The good part of it is – it means we need to try it again, until we get it right!
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The weather turned cold last week so I have not been in the mood to try my coffee milkshake experiment yet. 
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I wanted to use 100% pre-bolus, followed by 50% extended bolus over 4 hours. But I went low right away so I never did the extended bolus, just the pre-bolus. I knew I might go low the moment I saw the peak coming down right after I had injected, so I did not program the extended bolus: I thought I would be able to start it later if I did not go low.
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I was going to say I think 100% pre-bolus would be a lot for anyone in this circumstance, since it’s such such a LARGE amount of insulin (more than you and Liam are used too for normal meals.) If you haven’t tried my method, since you use Omnipod, you might want too! Who knows, it may work for you also!
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If you like chocolate flavor in your coffee milkshake consider adding a Tablespoon or two of Nutella. It makes a really kickass milkshake.
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We’ll be having another go at our test tonight. The only change we’ll be making is moving down to 50% over the 2 hour period. If it’s still too much, next test (there’s ALWAYS a next test. :P) we’ll eliminate the temp basal all together.
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Anytime we have tried anything like a 100+ carb milkshake (or whatever those frozen things that Starbucks sells are) and if it all gets dosed (even with an extended 50%/50% over 4 hrs) then we end up feeding more carb after carb after carb for hours. The only benefit we have seen to the extended bolus (in a 100+ carb situation) is being able to cancel it once we realize it is just going to be a low-low-low event following.
I have decided that in our case for whatever reason, 100 carbs can not be digested in a single sitting and at least half (or more) of it just passes through.
Probably the highest carbs we have ever done successfully in a single sitting would be ~ 55 carbs.
Edit: There COULD be some sort of minor lactose intolerance thing going on. Not really sure. Possibly no issue with less than 3/4 cup of milk (in a single sitting) but past that could be something. Discussed it with GI - but nothing definitive. But maybe that is part of what could be coming into play here as well?
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I can absolutely understand. Everything is so crazy different with each person and their digestion. Last night my son ate a 1/2 sandwich and chili followed by a piece of pecan pie. (Not a milkshake, but still pretty challenging).
We got the prebolus nailed right, but didn’t get the extended bolus correct. And instead of low, we went high. But of course, because of the volume of sugar it took a while to digest. We ate dinner at 7:30.
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@Thomas, celiac disease destroyed my ability to digest lactose. Possibly a similar issue?
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This particular one is only 65 carbs…and it’s the most he’s ever digested at one time. Our only difficulty came 2.3 to 3 hours later with the low. Extended is CRUCIAL for us…without extended, giving Liam 3u up front would crash his BG. Extended is what we use for most every meal…do extended bolus for 1 hour, 0% up front everything over 1 hour, then he eats at the 30 minute mark. For us, it’s magical.
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Could be. We were told the damage from the previously undiagnosed Celiac would repair over time. Time frame for “repair” was said to be 12~24 months once being completely gluten-free.
At one point, we did have a fairly severe lactose intolerance and had to use the lactaid pills any time milk (or products containing milk even cheese) was consumed. But then over time that went away and we don’t have to use the lactaid pills any more. But there might still be some lingering issues as it does seem 1 cup of milk (or more) does have some negative effect but less milk is fine and cheese is fine.
And being (mostly) able to have dairy products again is really great. Anytime we can add food back into the diet is a good day !!!
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Yes! During this last pregnancy, I had to cut out dairy, tomatoes, and all other fruits except berries. Now I’m back to no dairy (and no eggs except baked) because of baby’s issues. 
From what I understand, the ability to produce lactase enzymes can be temporarily or permanently affected. I seem to be in the permanently affected group, as even 4 years later, I have trouble at times even with taking enzymes.
But that won’t stop me from a milkshake challenge as soon as I can have dairy again! 
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We just did another banana split challenge! Can’t wait to see how it will turn out. My son did not have a hormone spike before the split (last like week), so now I am hoping there won’t me one spoiling it all during/after 
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Here’s what his BG looked like during last nights challenge. It got to a peak of 208, then came back down. The only change we made was to give him 50% temp basal instead of the 95% extra. We still had to give him a snack on the way back down (around 2130) so next time, we’re going to try with the zero temp basal.
