatever you say on the letter - plus ketone testing strips - and they do a strip letter for diabetic pregnancies too, cos you could be testing every 2 hours whether T1 on MDI or pumping - or T2 !

'Super Bolus' is explained in Gary Schneiders Think Like a Pancreas and I'm willing to bet it's in the Bible (Pumping Insulin John Walsh) too!  (still in France right now - TLAP and PI are at home LOL)

Gemsa - I remember Winni using it when she was preg !
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline himtoo

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Re: "Super Bolus" to avoid the post meal high
« Reply #5 on: 20 October 2014, 08:30:55 AM »
Paul - when you go onto a pump, your DSN will send a letter to your doc saying you still need cartridges of long and fast acting (in case of pump going base over apex or some other emergency) AND vials of fast acting, and at least 200 strips a month, if you want more just say so to her and she'll put whatever you say on the letter - plus ketone testing strips - and they do a strip letter for diabetic pregnancies too, cos you could be testing every 2 hours whether T1 on MDI or pumping - or T2 !

sedge -- thanks for that -- it does seem as if you have minimal problems with the pump you will end up leaving a fair bit of MDI insulin cartridges in the fridge to end up going out of date though ??
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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Re: "Super Bolus" to avoid the post meal high
« Reply #6 on: 20 October 2014, 10:09:03 AM »
Paul


Yes inevitably you will have cartridges going out of date.  I have 3 of Levemir in the fridge and 2 Apidra that will go out of date this December, but if your pump fails then you only have a minute amount of fast acting insulin in your system and will very quickly be heading for DKA.  So that back up is very important.  In any case, the life of an insulin cartridge is 2 or 3 years, so thinking of the cost of wasted insulin it's only a drop in the ocean compared to the running costs of your pump.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline gemsa

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Re: "Super Bolus" to avoid the post meal high
« Reply #7 on: 20 October 2014, 09:33:19 PM »
Hmmm, that's interesting sedge that it's covered in Think Like a Pancreas, I thought I knew that book inside and out but shall re read and see if there's anything else my memory needs refreshing of!!

Thanks Paul, I'm working on my GP with several of the bits mentioned in that pack, it just seems to be one step forward and two steps back.
T1 diagnosed 1985, DAFNE Oct 2012 (HBA 9.2%), started pumping April 2013.
HBAs: Feb 2013 8.6%, Jan 2014 7.4%, June 2014 5.9%, Jan 2015 7.5%
Healthy baby delivered Nov 2014 predicted 97th+centile but actually 50th centile.

Offline Pattidevans

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Re: "Super Bolus" to avoid the post meal high
« Reply #8 on: 20 October 2014, 10:19:48 PM »
Quote
Hmmm, that's interesting sedge that it's covered in Think Like a Pancreas, I thought I knew that book inside and out but shall re read and see if there's anything else my memory needs refreshing of!!
Can't find it in my copy of TLAP but it's in Pumping Insulin 5th Edition starting on page 153.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline himtoo

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Re: "Super Bolus" to avoid the post meal high
« Reply #9 on: 19 December 2014, 07:35:12 AM »
Hmmm, that's interesting sedge that it's covered in Think Like a Pancreas, I thought I knew that book inside and out but shall re read and see if there's anything else my memory needs refreshing of!!

Thanks Paul, I'm working on my GP with several of the bits mentioned in that pack, it just seems to be one step forward and two steps back.

Hi Gemsa
wondering how you have got on with the super bolus and additional strips -- i had a re read of this topic and it definitely is achievable as the additional testing would show the rate of change post meal following the super bolus method. going forward it should give more confidence in making that increase in bolus and decrease in temp basal rate. 
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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  • It's ONLY Diabetes. It could be something worse!
Re: "Super Bolus" to avoid the post meal high
« Reply #10 on: 19 December 2014, 10:20:17 AM »
Roll on availability of the Freestyle Libre which will show exactly what's going on without all that extra finger pricking!
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans