Wednesday, June 21, 2006

We have an ID-10-T problem here.

I feel like an idiot. A few weeks ago, I just took my Lantus shot once a night and Humalog according to my sliding scale before each meal. It wasn’t perfect at least according to my A1C but it made sense to me.

Now with “Master P” (my pump) I am totally confused. I bought a carb counting book and have been really good at only eating things on it and not snacking in between meals or trying to psyche out the pump and my machine (they seem to know all). But I cannot figure out why my BG reading suck!

So I have the Paradigm (this is the only pump I know about so if all the others have this feature then I apologize for stating the obvious) and there is the feature on it called a Dual Wave Bolus. Seems like a cool idea I mean at least it sounds cool right? Anyhow, after I enter my BG and the carbs I am going to scarf down, it asks me…

“Yo G! So what do you want Master P to do? You want 50% of the insulin now or 36% now and the other 64% later? Oh yeah and let me know do want that extra 64 over the next half or an hour and a half or 5 hours or what? Talk to me G, YOU TELL ME cuz man, I’m cool with whatever!” He is a very hip pump.

I stare at the screen like a kid watching a Sponge Bob marathon and have no clue what to do. My Pump Trainer told me “You just have to figure it out!” as she quickly skipped away on another call or something. So I guess, I try different combinations, I pray, I cry, I get pissed off, I toss a coin, I try and I try and have yet to get it right.

On a side note, my night time basal rate seems to be set. I have been testing at 2AM in range and waking up also in range so I guess that is something. But I just want to know NOW how to do this. Isn’t there a chart or a diagram or spreadsheet or something??!?!? I am so annoyed because I cannot stand to feel dumb. I am not the sharpest tool in the shed but I know I am not a complete idiot but right now, I feel hopeless.

Well, I am going to a Normal Bolus day today and screwing the Dual Wave thing to see what that does. I will let you all know soon.

I gotta go, Master P is complaining that I don’t have any bling on him. I hope the Groovy Patches I ordered will chill him out!


Val said...

Hi George!

I never used to use the dual wave/combo/whatever bolus feature until I started using a continuous monitor. Since then I've found that doing 50% now, 50% over a half hour seems to work for most meals. I tend to go low if I walk right after lunch, so on those days I stretch it out to a 1 hour extended and kill it early if things seem to be too low.

For really high fat meals, I've gone up to as much as 3 hours, but that's usually more like 30% now, 70% over 2 or 3 hours.... Of course, that's my body, which bears no relation to yours or anything else ; ) but it might be a good starting point if you feel like experimenting...

Good luck with pumping!

Val said...

PS - the only things I dont do extended are corrections or pure carb snacks...

Kevin said...


First: Do not fret.
Just chill.

Like Val said, there is definately experimental work required. But we can all provide you with what we do or what works for us as starting points for your own testing. The key is keeping good notes on what you do and searching for a pattern.

Like I've mentioned to you before, I found working with Gary Scheiner to be extremely helpful to this end.

As for me, personally, I almost always just use Normal boluses. The only time I use a Dual wave bolus is when I'm eating pizza, chinese, or mexican food with lots of guacamole (high fat foods, essentially). And even then I'm often just guessing just like you: 50/50? 60/40? 40/60? (I stay away from things like 64/36 -- that just makes things much, much more difficult) 1hr? 2hrs? 3hrs? I make a guess and then test to see how well I did. Some times it works like a charm, other times I crash and burn.

If there's something to figure out, I keep detailed notes on what happens to my blood sugar when I eat certain things and try to figure out what the "best" way to bolus for them might be.

Keep punchin' man! You can do it!

LaLa said...

I definitely understand your dilemma with the dual wave bolus. I have yet to figure that one out, so I have just stuck with the normal bolus. I'm eating salmon tonight, so I might try to do a dual wave, perhaps a 60/40??? Pure game of chance there, though... oh, the frustration!!! I guess it's par for the course, though; everything with diabetes seems to be a guessing game. Is my insulin/carb ratio 1:10, 1:15, 1:17??? Is my sensitivity really 65, or should it be 50 in the mornings and 75 at night?? UGh Ugh Ugh!!!

Sorry I don't have any good advice or pearls of wisdom, but hopefully it helps to know that I can definitely relate to your situation! I'm sure many diabetics can, actually :)

Penny said...

I'm going through this with Riley right now. We have found that if he has rice or pasta (especially spaghetti) he tends to need a dual wave (his pump calls it a "combo bolus"), but trying to find that right formula is not fun.

Shannon said...

For "normal" foods, we don't do what Cozmo calls an "extended bolus" (or dual wave for your pump).

For pizza, we dose him for half the amount of carbs in the pizza before he eats. When he's finished eating, we dose him for the other half and set the delivery for 8 hours. He's gotten excellent numbers.

Keep it's the best way to go while you're new at this.

If your mealtime numbers are too high or low, adjust the bolus before the basals. If they're still too high or low, adjust the basals next.

Be as methodical as possible...and work with one feature at a time to tweak your numbers.

It gets to be too overwhelming if you work on everything all at once.

George said...

Thanks for sharing what you guys do, that gives me a starting off point instead of just guessing here and there. I am writing everything down and looking for patterns. Kevin, i am in chill mode now. Thanks

Sarah said...


Its been 6 yrs, and I still have issues with the dual wave (called combination on the Cozmo). I really only use it for really fatty foods (pizza, fish and chips) and then I give 50% now, 50% over the next hour. I find thats a good starting place for experimenting. Then test, test, test. If your high after 1 hr, then next time give a little more upfront (don't worry about the extended time, yet). If 1 hour is right on, but 3 hours later you're high, then play with the extended time...

Its all about play. I found that I had to take it 1 food at a time too. So what I did was to have Pizza every Friday for a while, till I got it down pat. Then moved onto the next food.

Most boluses for me though are just regular ole boluses.

KSC said...

I use the square one at parties where I know I'll be "grazing" for little things - I've always used and hour and half and then just eaten until I hit the right "estimated" carb amount. It works sometimes, but....As for the dual wave, I've really only used it on truly greasy pizzas and things with a ton of cheese. It works quite well for that! Best of luck!