Square Wave and Dual Wave Boluses

[Tony R]

My son went on the pump over 6 months ago and we've been trying out square wave and dual wave boluses. He's found a square wave bolus over 6 hours works really well for pasta and one over 4 hours works really well for chips.

Just wonder if people could share what other foods they find square wave and dual wave boluses work for and how long periods they're setting.

 

[Riri]

His Tony, I've had no joy with them so far. Can you tell me with the pasta square wave - did you do any up front on did you do the whole amount over he 6 hours?

 

[Redkite]

Hi Tony, different square/dual boluses seem to work in different ways in different people!

We use a dual wave for pasta, about 50% up front and the rest over 4 hours. But if it's wholemeal pasta, we give less up front as it digests more slowly. For basmati rice, we bolus all up front, but for wholemeal rice we need a dual wave (still experimenting with the duration of the square part, after all these years!). The problem can often be in what you are eating with it - sauces high in fat like carbonara, or curries for example, can cause a rise in BGs hours later. We then find that the pump doesn't want to allow a correction bolus because there is "active insulin" from the square part of the bolus. We find it better to use an increased temp basal over several hours (in addition to the meal bolus) to deal with meals like these.

Similarly for fish and chips from the chippy. For oven chips we just do a normal bolus. For chipshop chips we bolus all upfront for the carbs, but do a 140% temp basal for 2-3 hours to account for the fat metabolising into glucose.

We also use dual waves for treats like chocolate brownies etc! But these aren't a regular enough item for me to be sure we're getting it right.

 

[Hanmillmum]

My tried and tested for dd are up for review with the new no gluten diet (coeliac).

Previously always have used dual wave, for pasta - 2 hrs has been enough 60/40 but portions are smallish as she likes salad or fruit and or yoghurt after too.
Fish n chips or something of that ilk have been 50/50 3-4 hrs dependent on portion size.

Dual wave has been good for party/buffet style foods and I find I add bits on top if she has eaten more than first predicted. Usually do 50/50 over 2 hrs and add as needed.

 

[Pumper_Sue]

Hi Tony, if you look in the food section Bev did some food experiments so well worth having a look at that.

 

[Tony R]

His Tony, I've had no joy with them so far. Can you tell me with the pasta square wave - did you do any up front on did you do the whole amount over he 6 hours?

Yes I give a square wave just for the actual pasta and give a regular bolus for the sauce and anything else.

One thing I also do is count an extra 10g of carbs of pasta than there actually is. I'm not sure whether that's a good practice. When I tried the square wave over 4 hours, he nearly hypo'd at 4 hours and his readings started rising after 6 hours. While giving the square over 6 hours prevented the readings rising later, the readings were a little too high at 4 hours.

The nice thing is if you do crack it, you get nice steady readings over a long period of time.

One thing to be careful about is when you carb count for spaghetti, different makes have very different amount of carbs per 100g so check the packaging.

 

[Debi]

I have no idea - despite being on a pump for over a year - how to use this square wave / dual wave facility!!! #feelinginthedark!!!

 

[HOBIE]

I use Duel wave for nearly all my meals. Depends what,where i am working. If i have my breakfast then straight at work or if i have to wait/travel before different wave. (time & %). Love the flexability happy as a pig in 😱

 

[Redkite]

Debi, you need to get yourself a copy of "Pumping Insulin", as you're missing out on some great pump features!

The other really useful thing about dual/square waves is when you are recovering from a gastro illness. D&V type bugs damage the gut and cause delayed digestion/absorption for a couple of weeks after the illness itself. Nightmare for balancing meals/insulin, but much easier using square wave boluses. Having experienced vomiting bugs when he was on twice-daily mixes, MDI and a pump, the pump is a million times better at helping cope with this! 🙂

 

[Debi]

Are the authors John Walsh and Ruth Roberts of Pumping Insulin?

 

[Pumper_Sue]

Are the authors John Walsh and Ruth Roberts of Pumping Insulin?

Hi Debi, yes John Walsh and Ruth Roberts are the authors of pumping insulin.

 

[everydayupsanddowns]

I think the only thing to do with Square Wave and Dual Wave options is to identify the meals where you need to use them and then 'suck it and see'. Keep notes of what you try, and how well it worked.

Meals to watch out for are ones where your levels dip lower than premeal BG an hour or two after eating and then gradually rise and rise several hours later.

Don't necessarily expect it to be logical or play by the rules either.

As an example... for 60g CHO of wholemeal (allegedly slow release) pasta I need to bolus all up front, immediately before eating to prevent a 1-2hr 'spike'

For 70g CHO of white spaghetti (which *should* be faster) I use 40:60 dual wave over 2.5 hours.

So I'm delaying the majority of the insulin when you might reasonably expect the meal to absorb slower. Craziness!

I like to use short Square Wave boluses to 'ease in' a dose when I'm a bit near the low edge of range premeal. Something like 30 mins has worked very well to give the food a tiny bit of a head start.

As with all things what works for you will be very individual. I have a little 'note' on my phone pf various strategies that have worked well at different times that I can refer to. I also log my results in mySugr which allows me to search 'Pizza' (or whatever) and get a list of times I've eaten it, what split/TBR I tried and how well it worked.

Give it a go!