Sudden Change in Bolus Rates?

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Tony R

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My son appears to have had a sudden change in his bolus rates and wonder whether other people have experienced this.

It's mainly noticeable after breakfast. His rates seem to jump 2 hours after breakfast to around 14BG. I gave him the bolus with the pen yesterday as opposed to with the pump but the same thing happened. I'm checking his basal rates by asking him to skip breakfast and test every two hours but when he had a couple of lie-ins, his levels were fine.
 
Hi Tony, we have always encountered problems with spiking after breakfast. What has helped hugely is giving the bolus 10-20 mins before eating so the insulin works at the same rate as the food is absorbed - cereal is pretty quick. I wonder if this may be worth a try?
If the rise was sustained until his lunch then perhaps the bolus ratio does need changing .🙂
 
Hi Tony

What does he eat for breakfast? I have found some breakfast cereals (porridge in particular, but sometimes others too) to be a bit of a pain for causing post meal spikes. But with toast for breakfast we don't seem to have any problems.

If it seems to be the breakfast causing the spikes could you try doing a multiwave bolus? I.e. some of the insulin straight away and the rest spread over a couple of hours. You might have to experiment a bit to find out what works best, I.e. how much up front and how long to make the rest of it last.
 
If it seems to be the breakfast causing the spikes could you try doing a multiwave bolus? I.e. some of the insulin straight away and the rest spread over a couple of hours. You might have to experiment a bit to find out what works best, I.e. how much up front and how long to make the rest of it last.
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Hmmm wouldn't this have the opposite effect, make it spike even more by extending some of what's needed? If his levels are back within normal range by lunchtime, and it is just a spike issue (rather than the bolus ratio being wrong), you can try that 'borrowing from the basal' thing (forget what it's called) where you add X units to the meal bolus and then balance it out by taking those X units off the basal over the next couple (or so) hours? That way you get more insulin working quickly upfront but total insulin ends up the same eventually.

The multiwave bolus is for foods which take ages to be absorbed/digested, isn't it?

Brekkie cereals are pretty spike-inducing and porridge seems to have very different absorption rates with different people. I now eat fruit for breakfast but with yog & ground nuts/seeds added, which slows down absorption for me. You could try adding something fatty or proteiny to the cereal to see if that reduces the spiking? As well as (suggested above) waiting 20 mins or so between bolus & eating.

Are you saying it's happening after other meals too, to a lesser extent? Either bolus ratios need re-tweaking (if his BGs stay too high) or it's a spike prob (if BGs come back down several hours' later). Seems odd to get spiking if he hasn't had that before and hasn't changed what he eats?
 
ingrid said:
The multiwave bolus is for foods which take ages to be absorbed/digested, isn't it?
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Exactly - foods which digest quickly will hit your blood stream within minutes, I thought that if you get a spike 2 hours after eating it's because it's taken the food that long to digest and the insulin which went in up front will be past it's peak by then. Therefore spread it out so that there is still some active insulin around to stop the rise.
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We find that foods which are slower to digest dip first (at 2 hrs) then rise later - say 4 hrs on. I personally wouldn't use multi/dual for cereal, it's high GI. We started off with a multi/dual but over time found things much better with normal bolus and a little gap prior to eating.
 
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Hanmillmum said:
Hi Tony, we have always encountered problems with spiking after breakfast. What has helped hugely is giving the bolus 10-20 mins before eating so the insulin works at the same rate as the food is absorbed - cereal is pretty quick. I wonder if this may be worth a try?
If the rise was sustained until his lunch then perhaps the bolus ratio does need changing .🙂
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I 2nd this advice
 
Hanmillmum said:
We find that foods which are slower to digest dip first (at 2 hrs) then rise later - say 4 hrs on. I personally wouldn't use multi/dual for cereal, it's high GI. We started off with a multi/dual but over time found things much better with normal bolus and a little gap prior to eating.
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That's interesting, thank you! That's one trick I haven't tried yet so shall have to experiment. Although on my list it says that porridge oats are low GI... And I still haven't found a system that works every time for that so will try anything!
 
This has prompted me to dig out the stuff that a dietician gave me once about low and high GI and multiwave boluses. They say most cereals are high GI, but Weetabix, mini wheats and instant porridge are medium and porridge oats, bran, Special K and Frosties (?!) are low GI. They then tell me that for a low GI, low fat meal I should do 30/70 or 50/50 over 1-3 hours. Which is where I got that idea from. As i've had such mixed success with it though maybe it isn't right for porridge. It also suggests that you should do some sort of multiwave for every meal and only use a standard bolus for a high GI snack! Breakfast cereals - try 70/30 over 1-2 hours. I quickly gave up on that, found it far too much faff!

I went on pump training last summer with the Roche rep and she was also implying that you should use multiwave boluses nearly all the time! Can't say I agree with that, I find standard boluses work perfectly well most of the time and would only entertain the idea of using a multiwave if I'm having obvious problems with a certain food. Maybe it's one of those things that's different for everyone and you just have to experiment!
 
I know a lot of cereals are classed as complex carbs and "keep you filled up 'til lunch" but that's just not what we've found. Worst culprits are Weetabix and shreddies and more refined oats like ready brek - just hit the system like a speed train and we were seeing BG's in the high teens.
It would be worth experimenting with for sure though everyone probably is a little different to degrees. My daughter has cornflakes, rice krispies, porridge oats and various other gluten free cereals including choccie ones once in a while and we no longer have the spike issue on a normal bolus with a wait before eat approach. 🙂

Just to add we tend to use multi/dual for tea/dinners as well and it works well, some things just need a little time like an hour, others can be 4hrs.
 
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Bolus and basal rates

Since the post I've checked his basal rates, without breakfast he shot up to 10BG as opposed to 14BG

I ended up increasing his basal rates so he got an extra unit over the problem period as well as his bolus rates so he got an extra unit of that for a typical breakfast. Seem to have worked pretty well so far.

Does seem a big jump though.
 
Glad you found the reason behind it Tony, hopefully things will be more settled. Good idea to check basal before other changes 🙂
 
Tony

You said
I'm checking his basal rates by asking him to skip breakfast and test every two hours but when he had a couple of lie-ins, his levels were fine.
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in your first post and now you said that his BGs go up when he gets up without any brekkie. Sounds like he has "foot hits the floor" syndrome i.e. as soon as he gets up his BGs start going up but if he stays asleep they don't. I have FHTF which is a pain cos if you can't predict the times you get up you can't programme a suitable basal. Some peeps get round it by having 2 distinct basal profiles, one for week days and one for weekends with basal increases dependant on getting up times.
 
Incidentally, the thing that Ingrid mentioned (I think it was Ingrid anyway) where you sort of borrow some of the basal and add it to the bolus, is generally called a 'Super-bolus'.
 
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