bolus 'capping'?

[Patricia]

Glad I've remembered to ask this, keep thinking it...

When E was first diagnosed (Nov) and we set about carb counting, he had a 'cap' on his bolus of 8 then 9 units. We've now moved it to 10 units of our own accord...We gave him 10 last night, and he was high before bed. Admittedly the dosage didn't actually 'match' the carb (he should have had 12 on strict ratio)...

Sometimes capping seems to work, and sometimes it doesn't. For instance, he almost always has more than 10 units of carb according to his ratio for breakfast on a school day -- but we only give him 10 and that gets him through to his late lunch okay... At first I thought oh then the ratio just needs changing (say from 1:8 to 1:9/10) -- but at the weekend, we adhere to the ratio (1:8), give him 6 or whatever, and it works. So it doesn't *seem* like the ratio is out generally?

Do others cap doses? And how do you handle it if you do/don't?

 

[bev]

Hi Patricia,
I havent even heard of 'capping' a dose? I would be interested to know why this is done? We always match the insulin to the food intake and if that means giving Alex 10 units for example,then we just give it. I think the most he has had so far is 10 units plus a 2 unit correction dose. I know this will sound strange but for some reason i have it in my head that it is somehow 'wrong' to be giving large doses of insulin - i dont know why - i think its phsycological perhaps? Bev

 

[sasha1]

Glad I've remembered to ask this, keep thinking it...

When E was first diagnosed (Nov) and we set about carb counting, he had a 'cap' on his bolus of 8 then 9 units. We've now moved it to 10 units of our own accord...We gave him 10 last night, and he was high before bed. Admittedly the dosage didn't actually 'match' the carb (he should have had 12 on strict ratio)...

Sometimes capping seems to work, and sometimes it doesn't. For instance, he almost always has more than 10 units of carb according to his ratio for breakfast on a school day -- but we only give him 10 and that gets him through to his late lunch okay... At first I thought oh then the ratio just needs changing (say from 1:8 to 1:9/10) -- but at the weekend, we adhere to the ratio (1:8), give him 6 or whatever, and it works. So it doesn't *seem* like the ratio is out generally?

Do others cap doses? And how do you handle it if you do/don't?

Hi Patrica
I cant help to much on the carb/insulin ration, as Nathan refuses to allow us to use this method..unfortunatly in his current mindset it is not up for discussion....hey ho teenagers.
So in our case every meal requires different amounts of Novarapid depending on blood sugar reading and the food in front of him. The only consistant amount of insulin is his Lantus which is at 46 units, having dropped from 62 at the start of the year.
The consultant kind of leaves it up to me as to what to give him, and in some ways kind of get on with it, Nathan's DSN is about if i need urgent advice.
Sorry I cant help, im sure some one will be able to point you in the right direction though.

Heidi
🙂

 

[Mand]

Capping

I have never heard of 'capping' either. My son works on different carb: insulin ratio for each meal. Currently on 1:6 for breakfast, 1:10 for lunch and 1:12 for tea with 19 units of levemir before bed. So his units of novorapid vary depending on which meal he is having, how much he is eating and whether we need to add a unit or two if he too high. Exhausting!!

 

[aymes]

I know this will sound strange but for some reason i have it in my head that it is somehow 'wrong' to be giving large doses of insulin - i dont know why - i think its phsycological perhaps? Bev

They do say you shouldn't inject too much in one go, ie if you need to give 20 units for a bolus split it into two injections of 10 etc.

I've not heard of capping the bolus, unless it's part of a lower carb policy, so also capping the carb intake...

 

[sofaraway]

I don't cap my boluses, but there is a limit on what i feel comfortable injecting in one go, it's a psycological thing and that's 6 units.

 

[katie]

I don't cap my boluses, but there is a limit on what i feel comfortable injecting in one go, it's a psycological thing and that's 6 units.

nikki, do you only need a bit of insulin? i have a psycological thing about doses over 20, the most ive done is 26. I wish i only needed 6 units at most

 

[sasha1]

nikki, do you only need a bit of insulin? i have a psycological thing about doses over 20, the most ive done is 26. I wish i only needed 6 units at most

Hi katie
I feel like that too regarding nathan, not keen on giving him anything over 22, although like you he has had to have 26...and i've been a right nervous wreck after it.
Heidi
🙂

 

[sofaraway]

nikki, do you only need a bit of insulin? i have a psycological thing about doses over 20, the most ive done is 26. I wish i only needed 6 units at most

not a lot really, 12 units basal and 1-6 units per meal/snack

 

[katie]

not a lot really, 12 units basal and 1-6 units per meal/snack

I used to only need that much lol

 

[katie]

Hi katie
I feel like that too regarding nathan, not keen on giving him anything over 22, although like you he has had to have 26...and i've been a right nervous wreck after it.
Heidi
🙂

At least im not alone

 

[Patricia]

The capping thing is obviously not widespread -- I'm interested to hear though aymes' take on not giving too much at once, will ask. Maybe it's something just as simple as not risking overdose/miscalculation for newly diagnosed?

Yes we match carb to insulin up to 10 units at the moment, though my gut is now saying we just need to press on and keep raising if necessary. But I'm like everyone else, and have a psychological thing, always wanting to keep the dose as low as possible...slowly it's dawning on me that this can't be right. It must match. I feel scared though we when have to have large doses. Actually, now that I think about it, the biggest doses are pasta and rice, which we always split. He's had 12 in two doses on those before...Hmmm..

