Need Feedback Please! Combo boluses with the Animas Pump

[EmeeSu]

Can all the pumpers out there comment on the duration you set your combo's, please?
Matthew's is set for 3 hours, but I think that may be too long and make him higher overall.

Do you change the duration depending on the food?

Do you only use combo for meals (vs. using carbsmart)? My former nurse (who is an Animas pumper) says she only uses combo bolus unless the carb amount is small - like under 30.

If you use carbsmart, do you do a correction for a high bloodsugar using EZBG and then just do the carbs in carbsmart? OR Do you add the BS to the carbsmart and let the pump calculate the insulin? I have done both, however I am trying to figure out whether his BS is more manageable doing a correction using EZBG and then just adding the carbs using carbsmart or doing it all as one action.

Any comments would be much appreciated!!

Thanks!

[Momof4gr8kids]

From our days on MDI I pretty much know when I would need to correct for different foods. I start the second part of the combo an hour before then so that the insulin peaks at that point.

Julia is on novolog, and it seems to work the strongest between hrs 1 and 2, and run out, or be on the last little tail at hour 3.

The Carbsmart, and ezbg will calculate the same numbers either way. I find it easier to do it all with the carbsmart. Also I have noticed if I do a different I:C for foods with a spike that helps. Example: Julia's normal I:C is 1:15, but for cold cereal we do a 1:12 as suggested by our endo.

I use the combo bolus for foods like pizza, fast food, or anything high fat, high carb that is going to need insulin to correct a few hours later.

If he is high, do you correct the b/g before the meal? Boluses work a lot better if you can do them before the meal, but with kids it is hard to know if they will eat it all. I would suggest that even if you can't bolus for food before the meal that you correct the high with the ezbg first. That should make it easier. If we are eating and she is low I will usually have her eat something first, and then do her bolus.

I hope this helps. Do you have a CDE office that you could take an advanced pumping class at? That might help with the combo boluses, and such.

[Elias's Dad]

We handle our son in many ways in common to that described by JmeB78.

We've been pumping for about 1.5 years and were afraid to use combo boluses for many months. After cautious introduction, we've been using it increasingly with good results.

Do you change the duration depending on the food?
Yes. Depending on the GI of the food and his history (i.e. he's gone low then high), we adjust the duration. Because we're never consistent, programming is a minor nuisance. We use it so often now we'll combine bolus to bolus (cancel then add remaining to new). Occasionally, if we're concerned that the recommended correction may be too much, we'll use a combo to play it safe. Instead of using percentages, often, we'll give a normal bolus then separately give 0/100 at X hours. When we introduce new foods (for instance eating out), we'll use the Calorie King book to estimate carbs then use combo to blunt the effects of the bolus. Trial and error :( helps us figure out what works best for our child.

Do you only use combo for meals (vs. using carbsmart)?
No. It depends on the situation/food. Sometimes we'll give separate boluses using carbsmart and combo in the same meal. Since our son's ratio is 1:40, it's .05U for every 2 carbs so it's simple to do the math and avoid carbsmart altogether/ezBG.

If you use carbsmart, do you do a correction for a high bloodsugar using EZBG and then just do the carbs in carbsmart? OR Do you add the BS to the carbsmart and let the pump calculate the insulin?
Since we don't know how much our child is going to eat ahead of time, we test before he eats, use ezBG to determine the correction, then use carbSmart to deal with the food. Anticipating that he will eat at least .25 (10 carbs), we give that up front then bolus food items as he finishes.

For us, using combo has been as dramatic as going from MDI to pumping. Now that we using it increasingly effectively, I can't imagine going without it.

Best regards,
Rich

[EmeeSu]

Thanks to both of you for the feedback!

I think I do need to break down and read the darn pumping book! I had been relying on my nurse CDE, but she is gone now so until I meet her replacement, I'm on my own.

We do alright with the pump, considering it's only been 3.5 months since he started. It's just that I try not to play with the settings too much. It seems that this is where I, knowing my child the best, am going to have to get more learned in boluses.

Thanks again!

[hold48398]

Hey Emily, I just saw your post. Here is what we do:

Can all the pumpers out there comment on the duration you set your combo's, please?

Do you change the duration depending on the food?

>>> We use a true combo bolus only for high fat/high carb foods like: Pizza, fried chicken, french fries, pies or desserts heavy in butter. Pizza we use 50/50 over 2 hours, the rest is anywhere between 75/25 or 60/40 over 1 - 1.5 hours. Trial and error has been our method for establishing what works best in Mia.

