FUDiabetes

Double bolus as a daily thing?

So I’ve been trying to figure out the dosages for a couple things I miss - oatmeal, sweet potatoes, etc. I already discovered I have to dose at a 1:20 ratio for my daily apple and nut butter (same for my occasional sweet treats), which isn’t quite a double bolus, but it’s close (normal ratio is 1:35).

This morning I tried it with oatmeal, and while I went a little higher than I wanted (144), I think I will end up needing about a 1:10 ratio instead of my 1:25 breakfast ratio to eat it with a normal rise - so a little more than double.

My question, though, is - is it unwise to “double bolus” often (once every day, at least, for my apple)? When I think about it in terms of double bolusing, I start wondering if that’s just too high a TDD, and maybe it should be reserved for special occasions or once a week treats. But then I think of it in terms of just figuring out what works to eat the foods you love and, as long as they’re mostly healthy choices, it shouldn’t matter how much insulin it takes; as long as your numbers are good, it’s just another trick to deal with this disease. Thoughts?

I agree with that sentiment. After all, if your pancreas were working, that’s what it would do: give you whatever amount of insulin your body actually requires to control your BG. Exogenous insulin isn’t entirely trouble free, for instance we can get hyperlipotrophy (“scarring”) or problematic insulin antibodies over time. But T2 insulin resistance can cause people to take 100u or 150u or more each day: the quantities you need for oatmeal or sweet potatoes really won’t hurt you.

My CDE made it very simple and easy for me when I started: she said “If your blood glucose is too high, you need more insulin.” It’s really as simple as that. We can get caught up in all kinds of “what if’s” and “why did my BG go up this time?” but don’t ever let the desire for explanations interfere with this simple rule: take the insulin that your body tells you it needs.

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I haven’t had enough coffee today so I am not sure what you mean by “double bolus”?

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I’m not sure if that’s the “official” term - it’s when I take my actual carb count and double it, then bolus for that amount (and if it’s successful for that food, I just remember to use that ratio in future, like I did for the oatmeal).

Thank you! I always forget to think about it in terms of what a working pancreas would be doing, ha.

Ah, yes, I do that as well sometimes, not doubling necessarily, but “padding” the amount of insulin for higher GI foods or when I am more sedentary or insulin resistant. It can really help a lot to offset spikes.

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It really does, but I guess I’m just wondering if its “healthy” to do that regularly.

It’s healthy to do whatever it takes to keep your bg from spending prolonged periods of time in an elevated state, say over 150… debatable at what level it actually matters. Do whatever it takes to minimize amount of time your bg is above 150 or so. That doesn’t mean it’llnever be above that just means you’re trying to minimize duration of time spent there

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I don’t worry at all about the amount (TDD) of insulin.

Realistically - I can not deal with everything. Already my plate is overfull. I have to focus on those areas that are most reasonable to deal with. The rest - gonna have to work themselves out.

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@Pianoplayer7008 Pianoplayer, we don’t think about the TDD at all, we only think about what we want to eat. If you were eating 6 candy bars a day, and you were related to me, I would have a talk (D or not) about eating that much c r a p. If you are talking about eating a normal healthy diet, do whatever it takes insulin wise and don’t look back.

I take that back, we do think about TDD about once a month to see if things have changed but not othewise.

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Thanks, y’all. The only reason I wondered is because I’ve seen some things about how a person’s TDD should ideally be around a specific amount relative to their weight? I honestly had never given a single thought to it before I met with a CDE the other day, and she asked what mine was (had to stop and think, then give her a pretty wide range, ha!).

It’s not that TDD ‘should’ be a certain percentage of body weight; it’s that for many insulin-sensitive T1’s it often ‘is’ around a certain percentage - though this can vary a lot in reality. That common percentage helps when trying to figure out how much insulin to start with (Walsh does this in his books), and it helps to figure out if you may be getting insulin-resistant (due to weight gain), but otherwise, you need what you need and you should just adjust your insulin input to match your needs.

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My TDD is less than predicted by my weight but if I feel like I am eating dosing the right amount of food to keep my weight steady and have less post-prandial variability. That’s the goal: fibding what meets your needs. All the formulas and charts are just guidelines or starting places, not hard-and-fast rules.

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Totally agree. It is a better starting point as opposed to random numbers.

It is not however (IMHO) a goal of any sort. Each person is different.

I neither care what the TDD is, nor do I care what the percent of basal vs bolus is. We had one Endo NP who wanted to make a big deal out of this. The vast majority of our medical team is great. This particular NP is somebody who I simply will no longer make appointments with.

Eating a somewhat well balanced and mostly nutritious diet along with reasonable amounts of enjoyable and non-nutritious foods while providing whatever insulin is necessary to maintain the best BG control we can realistically manage is what is important to me.

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Ok, that makes sense!

Amen! I’ve been having to avoid so many “good for you” things because I couldn’t find figure out why they wouldn’t work with my current ratio; just thought those things would just be offlimits indefinitely…this is opening a whole new world of unlimited eating for me (just in time for the holidays)! :slight_smile:

From an insulin perspective, which is better?
A bowl of rice or a chocolate bar?

Which is heavier? A pound of feathers or a pound of bricks?

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I want to write a smart post on this topic. But until I can put it together, the simple idea is this:

For most PWD’s, their insulin duration is 3-6 hours (varies based on infusion, activity, etc).

And for most people (diabetic or not), meals take anywhere from 1 hour to 2 hours to metabolize (varies based on the type of meal, fat, gastroparesis, etc.)

The general pharmacokinetics & pharmacodynamics for insulin (again this varies for everyone) is that half your dosage is used in the first hour. The remaining duration is where the rest of the half dosage is used, hours 2-3 or 4.

So the reason for the double - if food is metabolized in half the time as your normal duration, and normal absorption is 1/2 of the total in the first hour…doubling matches it better. The remaining insulin for the the next few hours is extra, that needs more food. But at least your dose matches your first few hours of food metabolism better.

In simplest terms:
Rather than waiting for a high to come down for 2-3 hours, you take more insulin at mealtime, and eat more food an hour or 2 later.

That’s my quick explanation. We should expand on this a bit as time permits.

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So then would you risk going low if you don’t eat more later, because you’ve got that other 1/2 still going with no food digesting?

You really need to get that Dexcom. Once you do whole worlds of treatment options open up. He isn’t risking going low, because he is watching what happens and responding.

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