- advertisement -

Fat spikes plus temp basals, instead of extended bolus

Discussion in 'Parents of Children with Type 1' started by saxmaniac, Mar 29, 2009.

  1. twodoor2

    twodoor2 Approved members

    Joined:
    Oct 30, 2007
    Messages:
    6,440
    Protein does have a small effect on blood sugar, but it's so insignificant for most diabetics, that insulin is not dosed for it. Some people do have to dose for it though.
     
  2. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    Great job! We use the temp rate as an "extended" bolus when we already have a combo/dual-wave infusing (like when she's at a birthday party with pizza, then later has ice cream and cake). My only caution with this is what HawkeyeGirl already mentioned--temp rates do not take IOB into account. So if you overdo it, like I've done at times :eek:, you have to remember how much extra insulin he's been getting over and above his basal and figure out how to treat the low that way.:)
     
  3. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    I guess I'm not really worried about the IOB issue for a couple of reasons. One, no pump tracks IOB for basal, and this is a basal issue. Second, Omnipod doesn't track IOB for meals, only corrections, so I'm used to keeping meal IOB in my head.

    If you really want the IOB, you can tally up the extra basal needs, and give that as an extended bolus. However, Alex's basal rates change a few times in the evening which makes it a little more complicated

    Alex's basal is 0.4 until 12am, then 0.2. So an 8-hour temp basal of +60% would be:

    .6 * (.4*6 + .2*2) = 1.68u over 8 hours

    The .6 is 60%, .4 is evening basal, 6 is 6 hours. .2 is night basal, .2 is 2 hours

    I undershot last time. Next time I will be getting closer to Gary's recommendation of 8 hours, and maybe try 50%.
     
  4. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    It's interesting to see it totalled up like that. We do it as an extended bolus at about 30% of carbs consumed, and with the amount Jack typically eats, it usually ends up being somewhere between 0.2 and 0.3 per hour for 6-8 hours - about what you did.

    If we did it based on basal, Jack would get quite a bit more than that (his basal ranges from 0.3 to 0.5 during the evening hours), and I think we'd end up with a low. YDMV, of course.
     
  5. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    That's the whole point of the thread... we used to do what you say, and just it never worked -- he'd still be 350 all night. Note I'm talking only really high-fat food like McDonald's. Pizza or pasta works with the regular combo bolus.

    I'm really surprised that giving so much insulin didn't make him low.
     
  6. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    We dose high fat foods the same way as pizza and pasta. We have the best success with pizza, the worst with pasta, and with McDs, his "reaction" to the food varies enough that sometimes we do well, and sometimes we totally crap out.

    So do you think that the reason that it worked this time is because you gave so much (i.e., the percentage of the extended part of the bolus wasn't high enough when you tried it before) or that it worked because you specifically tied the amount given to the basal rate? ETA: Don't you almost have to consider the number of carbs consumed too? I can't imagine the same basal rate increase being effective if it's 50 high fat carbs consumed as opposed to 100 high fat carbs. (I'm not trying to be argumentative here - just trying to puzzle this out. I would LOVE to figure out a foolproof way to deal with problem foods.)

    I'm going to the CWD Seminar in Chicago in April where Gary will be speaking. I'm interested to hear what he has to say about this.
     
  7. twodoor2

    twodoor2 Approved members

    Joined:
    Oct 30, 2007
    Messages:
    6,440
    For high fat food I need to dose enough for an elephant. It's amazing how much insulin she needs for high fat food. BTW Karla, are you sure it's pasta giving delayed spikes? The reason I ask is because if you go to a restaurant, they put a lot of hidden fat in the pasta sauce, or just on plain pasta (oil and/or butter). I always order pasta and specify to put the sauce on the side, and do not put oil or fat on it. This really helps as far as restaurant pasta is concerned. Just thought I'd mention that.
     
  8. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    The latter. We have seen good-sized spikes from only a tiny bit of McDonald's, say in the 30 carb range. How could 30 carbs make him 350 all night?

    Let me do the opposite math here, demonstrating what did not work:

    30 carb meal, I:C 1:22 = 1.35u for carbs alone
    If I added 20% for "high fat meal" as a combo = 0.27u spread out over 6 hours
    If I added 50% for "high fat meal" as a combo = 0.657u spread out over 6 hours

    Now compare these to the 1.7u based on basal, posted previous. Even at the aggressive +50% rate, it's still 3x less.

    Other than the usual bolus for the carbs, no.

    I don't know yet, but that's the theory.
     
  9. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    Edited--I posted a dumb question that was already answered earlier in the thread!

    We have good success with extended boluses for high-fat meals, but this information is very interesting. One thing we do poorly with is cheesecake--she loves it, but it comes back to bite us HARD later. I may try this with cheesecake and see if it works.
     
    Last edited: Apr 2, 2009
  10. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    I have an update here, even though we goofed it a bit. Same food again, cheeseburger and hotdog and fries and buns. This time I did a +50% basal for 7 hours.

    To my surprise I saw a 300 a few hours later and was ready to hit the roof. Turns out that we messed up the carb calculation for dessert, and bolused 10g when it really was 30g. Ooops. 20g uncovered.

    His night target is 150, so an extra 150 points for 20 uncovered carbs is explained perfectly with a BCR of 7.5.

    Good thing the temp basal was on, otherwise it would have been a HI for sure!
     
  11. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    I've tried this method 3 times so far. The first time, it worked like a charm! I was so excited. However, the next 2 times she was quite high for several hours after. :(

    Her basal rate isn't that high during the day, and I'm wondering if this has something to do with it (the first time we tried this was in the evening, and her basal rate is much higher in the evening and overnight). I know it's supposed to be a basal issue, but it didn't appear to work for us. At least, not during the day.

    So we're back to our old method of counting fat and protein and combo'ing over 6-8 hours. :cwds:
     
  12. saxmaniac

    saxmaniac Approved members

    Joined:
    Jun 1, 2007
    Messages:
    4,057
    Interesting point. Our evening basals are pretty high too, but then they go down at 12am. I haven't tried any really high fat meals during the day - it seems that if Alex has a big bacon and egg breakfast, we don't get a fat spike.

    I'm not about to feed him McD's at 8am to find out though! If I were, I'd probably look at the total basal when we last had success. Say it was .4+50% = .6u/h. Then, I'd just run a fixed basal of 0.6 during the day. Of course the same thing can always be done with a square wave.
     
  13. Twinklet

    Twinklet Approved members

    Joined:
    Jun 29, 2006
    Messages:
    2,123
    So how did the breakfast at McD's with the temp rate go?
     
  14. Jacob'sDad

    Jacob'sDad Approved members

    Joined:
    Nov 20, 2007
    Messages:
    3,803
    I've been experimenting with giving .2u per hour extended anywhere from 5 to 8 hours. So after giving a normal meal bolus I would also do a combo bolus with 0% up front and 100% extended for 5 to 8 hours. For 8 hours it would be 1.6u total. It accomplishes the same thing as the temp basal, but instead of it being a percentage increase, it is a fixed amount.

    For an 8 hour extend I would also back off the meal bolus by .6u and let the first 3 hours of the extend (.2u per hour) take care of the shortage. This helps prevent a low from the slow absorption of carbs.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice