Highest Bolus Dose?

[Sally71]

My daughter’s current pump has a pre-set maximum of 25 units and I don’t think she’s ever hit that yet, she’s had something like 12 or 13 in one go though (usually spread out on extended boluses because of eating all sorts of carbs at parties). I’ve also heard that larger doses above about 7 units should be split to aid absorption. I’ve also found that not going ridiculously carb heavy on meals, and therefore taking less insulin, does make the blood sugars more stable! So whilst in theory a type 1 on insulin can eat anything they like as long as they count it and dose correctly, real life is a bit more complicated than that. I found one of the hardest things was finding the right balance between trying to micromanage things so tightly that blood sugars were almost perfect, or relaxing a bit and allowing my daughter to enjoy life without letting the control slip too far.

 

[Proud to be erratic]

The John Walsh "thing " happens to make some sense for me; I'm a bit over 70kg, lowish BMI and in practice I rarely these days need more than 7 units of basal at any one time. I, now, regularly aim at a split dose if my meal is going to be bigger than 70gm content; partly because that sort of size meal will be for more than one course and the split dose helps to get the insulin and glucose better co-ordinated. It would be a rare meal that has more than 70 gms carbs without being just too much volume.

The observation by @eggyg (post #18) resonates with me. I often need 1-1.5 hrs for a modest prebolus of 4 units at breakfast time (toast, egg and frothy coffee + maybe a small correction) to start to show any effect. If I don't wait and start eating straightaway the benefit of that bolus gets "lost" and my BG quickly gets into double figures and then needs extra correction. I assume others experience this to a certain extent, otherwise why do others need a prebolus? Whereas in the evening I barely need any prebolus unless I happen to be in double figures as that meal becomes imminent. Catering /coping / adjusting for this pre-bolus vagaritiy is part of the many minor "stressers" that contribute to the diabetes burnout.

These decision points take an unreasonable amount of my decision making time; they are rarely a simple decision and once that decision is made it needs constant monitoring and I need to be ready to override whatever that decision was. Even though that constant monitoring can be aided by astute juggling with CGM alarms, that juggling takes time and concentration (plus remembering that the changed alarm is not its usual setting!). If only either Dexcom or Libre could provide a widget (or equivalent) that constantly displayed my BG alongside (or even instead of) the time on my sleeping phone, then that would be amazingly helpful. But despite several modest upgrades of both companies software over recent years, there is absolutely no awareness by either company about how helpful such a modest improvement could be to someone who needs to know straightaway what their BG now is. With my G7 on android, if my phone is not awake and displaying that app then an alert (alarm) needs 2 or even 3 steps to just see what the alert is telling me. Dexcom don't seem to allow any other secondary app to provide that improvement.

Of course I'm ranting to people who understand these sorts of things. A recent call to me from the Dexcom medical care support team (apparently a DSN of many years before joining Dexcom) noted my concerns but clearly hadn't appreciated how such a basic improvement could be and she managed my expectations (inferring it was unlikely that such improvement would happen, since the app would need to be rescrutinised before medical reappraisal would be granted). I very much doubt if Dexcom One Plus (very similar to G7 and not purchasable privately, only on prescription) will provide that improvement. I wonder if G8 design team, not yet on a drawing board, would see the benefit.

 

[helli]

If only either Dexcom or Libre could provide a widget (or equivalent) that constantly displayed my BG alongside (or even instead of) the time on my sleeping phone, then that would be amazingly helpful.

This was one of benefits of using xDrip+ with Libre. I believe it also works with Dexcom.
I had a widget on my locked screen showing me my current BG.

It is a feature of the app and has nothing to do with the sensor being used.

 

[JJay]

This was one of benefits of using xDrip+ with Libre. I believe it also works with Dexcom.
I had a widget on my locked screen showing me my current BG.

It is a feature of the app and has nothing to do with the sensor being used.

Sweet Dreams app will do this too. I use it with Libre & iPhone, so no idea about Dexcom/Android I'm afraid

 

[everydayupsanddowns]

That John Walsh thing is interesting and I’d forgotten that

Yes I think he actually says half your weight in lbs as grams of carbs, but that’s a weirdly US imperial/metric quirk of only ever thinking lbs for weight.

So I’ve just adopted kilos, which is more or less the same! (2.2lb per kilo)

 

[Tom1982]

I split anything over 10units, so this morning I woke up with really high levels.... no idea why, but that is 2 nights in a row where levels have gone into orbit whilst I slept, despite a reasonable basal dose..... Anyway, I decided 12 units was going to be needed, what with the large correction to bring me down plus my breakfast bolus and a couple of units for FOTF, so I jabbed 6 units into one site of my tummy and another 6 in the other side. You get better absorption from 2 separate sites I think. I do the same with my morning basal which is 22 units of Levemir, so I put 11u into one buttock and the other 11 into the other. I think apart from the time I accidentally injected 24 units of Fiasp instead of Levemir one morning when I didn't realise I had the wrong pen in my hand, 12 is probably the biggest I have had at one go.... but Chinese banquets need more than 12 although that is over several hours and several injections.
I used to eat mega amounts of carbs pre diagnosis, including multipacks of Snickers, but all that had to stop and I thank the big D for giving me the kick up the backside to deal with my sugar addiction.

