Toronto works great for meals with a lot of protein and fat. I’ve never had as much success using an extended bolus on a pump, for some reason. When I was on MDI, I also had good success with splitting a Humalog injection and giving 50% up front and 50% after abuot an hour and a half.
This weekend I’m researching TAG so will start trying to bolus for protein with an extended bolus this week and see if it will eliminate the need to do double boluses iwth Fiasp.
You could do two 50% boluses on a pump, couldn’t you?
Yes, and I’ve had success doing this. But the advantage of using Toronto or an extended bolus is getting nice flat blood sugars with just one bolus instead of having to remember to do a follow-up.
And how is Toronto with carbs in a meal not weighted towards protein/fat?
I don’t understand this question. Toronto would be excellent to deal with protein/fat as discused above.
So, if you were eating 50g of carbs with a lot of protein and fat, for example, and your ratio was 1:10, would you take 5u of Fiasp and 5u of Toronto? Or how would you calculate it? This is what I’m getting hung up on.
In the past, when I was on MDI (this was like 10 years ago so long before Fiasp), I would just take my carb bolus (so say 5 units for 50 grams of carbs at a 1:10 ratio) and split it 50/50. So I’d give 2.5 units up front and 2.5 units maybe an hour and a half later.
With TAG, you are supposed to calculate the grams of carbohydrates and the grams of protein. These days I weigh most of what I eat, so I would just weigh out both and use carb factors or a food database to figure it out. You could also use packaging or a food listing if you’re eating something processed or from a restaurant. You’re then supposed to bolus for carbohydrates as usual (100% up front), and use an extended bolus (or Toronto) to cover 50% of the protein. So if you were eating 50 grams of carbs and 30 grams of protein, and had a 1:10 ratio, you would take 5 units up front (of Fiasp) and extend 3 units (or bolus 3 units of Toronto). Theoretically, that’s how it’s suposed to work. I’ve found bolusing for 50% of protein causes me to go low, so when I try this again I’m going to try bolusing for 30% of protein.
The discussion centred on Toronto’s effects on high-protein/fat meals like pizza, burgers, and fast-food meals. I only wondered what it was like with a more “everyday” meal, where there’s not an unusually high amount of protein or fat. There must be a downside, otherwise we’d still be using it.
Oof I did my math wrong, 5u total, not 10. I see what you are saying… thanks for the clarification!
I have found if I eat low-carb I do have to bolus for protein as well. Good luck with figuring out TAG!
I tried it last night with chicken and riced cauliflower. Bolused 100% for carbohydrates and 30% for protein with a three-hour extended bolus.
It worked well in that my blood sugar didn’t spike at all nor drop, just flatlined. However, I was running at around 11 mmol/L and the correction I gave only brought that down to 8 mmol/L before rising again. So it wasn’t the greatest test run. I’m still 11 mmol/L this morning, so I’ve raised my basal rates and am going to fast most of today. Hopefully I’ll get a chance to try it tonight (although I’ll be out and it’s anyone’s guess if I’ll be able to find something I can eat) or tomorrow.
Yeah, this I’m not sure. I think if you eat a meal that’s mostly carbs with little protein you wouldn’t have to worry about it as much. I think covering protein is more important for high protein meals or for people eating a low-carb diet.
Also, not many people would be willing to take two shots per meal, so that’s one disadvantage. And I don’t think Toronto alone would be good for covering meals unless it was very low carb.
Maybe 50% protein with five-hour extended?
I could try that. Although this high I’m having isn’t related to the meal. I’ve bumped my basals up by 0.2 u/hr, so hopefully at the next meal I’ll be starting at a normal blood sugar.
I’ve found Toronto/Regular pretty good so far. I use it in the morning if I eat a carb-free breakfast and it keeps me flat. I’ve also used it 2 nights in a row after eating dinners that included beef and lamb (which always digest in the middle of the night and raise me) and woke up with better numbers. I really think it has to be part of any good MDI program, what frustrated me so much about MDI before was no way to mimic a square wave bolus.
Awesome! How do you calculate how much to take? Seems like R is just injecting water…
I don’t really know honestly, I’ve just been trying 1.5 to 2 units at a time and seeing what happens. I think I’ve been conservative if anything and will try more!
Also, are you trying Novolin or Humulin? I’ve read that Novolin takes longer to kick in and has a longer tail, which I think is true, but this is probably better for what we are using it for (approximating extended boluses).
They gave me Novolin at Walmart… it just doesn’t seem to make any kind of a difference! I think I need to up the doses, as well. I was cutting back on my initial dose of Fiasp but that makes me go too high. I’m getting kind of frustrated and am tempted to go back to my Humalog, ha.
Yeah, I wouldn’t cut back on Fiasp, especially since it has a shorter tail than Humalog or Novolog in my experience. I haven’t changed my initial dose, I take the Novolin to cover when the Fiasp wears off.