 

[sasha1]

Hi Patricia,
Im also intrested on aymes..taking to much insulin, spliting the dose.
I cant recall anything mentioned about that at hospital visits, the only time splitting doses was mentioned was to do with Natans basal insulin when he was on Levemir, half in morning the remainder at night...
Heidi
🙂

 

[diagonall]

The idea of capping insulin has been around for years. IMHO it's a dammed good idea.
The more insulin you inject the bigger the hypo if things go wrong.
It also in the long run increases insulin resistence which is not good.
I must admit to being totally shocked at the amount of insulin some people esp children are injecting.
Carb portion size has to play a major part in this. Moderate the carb intake and moderate the insulin.
Control is so much better using this method.
My cap for a bolus is 7 units.
This method has served me well as it has always been used for me and I have just started my 44th year of diabetes with no complications.

 

[Pigeon]

Not heard of "capping" as such, but the dietician did mention that if you have a large meal, or a very filling one, it's better to split it. I've found e.g. when I eat a large curry with all the trimmings, if I add it up it's 140g carbs, so 14 units for me, but them I'm hypo 2 hours later, then BS is about 14 the following morning, as it was still digesting when I went to bed. So I tend to take about 10 at the start of the meal then take a few more units at bed if I still feel full. It's not a precise art though, and I seem to get it wrong a lot! Does anyone have a better suggestion?

 

[bev]

Hi Sue,
We have never been told to limit the carbs for Alex, he is a skinny child and is growing so surely his intake of carb/insulin will only increase as his body requires more energy as it gets bigger?

He typically will have 8 units at breakfast
6 units for lunch
8/9 units for evening meal

The portion sizes are not excessive - they are what every other normal 11 year old would eat - probably less as his appetite has decreased since diagnosis. His consultant has never told him to limit his carb intake - she just says that he can eat what every other 11 year old eats!

Also, surely it depends on the ratio a child is on? 1:10 obviously is a huge difference to 1:20 - but the same amount of carb is still being eaten - the only thing that varies is the insulin - which is matched to an individuals needs.
I think especially with children it is unwise to set an 'exact' daily intake of carbs as you could possibly invite food faddiness and/or anorexia/bullemia - food should never be restricted for a growing child - unless of course the child is morbidly obese. But that is a whole other set of problems!🙂Bev

 

[sasha1]

The idea of capping insulin has been around for years. IMHO it's a dammed good idea.
The more insulin you inject the bigger the hypo if things go wrong.
It also in the long run increases insulin resistence which is not good.
I must admit to being totally shocked at the amount of insulin some people esp children are injecting.
Carb portion size has to play a major part in this. Moderate the carb intake and moderate the insulin.
Control is so much better using this method.
My cap for a bolus is 7 units.
This method has served me well as it has always been used for me and I have just started my 44th year of diabetes with no complications.

Hi Type1 sue
After reading your post..I'm certainly going to raise this at the next hospital appointment for Nathan..because i'm not really happy either the amount of insulin Nathan requires.. the hospital know how much he is taking and have'nt said anything, other than it is natural and understandable he requires this much due to growth and hormones etc,and that children require far more insulin than adults..

Heidi
🙂

 

[aymes]

The capping thing is obviously not widespread -- I'm interested to hear though aymes' take on not giving too much at once, will ask. Maybe it's something just as simple as not risking overdose/miscalculation for newly diagnosed?
..

I think the theory behind it was that absorption could be unpredictable when injecting a lot in one go.

 

[aymes]

Hi Sue,
We have never been told to limit the carbs for Alex, he is a skinny child and is growing so surely his intake of carb/insulin will only increase as his body requires more energy as it gets bigger?

He typically will have 8 units at breakfast
6 units for lunch
8/9 units for evening meal

The portion sizes are not excessive - they are what every other normal 11 year old would eat - probably less as his appetite has decreased since diagnosis. His consultant has never told him to limit his carb intake - she just says that he can eat what every other 11 year old eats!

Also, surely it depends on the ratio a child is on? 1:10 obviously is a huge difference to 1:20 - but the same amount of carb is still being eaten - the only thing that varies is the insulin - which is matched to an individuals needs.
I think especially with children it is unwise to set an 'exact' daily intake of carbs as you could possibly invite food faddiness and/or anorexia/bullemia - food should never be restricted for a growing child - unless of course the child is morbidly obese. But that is a whole other set of problems!🙂Bev

I think it's just an ongoing debate, the benefits of a controlled carbohydrate diet vs taking a less strict approach. I think it's just up to each of us to decide what works best for us. For example I have taken a carb limited approach in the past, which worked fine but I found it to be too restrictive. I now don't limit my carbs and for me the control is about the same. Of course for some this will be different so we all decide where our balance lies...

 

[diagonall]

Hi Sue,


I think especially with children it is unwise to set an 'exact' daily intake of carbs as you could possibly invite food faddiness and/or anorexia/bullemia - food should never be restricted for a growing child - unless of course the child is morbidly obese. But that is a whole other set of problems!🙂Bev

Bev, Children diagnosed in the 60/70's and before that had a set carb amount per meal. As did adults.
That carb amount was set for each individuals need.
Simple truth of the matter is that we obtained a lot better control than what people do now days with massively high carb intake and insulin to match.
Reading posts from people that go way over the top with carbs just proves my point regarding control.
Now I love my carbs and eat them in moderation.... well aprox 200/day.
Also the more carbs you eat in one go requires more insulin this again affects the carb ratio.
Looking at things in a basic simplistic way................
Why would anyone with diabetes want to go overboard with eating carbs when their pancreas has kicked the bucket? Injected insulin can not mimic the pancreas so you have to help it out.
As a child I was never hungry with my carb restriction. There are plenty of other things to go on a plate besides carbs.