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Mac N cheese bolus?

Discussion in 'Parents of Children with Type 1' started by britbabi84, Jan 24, 2012.

  1. britbabi84

    britbabi84 Approved members

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    Ok we are still very new at pumping. One of my sons favorite foods is macaroni and cheese. This causes a problem with his numbers though. He can eat it at 6, Ill check him at 8pm before bed and he'll be 75 or so. So I will give him a little bit of chocolate milk or something to bring him to 100 and then send him to bed. I'll check again around 11 and he usually mid 300's. Now, he use to eat just mac n cheese and not have anything else with it. Today I added some protein with it as well to see how it affects his numbers. Check before bed was still low. I would like to do a combo bolus for this food but Im not sure where to start! I know how to set it up on the pump, but not sure what percentage to do up front, and how long of time period to do the rest. He seems to spike from it about 4-5 hours later. So maybe 50% up front and the rest of 4 hours?
     
  2. mandapanda1980

    mandapanda1980 Approved members

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    Try a 50/50 for 2 hours. If he still goes low after the meal you can try 40/50. If he hours high after the meal try 60/40. If he is good after the meal but spikes a little still later on, you can try extending it out to 3 hours and so on.

    We eat the 50% whole grain kraft. Almost always with hot dogs. With a 1/2 cup milk. Total carbs is 62. I bolus 50/50 for 2 hours and we get perfect numbers all night.

    Good luck!!
     
  3. Style mom

    Style mom Approved members

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    We do 70% up front and 50% over 5-6 hours. These sorts of boluses really vary between kids, and you just have to do a lot of trial and error.
     
  4. JaxDad

    JaxDad Approved members

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    Exactly, in our advance pump class they recommended that most combo bolus first attempts be at 60/40. For us, most fatty things like a mac and cheese, pizza, Jamaican meat pies, bacon, are 20/80 or 25/75 for 6 or 7 hours.

    I honestly think that adding different foods to the mix is a much more complicated way of doing it if you have a pump. On MDI that may very well be the better way. But on a pump I think it's much easier to learn how that meal will be digested, and use the pump to deliver the right amount of insulin at the right time.

    Here is the way I approach this stuff and it works really well for us. YDMV, yada, yada.

    Start with whatever your best guess tells you what the digestion profile will be. That guess can come from past experience with a similar food, or just "eyeballing" what carb amounts you think will digest fast or slow, and how much fat.

    Check after two hours, shooting for 160-180. If high, do a correction and a temp basal, or just the correction. If low, give some uncovered carbs.

    From here out check pretty frequently after that - we do about every hour if it's a new meal we're trying to figure out. Even sooner if you had to do give uncovered carbs.

    If insulin starts getting ahead of digestion and bg is dropping I usually cancel the remaining combo and do an extended combo for the same amount of remaining time but that's a bit lower in total insulin. If digestion is ahead of insulin and bg is rising, do a +temp basil. How much depends on how high the BG and how fast it's rising. Next check you can cancel the temp basal and enter a lower one if needed.

    Keep records, next time change your combo to either have more or less up front depending on your previous meals 2 hour mark, and use the U/hr you had last meal(both bolus and temp basal) that gave you a flat bg profile to figure out what insulin you want to have as the second part of the bolus. Use the total digestion time from last meal to figure if you need to change the duration.

    Hope this helps.
     
  5. Connie(BC)Type 1

    Connie(BC)Type 1 Approved members

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    I use the Pizza bolus over 5-6 hours, I use a lot of cheeses(2 or 4 varieties) in my pasta and cheese dishes. I do between 30 and 40 percent up front, depending on my meal time bg.
    Most times this works fairly well
     

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