When Jo was diagnosed they repeatedly told us “just eat whatever she wants” in reality that’s not really possible is it? I have seen various libre and dexcom charts on here that are lovely and straight. I think it must come down to discipline with what you eat!

 

[Inka]

Yes I think he actually says half your weight in lbs as grams of carbs, but that’s a weirdly US imperial/metric quirk of only ever thinking lbs for weight.

So I’ve just adopted kilos, which is more or less the same! (2.2lb per kilo)

Ah, that’s actually better with lbs! It works out as a slightly larger amount of carbs per meal

 

[everydayupsanddowns]

When Jo was diagnosed they repeatedly told us “just eat whatever she wants” in reality that’s not really possible is it? I have seen various libre and dexcom charts on here that are lovely and straight. I think it must come down to discipline with what you eat!

There can be a degree of that - to an extent.

I’ve certainly decided against eating something, because the enjoyment I get from it isn’t worth the hassle of chasing BGs for hours after (and failing to work out a system that works for it).

But on the other hand, there are other things that have a reputation for being tricky, that I’ve just worked out a system for, that’s not necessarily all that related to ‘diabetes maths’ but seems to work.

And I’ve had perfectly gently undulating lines from nightmare foods, and huge mountains and valleys from ‘safe’ thing that I’ve eaten dozens of times without problems.

So for me I think it’s learning which foods are exceptions to the rules, which are worth the effort of experimentation, and which make life easier by just sticking to boring predictable and tried and trusted options.

 

[Tom1982]

There can be a degree of that - to an extent.

I’ve certainly decided against eating something, because the enjoyment I get from it isn’t worth the hassle of chasing BGs for hours after (and failing to work out a system that works for it).

But on the other hand, there are other things that have a reputation for being tricky, that I’ve just worked out a system for, that’s not necessarily all that related to ‘diabetes maths’ but seems to work.

And I’ve had perfectly gently undulating lines from nightmare foods, and huge mountains and valleys from ‘safe’ thing that I’ve eaten dozens of times without problems.

So for me I think it’s learning which foods are exceptions to the rules, which are worth the effort of experimentation, and which make life easier by just sticking to boring predictable and tried and trusted options.

Very interesting. Even experienced campaigners like yourself still get the odd grim looking graph! Definitely a lot easier with the dash/G7 though.

 

[everydayupsanddowns]

Very interesting. Even experienced campaigners like yourself still get the odd grim looking graph!

Very much so! DIY chaos from today. Trying to carb load, but mistiming it around weilding the sledgehammer

 

[helli]

When Jo was diagnosed they repeatedly told us “just eat whatever she wants” in reality that’s not really possible is it? I have seen various libre and dexcom charts on here that are lovely and straight. I think it must come down to discipline with what you eat!

I don’t subscribe to the “lovely and straight” graphs strategy. People without diabetes do not have lovely straight graphs and people with Type 1 for 50, 60 or even 70 years didn’t have graphs to look at for most of their lives.
I target 70% in the range 4 to 10 with as little restriction in my diet as I feel comfortable with. There are some foods my partner asks for but I never enjoyed a huge bowl of pasta with pesto or nothing but bread and olive oil for lunch. I still enjoy pasta and bread (and olive oil) but it does not dominate my meals. Maybe I am lucky that I love vegetables so happily sit down to a bowl of stir fried vegetables without the need for noodles or rice, But equally enjoy the occasional homemade, thin crust pizza.
So, I do eat what I want and, like most people, regardless of diabetes, I enjoy it in moderation which maybe a little harder to explain to a child.

In short, please don’t obsess about the “lovely straight graphs” as they are not necessary for a balanced life and not natural.

 

[Tom1982]

Very much so! DIY chaos from today. Trying to carb load, but mistiming it around weilding the sledgehammer

View attachment 30070

Well that’s cheered me up I thought everyone else was straight as an arrow!

 

[everydayupsanddowns]

I don’t subscribe to the “lovely and straight” graphs strategy.

Nor me. I try to keep my wobbles within reason, but I don’t significantly restrict my food choices to achieve that.

 

[Inka]

Well that’s cheered me up I thought everyone else was straight as an arrow!

No! Mine isn’t. It would be if I didn’t eat or exercise, but obviously the former isn’t an option and I enjoy the latter There’s some very competitive CGM graph posting out there - take it all with a pinch of salt.

 

[Tom1982]

I don’t subscribe to the “lovely and straight” graphs strategy. People without diabetes do not have lovely straight graphs and people with Type 1 for 50, 60 or even 70 years didn’t have graphs to look at for most of their lives.
I target 70% in the range 4 to 10 with as little restriction in my diet as I feel comfortable with. There are some foods my partner asks for but I never enjoyed a huge bowl of pasta with pesto or nothing but bread and olive oil for lunch. I still enjoy pasta and bread (and olive oil) but it does not dominate my meals. Maybe I am lucky that I love vegetables so happily sit down to a bowl of stir fried vegetables without the need for noodles or rice, But equally enjoy the occasional homemade, thin crust pizza.
So, I do eat what I want and, like most people, regardless of diabetes, I enjoy it in moderation which maybe a little harder to explain to a child.

In short, please don’t obsess about the “lovely straight graphs” as they are not necessary for a balanced life and not natural.

That’s a weight off my shoulders actually. Didn’t even realise that was getting to me. Trying to get the right balance between “no, sorry mate, can’t have that” and letting her have the stuff all kids want, isn’t easy.