For pizza I’m finding a 50/50 extended bolus over 3 hours works really nicely. I recently used the same formula for mac and cheese (same amount each night, 33 g carb for 1 cup) for two nights, but forgot on the third night and did a straight-up bolus. The difference is obvious. (And sorry about the clumsy merging.)
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I love using dual wave boluses. I use them for nearly all my meals and that works really well for me, especially since I’d found that FIASP prebolused 100% up front was dropping me for nearly all meals
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@Beacher, I am curious: your upfront bolus, is it 100% of what is calculated from your ICR, or 50%? Or something else?
50%, with the remaining 50% over 3 hours. I’ve also used 60% up front, 40% over 2.5 or 3 hours for pizza, but recently it wasn’t working so reliably, which is why I’ve gone to 50/50. (40/60 was a major fail.) It looks like too much up front the second night but I was probably too aggressive with my correction since I was slightly elevated to begin with.
Because I can’t bolus more than 4U at a time, the up-front portion ends up being a half-hour extended bolus, and then I have to remember to start the second bolus for the 3 hours.
Since @LarissaW says they work well for her for all meals, I just did a 50/50/3 hours for my dinner, injecting the first half. My gut tells me I’ll be low all night, but I won’t know if I don’t try! If you never hear from me again, you’ll know it didn’t work.
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O gosh, now there’s pressure!!!
@Beacher omnipod doesn’t allow for extended boluses or >4u boluses???
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Omnipod allows 8 hour extended bolus periods.
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I’m proud of this one I did: dual wave bolus for a bag of cheddar ruffles and a 6 inch turkey hoagie with cheese, lettuce, tomato. 45/55/1hour and I was pretty stable at 90. I’d decided to do dual wave because it was a bigger meal for me and because of the protein/fat in the hoagie
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I am not judging you, but really, I am judging you, because there are better options out there for the carbs. No complaints with the 6 inch hoagie, especially if this is from some fancy sub shop, but come on, cheddar ruffles. Stern look…
Only the fanciest and classiest- wawa 
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It sure does, but if I bolus more than 3 or 4 U at a time, I get tunnelling. If the bolus is smallish, I’ll do 3 or 4U then extend the rest over half an hour (the minimum extended time allowed). If it’s larger, I’ll usually inject all of it.
The extended for a not-high-protein/not-high-fat meal worked quite well. I had a strange spike about 5 hours after eating that quickly turned to a steep drop, I had a couple glucose tabs when I approached 63, then I stayed flat at 70 all night. Worth trying again with some tweaks – probably more up front would be useful.
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Dual wave bolus and tunneling? Can someone elaborate?
A dual-wave bolus is something a pump can do. You set it to give part of a meal bolus right away, and dribble the remainder of the meal bolus in over some number of minutes or hours. This effectively slows down the speed of the insulin, which is helpful for meals like pizza that have lots of carb combined with lots of fat or protein that slow down the digestion. On injections the similar technique is called a split bolus. You split the meal bolus into two parts, and give the first part immediately and the second part after an hour or two (or three). When to use a dual-wave or split bolus? It’s something to try for foods that usually cause you to go low after an hour followed by high after 3 or 4 hours, which shows that the insulin was faster than the digestion (causing the early low) and also there wasn’t enough insulin total (causing the later high.)
Tunneling is the idea that if you put too much insulin in all at once, some of it can leak back out. This rarely is a problem with a syringe, but it can happen with some insulin pump cannulas. My impression is that it’s not a widespread problem. I’ve read complaints about tunneling mostly from Omnipod pumpers, especially the lean ones. People who have this issue typically give large meal boluses by injection, saving the pump for basal and smaller boluses.
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For baseball my son most often used an unthethered pumping technique. That is he gave 50% of his basal through Lantus, and the other 50% through the pump. That way when he started baseball he just unplugged the pump but didn’t rise or go low very often through the game (he still monitored through sticks). This allows him to use Dual Wave bolus when eating the pizza afterward, but still not being connected to the pump while he played catcher which was very important to him as well.
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Thank you that makes sense!
Thank you for explaining this. I really appreciate the information