Double bolus as a daily thing?

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?

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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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Yes. But if you are in the right situation, that is easier than fixing a high.

So in every circumstance, just think of this general question: Will it be easier to chase a high, or correct a low?

At home, fixing lows are easy. Sometimes when away from home, it’s not as easy.

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That makes sense. With the muscle disorder/eating every couple of hours anyway, it’s very easy for me to “fix” a low (I actually do think I would’ve gone low after the oatmeal this morning, but I ate some peanut butter ~2 hrs later, then was at 79 before lunch an hour after that - pb usually raises me ~20 if my BG is steady). I’ll remember to take care especially when I’m not at home.

I would not worry AT ALL about using as much insulin as you need, even if you had to go 3x or more. Don’t worry!

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i’ve read through this whole thread and have found it tremendously helpful. there was one thing, though, that wasn’t mentioned and that is the I:C ratio. i have a much different morning carb ratio than i do for the rest of the day; in fact it is quite significant ; almost double the insulin between the hours of 6 am till 10 am.

i discovered this through trial and error. it took a while, but i got there and it has been a real relief. also, in the mornings, if i am going to eat a bowl of oatmeal (or any kind of Carby food) i pre-bolus for about 1/2 hour before eating. i noticed that when i eat oatmeal for bfast i absolutely must pre-bolus and then after 2.5 hours, my BG is in target range. no spiking.

don’t know if this will help or not, but it worked for me.

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I have the same issue - my breakfast ratio is 1:25 (the rest of the day it’s 1:35). But what I’ve found with oatmeal (ok, the quick oats kind; I have to cough up the dough for some certified GF rolled oats here when I run out of these, and that will probably be easier on my BG) is I have to more than double my dose to prevent a spike. And I now pre-bolus 45 minutes for everything with Novolog. I don’t go low (unless I miss it and hit the 50-55 min mark), but it helps with minimizing the rise I get from the main staples of my diet (toast, rice, etc).

I don’t know if you have this company in the US, but Only Oats makes certified GF rolled and steel cut oats (produced in a dedicated facility that only processed oats, no other foods) and they are great and cheap! It’s only about $6 CDN for 1 kg of rolled or steel cut oats, and they also make quick oats (oat flakes) and oat flour. I buy them off Amazon.ca because they’re cheaper there than in stores. Maybe you can get them shipped to the US or find a US site that carries them.

wow. i am surprised by your I:C ratios. my lowest (morning ) one is 1:6 and then the most part of my day is 1:12.

i have tried the irish steel cut oats, and i have always had a problem with them. i think b/c they digest so slowly, i would need to do an extended bolus for them. but i LOVE using the regular Quaker Oates ( the Quick 1minute kind). i always get a predictable level BG from them.

maybe i just need a longer pre-bolus with the steel cut oats than the other ones; i will have to experiment. one of the things i prefer about the steel cut is first off, the flavor, and second, that i can make several servings and keep them in the fridge and use as needed. very convenient.

I would think that @Pianoplayer7008 has some significant endogenous insulin production, so for now her ratio’s are going to be quite large number (small amount of insulin)

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As @Chris pointed out, I’m still in early honeymoon with quite a bit of my own insulin production - suspected anyway. I’d love to get a c pep done like @Sam did recently. The last time I had a non-fasting done (BG was normal, though, not high), was over a year ago, and it was 4.5 (fasting levels are around 1).

That’s interesting. I’ve always heard steel cut/rolled are supposed to be “better” because they digest more slowly, so cause a slower, lower rise!

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i think what you are saying is 100% right. maybe i just didn’t give myself enough of a pre-bolus or perhaps my I:C ratios weren’t honed in at the time. either way, i had problems with them. i didn’t spike immediately, but i had quite a rise later at around 2 hours post meal. (this is for 1 Cup of cooked oats in the morning for breakfast.)

i think i will try my experiment with them again, because i really like them so much more. (it is a lot of work to prepare, though :wink: )

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I’d be curious to hear how it works out for you!

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i will deff keep you in mind and report back. i think i may make this on Sunday night and have it ready made in the fridge to eat on Monday morning before my swim.

i would love it if it works. its one of my favorite meals :blush:

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