Dual Wave or Basals- Going Low

[Abby-Dabby-Doo]

A little background before the question. We've been having highs for weeks as some of you know. We've been getting better tweeking some basals. We're on the MM pump, and most recently started doing a dual wave at EVERY meal. Dual wave is where part of the insulin is given up front and the rest over a time period. We use 60/40 every time over 2 hours. The numbers I'm giving you, we ARE NOT pre bolusing. The reason why we are using a dual wave is because we're seeing MUCH BETTER post numbers, and people on the CGMS are stating they're finding much better blood sugar control with meals using the dual wave (per CDE).

First day of school
Pre B 268
Post B 262
Pre L 237
Post L 296
I'm chalking it up to nerves!

The next day (Thurs)
Pre B 208
Post B 164
an hour later 43
Pre L 43
Post L 187
an hour later 56

Friday
Pre B 246
Post B 151
an hour later 43
Pre L 43
Post L 170 (2:30)
extra check 90 (3:15)
an hour later from post lunch 58

Saturday
Pre B 259
Post B 162
an hour later 46
Lunch -user error numbers not available

Sunday
Pre B 179
Post B 37

As you can see we're seeing much better post number than we've ever seen. The first day of school is what we normally see for numbers on a normal bolus. I'm convinced that the dual wave is helping. Would you change the duration of the dual wave or change the percentage of it given? I've back off on the basals and that doesn't seem to be helping.

[Momof4gr8kids]

I'd change the time first. I'd also consider what you think the GI of the meal is to determine the time. Maybe start with 30 min and gradually build up, or not dual wave for a day or so to see if the basal is at fault, and try to stagger meals so they are not at the normal times so you can see a different picture. Also call your CDE or endo, and ask them for advise. Second to your family they probably know Abby the best.
Take care, and good luck, Jamie

[Nana]

First, I would the duration first. Maybe to 1,5 or 1 hour, depending on the food. If that doesn't help, I would move to changing the percentage. I hope you figure it out soon :)

[Kaylee's Mommy]

I don't know much about the dual-wave.. we never had any luck with that.. We've always used square wave (and have had great success with that:) )

I'd actually be inclined to change your ratio for breakfast.. if she's dropping before lunch like that that would be my first step.. with school she's probably doing so much more activity in the morning that she was before.. how long after the meal was the post meal check done? if it was 3 horus, and she's dropping at the 4th hour then maybe you could go with the basal to take care of that .. its hard to tell because you've got two days and then the weekend.. so basically, i don't know what I'm talking about LOL ;)

[MLH]

Lanae, I was looking at you #'s. I am sure what I am about to say is nothing new to you. Her pre B #'s are high, so the first thing I would try to do is get that # down. I am assuming the bolus she gets for bfast includes a correction. Once that # is down, you will be able to rule out one factor in dealing with your post prandial #( too much correction, too much basal, or too much bolus).

When Analeigh starts the morning high I back up two hours and change the basal. That seems to help sort things out a bit.

IMHO I would not change the duration of action yet.

Good Luck! Keep us posted.

[Rachel]

Hi Lanae,
I am with Michelle - it might be the correction factor that is bringing her down so you might want to nail those early morning numbers first.

Depending on the times for the post-meal #s, could it be that the second wave is hitting long after the food has been absorbed? Given the severity of the lows, I'd probably remove some insulin from the bfast ratio and do a straight bolus until things settle down. Maybe breakfast is just a different beast and needs just a straight bolus, done 20 minutes early?

Thanks for the heads up on the use of the dual wave as a regular tool. Interesting.

Keep us posted on how it goes.

[Isabelle's Mom]

We have been doing a similar thing, using a dual wave for Isabelle with lunch and dinner, duration 1 to 1-1/2 hours depending on the GI of the food she ate. Otherwise, she goes low about an hour after eating, just like your dd.

For breakfast she gets a normal bolus, I think because she is so insulin resistant in the morning. Also, her carb ratio for breakfast (1:16) is much higher than for lunch or dinner (1:26).

[Lindy]

Lanae - I know you have really been struggling with getting things going with the pump.. I think your basals are off and need to be tweaked. I have found that the cde's are not aggressive enough at making changes - it's not for everyone, but I tend to bypass them and just do what we need to do...

You are going into the meals too high... I think you need to set the basals first, then worry about pre-dosing meals... and, yes - we also have the cgm and find that pre-dosing (especially breakfast) makes a HUGE difference, but we are going into breakfast in range (90% of the time)...

Get your basals set first, get her in range (at night I have 3 to 4 different basals rates set)... then focus on the bolusing to cover carbs, then tweak that by pre-bolusing for meals...

It's easy for all of us to say "do this" - but in the end you need to do what works for your family!! Not sure if this helps or not?! Hang in there!