Challenge started at 1733.
- Extended bolus for 60g (3 Units) over 1.5 hours.
- Temp basal of 50%
- Fed him ice cream at 1803
Here’s the 3 and 6 hour data.
3 Hours
6 Hours
Erin and I agree that he’s OK eating ice cream at this point. I’m sure things will change as he grows, but at this point, he does OK with it, so we’re definitely not going to deprive him of it! 
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I love this. That line looks stellar!
Awesome job!
Can you give some insight in your method? I see you do an extended bolus and also a temp basal. Are these over the same time?
Since extended boluses show up on the PDM’s IOB, but basals do not, is it hard to keep track of his IOB when using both extended and temp basal instead of only using the extended?
I have often wished for a better way of tracking IOB from basal, but I know it is currently not done with any pump.
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This is how it turned out. It went well, but I cheated:
I had a late brunch and I went a bit high. Instead of correcting, i went on a long run (about 90 minutes). Right after coming back, I bolused for a large banana split. Since I knew i was going to go low from the run, I only bolused 80% upfront. I rode the curve down until I was right above 70 then ate. The banana split was 95 carbs. My CGM went in a deep low but I didn’t. However, I did not go back up enough, so I ate some more carbs (another 20 carbs of fruit). I also decreased my temp basal by 20% for about 3 hours. Finally, I started going up 4 hours after eating the banana split, so I dosed 25% again, extended over a bit less than 2 hours.
I did not go high: the highest I went was 122. But I was in the mid to high 60s for too long.
So, for me, this shows a way to deal with a big banana split – take a long run first! But I still haven’t
figured out how to eat it straight without running. So I still have to study more. Maybe next week 
Thanks to my dad for the Clarity data and the track.
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Nice Job Kaelan. That is a bunch of exercise required to make the banana split happen, but that seems like a small price to pay for a great treat.
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What it boils down too, for us, is the MORE METHODS of insulin delivery we can have going at one time, the more methods we have the ability to STOP if they’re too much. This method allows us maximum ability to refine his insulin dosing because it’s coming from many directions. If we had only one method going on and it was too much, we’d cancel it, then he’d skyrocket.
The extended bolus is what we do FOR EVERY MEAL now. We always follow this procedure for every meal…
- Begin extended bolus for whatever the amount is, and it’s extended over 1 hour.
- Wait 30 minutes
- Feed him
Then, depending on what it is that he’s eating (based on many many tests) we know he will need more insulin…PROBABLY!! “PROBABLY” is always a big word with toddlers because what doesn’t wreak havoc on them today, may very well shoot them to 300 tomorrow. So for those known meals that we know cause a sharp spike, we’ll add a 95% additional temp basal. For those meals that “usually” cause no, or just a little spike, we’ll do a 50% temp basal.
By doing this it really does avoid the severely sharp spikes. IF we see that his BG’s aren’t rising as sharply as anticipated, we can just suspend the temp basal.
Really, for us, this is the culmination of lots of missed nights sleep and endless failed tests to come upon this “golden” formula that is working for us right now.
If we eliminate one of these and just tack that insulin onto one of the other methods, it always tends to bring him low. Managing a toddler really is a tight-wire act, and this is the formula we’ve found that works due to the ability to manipulate multiple variables if necessary.
As far as the basal IOB, we aren’t as concerned with tracking how much as the direction of arrows and the thresholds we have set for specific actions to take.
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Nice going @Kaelan! I said when I exited the Army in 2002 that, if you ever see me running, you would be smart to turn around and run too because something is chasing me. 
And I just hope I’m faster than you!
lol.
Great job and no matter what it takes, it’s always nice at the end of the day to enjoy some amazing ice cream. Life just wouldn’t be the same without sweets - especially Ice cream.
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Makes sense, you can stop one and leave the other going, leave them both going, stop both, etc. More options.
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