Found something that works (for us) for slow-digesting carbs

Parenting a D-Child Toddler
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So, we had previously been running into issues with Liam going low (or needing additional fast-acting carbs to keep his BG’s up), after being bolused because his insulin took effect before his food began being digested. We had tried many things and nothing worked for us (using an Omnipod.) This resulted in spikes up to 250 for sometimes 3 or 4 hours later as well. However, recently we’ve been trying something that has been working for us and I thought I would share as an option for those having the same issues with those slow-digesting carbs. Hope it’s successful for you as it has been for us these past few slow meals.

So here’s what we did that works.

  1. Determine the carbs we are going to bolus for.
  2. Set the bolus as an Extended bolus over TWO HOURS (we usually do 1).
  3. Feed after 30 minutes. (Erin corrected me on this one)
  4. Turn the Temp Basal (95% increase) on ONE HOUR after the extended bolus has started and turn it on for 5 hours.

This system has resulted, at least for us, in his BG’s not even crossing above 200 at any time.

If he’s also getting something fast acting (like Milk), we just make sure we bolus him that amount up front before the meal, then let him have the milk after 15 minutes.

Anyway, this is what we finally found that works (right now) for us so I thought I’d share.

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Different pumps have different terminology for temp basal. By 95% increase do you mean almost double the normal basal rate for the next 5 hours?

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That’s correct. So instead of his usual .10u/hr, it would be .195u/hr

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Harold, why do you do the temp basal? Is it because, when you tried setting up an extended basal for 5 hours you did not get what you wanted? It seems strange to change basal for a bolus-related activity.

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Glad you found something that works! WE too have found that, while spikes can certainly be a problem, most foods tend to outlast his insulin if we give it all upfront. I wonder if that will change as the kiddos get older and their stomachs get bigger? But for now we are wary of bolusing for an entire meal upfront unless the meal is like a popsicle or something. Even birthday cake often causes a low at 1-2 hours post bolus if we do it all upfront.

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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.

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So, this goes to my (possibly crackpot) idea that’s been brewing about Diabetic Tetris. Basically, you have a bunch of tools (or insulin shapes) – they’re different boluses or basal settings of different sizes and widths and amplitudes – and you are trying to find the minimal number of them that can keep the BG curve at the top “flat” as much as possible. I’m guessing there are other ways you could do this but that you’ve essentially converged upon this system because overall, it requires the fewest number of operations to keep BG as steady as possible.

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You said in that short paragraph what I attempted to say in my novel above. Thanks! You said it so much better. @ErinElizabeth has accused me once or twice of being long winded.

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I love this idea!