>>> We also use a "combo" bolus for other meals but with a different intent. Mia complained for a while that her boluses stung, even on "slow" delivery. This was the case especially with large boluses like the breakfast bolus. Our Animas trainer recommended that we use a combo bolus of 0/100% over 10 minutes which would in effect distribute the insulin delivery over 10 minutes instead of all at once. This has been a great tip for us which we continue to use! Mia is a very predictable eater, so we give her her bolus at the beginning of her meal. It always takes her longer than 10 minutes to eat, so she still gets all the insulin before she is finished eating.:)

Do you only use combo for meals (vs. using carbsmart)? My former nurse (who is an Animas pumper) says she only uses combo bolus unless the carb amount is small - like under 30.

>>> When we use combo bolus, we still go through carbsmart. You can click on "normal" and change it to "combo" on the carbsmart screen, and the pump will get you right into the carbsmart screen after you click "OK".

If you use carbsmart, do you do a correction for a high bloodsugar using EZBG and then just do the carbs in carbsmart? OR Do you add the BS to the carbsmart and let the pump calculate the insulin? I have done both, however I am trying to figure out whether his BS is more manageable doing a correction using EZBG and then just adding the carbs using carbsmart or doing it all as one action.

>>> When we check before meals, I enter the BG directly into the carbsmart screen. It goes like this: Menu->Bolus->Carbsmart->Enter Carbs->OK->enter BG->ok.... Now, in the morning, we often check Mia right when she gets up, and if she is high, we will use EzBG to do an immediate BG correction. Then, when it is time for breakfast, I skip the "AddBG" and just enter the carbs in carbsmart with disregard of the BG since we already corrected her BG earlier, if breakfast is within an hour or two or the first check. If you did check the BG once again and entered it into the pump, you will see that the pump knows that you already corrected for the BG, and it will show it as Insulin on board (IOB) and disregard another BG correction.

We have found that by correcting a high BG before a meal, we can give a high blood sugar a "head start" to start to come down and Mia will have less of a spike post-meal. Of course, this isn't always doable but it has worked well for us in the morning where generally we have the worst after-meal spike.



Hope this helps :rolleyes:. Good luck!:)

[wendyc]

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Can all the pumpers out there comment on the duration you set your combo's, please?
Our combo settings vary based on food. For example, we use a 60/40 over 2.5 hours for pizza and usually Chinese too.

Do you change the duration depending on the food? Yes, for example, while we use 60/40 for pizza/Chinese as stated above, we will use say a 70/30 over 1.5hrs for ice cream (a fatty Cold Stone Creamery treat!) and 70/30 over 3 hrs for McDonalds hamburger Happy Meal.

Do you only use combo for meals (vs. using carbsmart)?
At this stage we only combo for meals.

If you use carbsmart, do you do a correction for a high bloodsugar using EZBG and then just do the carbs in carbsmart? OR Do you add the BS to the carbsmart and let the pump calculate the insulin?
The only time we really do this is when she is having something to eat and her bg is say, 100 over target. We will do EZ right off, then go back and CarbSmart for the food 15 min. later. This will get things moving back down and generally works well. Normally, we just do all bolusing from CarbSmart 15 min. after start of meal.

The pump book is helpful, as is Pumping Insulin by John Walsh.
I'm looking into seeing if Animas is offering an advanced pumping class in my area as I'm ready for a refresher on that stuff. They went over it at the pump start, but as all will agree, that day is overwhelming!

Hope this helps. Good luck:)

[EmeeSu]

The only time we really do this is when she is having something to eat and her bg is say, 100 over target. We will do EZ right off, then go back and CarbSmart for the food 15 min. later. This will get things moving back down and generally works well. Normally, we just do all bolusing from CarbSmart 15 min. after start of meal.

I see that you give the bolus 15 minutes into the meal. I have never done that. Does that work better to manage the BS?

[wendyc]

This is how we were instructed to do it from day one at the hospital. We do find that it works, and for us it is safer than advance bolusing (I know some can do this without worries) since Abby may seem like she's going to clean her plate, and then about halfway through peter out. We find that it gives the jump start her body needs.

So, if in range, we bolus after 15min. If she continues eating, we bolus again in 15. If she is running high, then we cover the bg right then and there, and then start with our 15min. rule.