Replies to This Discussion

Permalink Reply by Yolanda Gordon on March 18, 2011 at 9:58am

Fantastic information! I am new to using TAG but am serious about learning it and using it. Question, I know you said you extended your bolus 3 hours after your meal, do you mean you took fast acting insulin three hours later? OR, a couple units for three hours? Also, I am having a terrible time with my Dawn Phenomena, do you take insulin all night long to get such great readings? OR do you just take more long lasting at night time?

Thanks for your help

Permalink Reply by Susi (Ladalife) on March 18, 2011 at 6:46pm

Very cool Danny!!! What a great post! Totally love the nearly flat-line in the first one!

You'd have to prove it to me 3 or 4 times before I'd be extending any boluses for that long.

This has happened to me on occasion and I can't nail it with an extended bolus - you almost have to have a time delay on part of the extended part! It's not ideal but I just correct it when it happens.

Could the rise have been a coincidence? If not, and if you'd bolused the right amount for the steak meal, then you'd expect to go low during the first 3-4 hours, no? How low did that slight dip go in the second pic, first up, go?

How much (%) of the bolus did you give up front?

Permalink Reply by Susi (Ladalife) on March 19, 2011 at 3:26am

Danny, a BG of 70 surely only means just a small part of that whole bolus wasn't right. If you consider you got down to 70. Would the same amount of insulin get you from 180 to normal? I'd hazard a guess and say probably not.

So what's the issue here?
Not enough bolus? You would have gone much lower too early.
Not enough bolus AND not extended long enough? Sounds like that might be the one. But I don't think the extended/combo bolus would work the way you need it to. It's like you need xx% up front; most of the rest in extended and another xx% a few hours later. Pumps aren't that smart yet.

So why not just up your basal to hit during that time? Could you manage it that way? (But you'd have to be awake to check your BGs regularly the first few times.)

Permalink Reply by Ricardo on March 20, 2011 at 6:36am

Has anyone here ever done an extended TAG bolus for 6 to 8 hours after a meal? Why am I so hesitant to try this?

Hi Danny,

I have to use a 6 - 8 hour TAG for high fat pizzas or an 8 ounce or more well marbled steak. Since fat seems to slow the digestion of carbs for me, if my current BG is at or below target, I take a little off the up front bolus and add it to the extended bolus to stop from going hypo early. Looking at your graph, at around 3 hours after the meal your BG started to dip to near below target, so you may have benefited from doing something similar.

In my case, I would try adding up the total amount of correction boluses and the amount of extended TAG bolus. This grand total should approximate the total extended bolus I should have taken. I would then use this total with my 1.0 - 1.2 rate of delivery to figure out how long to extend. For MY metabolism, I usually have to extend the 6 - 8 hours. YMMV.