Can someone walk me through Super Bolus?

azdrews · #1 02-21-2011, 10:15 PM

I would really like to try the Super Bolus for my son for breakfast...he has been spiking to the 3-400's and since he really loves cereal for breakfast...I'd like to figure out how to handle it.

I just have no idea how to do it! We are fairly new to pumping and I haven't tried any of the advanced features yet.

Adam is pumping Apidra with the Animas Ping. His TDD for basal is about 4 units. Breakfast ratio is 1:25 (although I just lowered it to 1:20 in an attempt to head off his spikes).

Can someone maybe give me a step-by-step on how to do this? Thanks!

swellman · #2 02-21-2011, 10:22 PM

Ok ... I'm no expert by far but we just started with breakfast because of the huge cereal spikes we've seen. I made a full-on Belgian waffle running around 58g CHO for breakfast just today and he never went over 180 and was at 100 2 hours later. I was happy. I was worried that he might go low but it worked - he dipped to around 80ish but I held off and he came back up. I assume that was because of the 2H temp basal off.

I added 2 hours of basal to the corrected bolus and did a temp-off basal for 2 hours. I'm not sure I would go that route for higher fat meals - I might extend a bit.

Nancy in VA · #3 02-21-2011, 10:26 PM

We do exactly what Swellman did. We tried 3 hours but found we were getting a low in there - so we backed off to 2 hours and it works pretty good.

That said, we use Humalog. I don't know if the different acting time for Apidra might mean differently. I would start with 2 hours and you might even end up backing up from there.

It definitely tames the spikes for us

mmgirls · #4 02-21-2011, 11:07 PM

How to actually do it.

Figure out 2hrs worth of basal. For that is .70units.

Go to the "fill cannula" option and dial up the 2hrs of basal. in our case .70units. If your 2hr basal is more than 1unit you will have to do it in 1unit increments since "fill canula" is limited to 1 unit.

You use fill canula and not just normal bolus because you do not want IOB calculations to be incorrect.

Then go to Temp basal and turn "off", basal for two hours.

With a super bolus you are moving the basal that would normally be given over a 2hr period to help deal with a spike. Then the "tail" of the insulin is covering the basal.

For us Just increasing the bolus led us to a low 2.5-4hr later, super bolusing has really helped for breakfast.

BTW you can search youtube for a video on how to do it.

Nancy in VA · #5 02-21-2011, 11:13 PM

I would NOT use Fill Cannula for this. I think you actually WANT the "pre-dosed" basal to be part of your IOB in case you go low or need a further correction. It is actually part of your IOB since you are using it to control your spike - if you don't put it in your IOB calculation, I would suggest that a correction or treatment during that time wouldn't be accurate. We were always taught to ADD it to the calulcated bolus based on ezCarb - and then turn off the basal for that amount of time

I never use Fill Cannula for anything but filling the cannula - I think its better to have the insulin IN the IOB and risk "under correcting" than NOT have it in the IOB and risk an overcorretion when you really have more insulin working. Besides, I would NEVER know when I last changed her site if I always put it through Fill Cannula.

mmgirls · #6 02-21-2011, 11:26 PM

Quote:

Originally Posted by Nancy in VA

I would NOT use Fill Cannula for this. I think you actually WANT the "pre-dosed" basal to be part of your IOB in case you go low or need a further correction. It is actually part of your IOB since you are using it to control your spike - if you don't put it in your IOB calculation, I would suggest that a correction or treatment during that time wouldn't be accurate. We were always taught to ADD it to the calulcated bolus based on ezCarb - and then turn off the basal for that amount of time

I never use Fill Cannula for anything but filling the cannula - I think its better to have the insulin IN the IOB and risk "under correcting" than NOT have it in the IOB and risk an overcorretion when you really have more insulin working. Besides, I would NEVER know when I last changed her site if I always put it through Fill Cannula.

The OP asked about a "super bolus", that is how it is done.

I know where you are coming from, but they asked how to do a super bolus and that is how it is directed to do so by the creator of the concept.

Basal is never accounted for in IOB calculations.

mmgirls · #7 02-21-2011, 11:30 PM

Quote:

Originally Posted by Nancy in VA

I would NOT use Fill Cannula for this. I think you actually WANT the "pre-dosed" basal to be part of your IOB in case you go low or need a further correction. It is actually part of your IOB since you are using it to control your spike - if you don't put it in your IOB calculation, I would suggest that a correction or treatment during that time wouldn't be accurate. We were always taught to ADD it to the calulcated bolus based on ezCarb - and then turn off the basal for that amount of time

I never use Fill Cannula for anything but filling the cannula - I think its better to have the insulin IN the IOB and risk "under correcting" than NOT have it in the IOB and risk an overcorretion when you really have more insulin working. Besides, I would NEVER know when I last changed her site if I always put it through Fill Cannula.

Looking under history you would just look at the amount givien and know which was a fill canula and which was a super bolus.( unless of course your fill amount is the same as super bolus amount)

We use contact detach, and only "prime" so , fill canual for us is only used for super bolusing.

azdrews · #8 02-21-2011, 11:48 PM

Thank you all for the tips...and for the step-by-step, that is exactly what I needed. I think I will try it out tomorrow with Adam's beloved Honey Nut Cheerios.

swellman · #9 02-22-2011, 12:21 AM

Quote:

Originally Posted by mmgirls

The OP asked about a "super bolus", that is how it is done.

I know where you are coming from, but they asked how to do a super bolus and that is how it is directed to do so by the creator of the concept.

Basal is never accounted for in IOB calculations.

I'm not sure what pump you guys are referring to but I kinda get the impression that if your pump doesn't have a "Fill Cannula" function that you can't super bolus?

Isn't it as simple as "add a (time) amount of basal to a bolus and turn off bolus for (time)? Not all pumps track IOB the same.

mmgirls · #10 02-22-2011, 12:33 AM

Quote:

Originally Posted by swellman

I'm not sure what pump you guys are referring to but I kinda get the impression that if your pump doesn't have a "Fill Cannula" function that you can't super bolus?

Isn't it as simple as "add a (time) amount of basal to a bolus and turn off bolus for (time)? Not all pumps track IOB the same.

I don't know how to do a super bolus on another pump for the simple reason that we have only used the Animas pumps.

To answer your question, yes IF the type of bolus will not be factored into IOB, you could simply add it to the bolus.

But on the Animas depending on you bg and your target bg set to the pump, then IOB could be a factor for a positive or negative correction within the IOB timeframe.

When I asked the omnipod people about a super bolus they had no idea what I was talking about