Dual Wave Bolus

Replies to This Discussion

Permalink Reply by Sophie on August 31, 2009 at 8:29am

I am really trying to understand this well, so I'm sorry if my questions are repetitive, or if I'm not getting something that is clear to others.

I completely understand the concept behind this, but am struggling with applying it to myself, which is self-centered, but maybe Ricardo, you'll be able to take just a minute to answer my personal question?

I rarely have eaten a meal that goes above 50g of carbs, maybe this is why I'm having trouble understanding? Okay, so my problem isn't about getting high 2 to 3 or even 4 hours after the meal, its at 1 hour to 1.5 hours after bolusing--while the insulin is supposed to be "working." At 2 to 2.5 hours I'm usually back to "normal" and worst case scenario, which is very infrequently, it takes until the 3rd hour after bolusing to be completely in target range.

Is there a way to employ the dual wave so that I can avoid the 1 to 1.5 hour spikes? I do understand that it is normal for one's BG to rise during the hour after bolusing only to come down around 2 hours (right?). I've been thinking that maybe I need to try bolusing earlier than I have. Like more like 10-15 minutes before eating, instead of 5.

An additional factor to my difficulty in understanding how to best use the dual wave to help me is maybe because I'm still honeymooning...maybe my body is kicking in with some sort of "secondary phase insulin release" and that's why I haven't noticed and post-meal (3-4hrs later) spikes?

I COMPLETELY understand if discussing my personal quandary is not what people are interested in, but perhaps there's someone out there with an idea for me?? Thank you so much!

▶ Reply to This

Permalink Reply by Danny on August 31, 2009 at 8:42am

"Okay, so my problem isn't about getting high 2 to 3 or even 4 hours after the meal, its at 1 hour to 1.5 hours after bolusing--while the insulin is supposed to be "working."

Sophie, Try taking your insulin 15 to 30 minutes before you eat your meal. Since I have been on Novolog the past seven years I have not been doing this. My doctor says I do not need to bolus ahead of my meal (when using Novolog). My body, like yours seems to need the insulin early, especially when my numbers are on the high side. When I bolus a few minutes ahead of my shot, my blood sugar numbers are always a lot more stable.

▶ Reply to This

Permalink Reply by Ray Marino on August 31, 2009 at 8:51am

Sophie, if you're back to normal in 2-2 1/2 hours I would just stay
the way you are. You are apparently doing well enough, why change.
If you eat a food with a high fat content and you find yourself high
after 2 hours than you might want to experiment with the dual wave bolus.
Being a new pumper I would leave good enough alone.

▶ Reply to This

Permalink Reply by Danny on August 31, 2009 at 9:58am

Thank you for your in put Dave... together we will find the next best thing to a cure, perfecting the Dual wave bolus ;)

▶ Reply to This

Permalink Reply by Ricardo on August 31, 2009 at 9:30am

Hi Sophie,

I agree with Danny.

Since you are spiking about an hour after the meal, it sounds like the carbs you eat are peaking sooner than your insulin bolus is peaking. If you bolus early as Danny said, it should moderate the spike. However, I would only do this if the meal had more than a minimal amount of carbs and you are expecting a spike. If you ate a high fat meal, the fat will usually delay the carb spike and you may not need to bolus early. With a high fat meal and an early bolus, you may become hypo shortly after ingesting the meal since the effect of the carbs will be delayed due to the fat and your insulin will peak too soon, yet your 2 - 2,5 hour post prandial will be back to normal.

I assume your spikes are more than a non-diabetic's BG spike of 140 - 160. Also consider that a non-diabetic's insulin is faster acting than the insulin analogs we take and also it is delivered more directly into the bloodstream. With a pump, you are infusing the insulin into a layer of fat under your skin. Some diabetic's find that Apidra will act faster than Humalog or Novalog to moderate spikes.

Also take into account the location of your set. Most pumpers may notice that they get better infusion at certain sites. If I have my site in my upper thigh and I go jogging, I can be reasonably sure that I will get faster absorption of the insulin than if I used the abdomen. In this case, I may not need to bolus 30 minutes before eating a high carb meal.

The important thing here is to find out how your body responds and tailor the treatment to your needs. Since you are returning to normal within 2 hours, it does not sound like you need TAG. Instead, it sounds like your spikes can be taken care of through a faster acting analog insulin and/ or pre-bolusing for high carb meals.

▶ Reply to This

Permalink Reply by Sophie on August 31, 2009 at 10:16am

Thank you SO MUCH to everyone! All your input is extremely helpful and has given me a lot to experiment with. I am so appreciative. :)

▶ Reply to This

Permalink Reply by Ruth on December 25, 2009 at 11:28am

Danny...
Is that you, mcdi? I started doing that, dual-waving everything, and my post-prandials have been much, much better. I'm awaiting the results of the A1c test I had done on last Friday...hoping it'll be lower. The last one was very high for me at 7.1, where I usually run between 6.6-6.8. I'm hoping both my renewed commitment to better diet along with dual-waving everything is going to make a huge difference.

Ruth

▶ Reply to This

Permalink Reply by Danny on December 25, 2009 at 10:49pm

Ruth, yes, I was Mcid3... I retired that screen name a few years ago :) You have an excellent memory. I will be sending you a friend add ASAP.

Is it not refreshing to stumble upon a new way of management? Personally, I was stuck in a Diabetic rut where my mediocre management was okay. This entire discussion has changed my outlook on Insulin Dependent Diabetes & it has made me realize better numbers are possible (without breaking my back).

You are managing to drop your post- prandial readings during the most difficult time of the year (Holiday Season). Keep up the good work my friend!

I hope you had a wonderful Hanukkah!

▶ Reply to This

Permalink Reply by Nadine on January 2, 2010 at 5:42pm

Danny,
"Is it not refreshing to stumble upon a new way of management?" I totally agree!

I read this discussion in the fall. Since then I have been bolusing 15mins before meals and using dual wave bolus. My A1C dropped from 7.3 to 6.5 with no other significant changes :)

Thanks for getting this discussion going and Happy New Year!
Nadine

▶ Reply to This

Permalink Reply by Danny on January 2, 2010 at 8:40pm

Nadine,

I am happy to hear this discussion has made a difference in your A1c (as it has mine).... it is the best news that can be posted on a Diabetic message board in my opinion (besides "we found the cure"). I wish you continued success my friend.

▶ Reply to This

Permalink Reply by Patricia on October 2, 2009 at 9:04am

Just read this thread today...great explanation and appreciate your insights! I have been counting PRO and fat as 1/2 the available glucose as CHO and giving it all in the same regular type bolus. I will try this w/ the square bolus option and see what happens! Thanks.

▶ Reply to This

Permalink Reply by Tess Heder on October 3, 2009 at 9:02am

Great post -- whether or not you expect to use TAG or want to experiment with the Dual Wave Bolus, don't miss the incredibly informative, clear and readable followup article -- that Ricardo links to at the end.

▶ Reply to This

• ‹ Previous
• 1
• 2
• 3
• 4
• …
• 12
• Next ›
• Page