I had a long write-up to try and explain why, but I’ve deleted it all…really what it has boiled down to for us, is that we’ve tried many different combinations of basal / bolus and this has what we found works for us for slow-acting carbs. With this configuration, we have two different “insulin” routes that we can manipulate if he’s trending high, or low, as opposed to a single method. If he’s trending low, we can suspend the temp basal.
Since most of the “spikes” come later, using both of these methods allows us to stretch out the insulin delivery into the system over 1 hour or more to give his food more time to begin digesting. If we only use extended bolus, he would spike high (no matter the hours). During these slow-acting carbs (as well as breakfast) we always add more basal because we know how his system is going to respond. So we start the extended bolus for the full amount, zero now, everything over the 2 hour course. Feed him 30 minutes later (so that a little, but only 1/4 of the full insulin has made it into his system at that point. Then 30 minutes later we turn on the temp basal for 95% more because we expect steep rises 1 - 3 hours later.
Honestly, the best part of using both is the fact that you can suspend the temp basal. You can’t suspend part of an extended bolus…you can only suspend the whole thing. So if, instead of using temp basal of 95% more, we decided to use only an extended bolus (with an increased I:C ratio), there would be a couple problems…first, once that extended bolus insulin is in his system, it’s IOB and you can’t suspend (or get rid of) it.
But having both the extended bolus (to cover only the carbs) plus extra insulin working in the background (because we know pasta and those types of foods causes significant spiking 2 - 5 hours later) allows us to a) have the knowledge that he’s been fully bolused for his carbs (in the extended bolus) and b) give him the extra ummph that we know he’ll need (in the temp basal). IF we see that his body isn’t reacting or spiking as he usually does, we have the flexibility of suspending that temp basal.
If we used an extended bolus over 5 hours and he started going low we would have a few problems. We would either have to feed the insulin if we wanted to keep that extended bolus going or we would have to suspend the WHOLE extended bolus which would definitely result in some pretty significant spikes in the hours to come.
We have tested your scenerios; however, and they just didn’t provide us the flexibility we needed to manipulate the insulin to work for us. The more methods we’re able to utilize during meals that can be partially suspended, the more we’ve found that we’re able to fine-tune his BG management. One method for a toddler just doesn’t cut it. Straight bolus or straight basal nearly always (for us) results in lows, or highs…I’ve found I have to be creative in his insulin mix in order to find the right balance that works for Liam.
Hope this rambling makes sense. Bottom line answer…because it’s what we’ve found works best FOR LIAM among the thousands of things we’ve tested and attempted over the past months. lol.
This will probably change for sure…but for now, this mix gives us a lot more flexibility in managing him. As he gets older we will probably be totally fine just piling on more insulin into his bolus or finding that perfect I:C for these types of carbs, but for now, this works best for us.
lol…I just posted this and realized that I had deleted a long post initially…and ended up making an equally long post again.