Looking for feedback from folks that have used the dual wave bolus. I always use the bolus wizard but seems this could be a useful option for foods like pizza. If you’ve used it and can share some tips that would great. Thanks!
best for mixed carb meals like pizza/pasta and almost anything ordered at a restaurant
@TIMG, I start out for something I want to eat, like ice cream, then bolus to try to find out things such as how long does this carb hang out? when does it peak? then you can kind of figure the dual wave.
for me (your mileage will vary) pizza almost no insulin up front, 40 grams carb per slice (this depends strongly on the pizza, when you try this try to always use the same pizza), given over a 5-6 hour period. IE 3 slices, 120g, 1 unit up front then 12 units over 4.5 to 5 hours. I have to test about every hour because I will crash very hard if the insulin gets ahead of the sugar. I find when I make my own pizza these values are a little rammy, so I have to count less carbs per slice. Doing this kind of thing at night is dangerous - I always test new stuff at lunch time.
your bolus wizard will be of zero help, because the IOB calculation in your pump will be meaningless while you try to figure out your own reaction to different fatty/sweet foods. if you are not comfortable with making changes to your pump please only do this under CDE or doctor supervision.
it’s all very much a science experiment, get the book “Pumping Insulin” for protocols and how and when to check/test. cheers and good luck!
ps and this is for “old timers” pig based NPH had the exact peak you needed for pizza, all I needed to do was bolus for the whole amount and it was fine, and HUmulin R is great for restaurant food, because it’s slower and hangs out longer than analog lispro. haha 2 steps forward and 1 step back.
Thanks for the great info Joe. As with many things managing diabetes, a bit of trial and error. Didn’t try the dual wave last night when I ate pizza (which is what prompted my post) but did delay my initial bolus by at least 30 min after eating (versus 15 min before for most foods) then gave more bolus 2 hours later. I didn’t check throughout the night but was pretty happy to wake up with a 117 this morning. So in this case it worked out ok I’ll give the dual wave a try next time with your tips.
I agree and confirm [from my experience] with just about everything @Joe said. One possible expansion, depending on what else you may have before or with the pizza you may want to cover with the “immediate” portion of the dual.
today we are having homemade pizza with which I will consume at least one brew and I will use the dual with a 10% / 90% spread - the 90% over 4 hours.
This dual feature is certainly a good feature for the pizza/pasta meals and very valuable for restaurant meals that usually have more fats than our home-cooking - my wife is a great cook and very conscious of what she puts on the table.
FATS: there are some studies under way concerning the need for additional insulin for fats consumed by people with T1D. One study involves a bolus several hours AFTER a person with T1D consumes a “heave” amount of fat - such as deep-fried potatoes. One caution I have applied to myself, if I indulge on fries with my burger in the evening the bolus would be given shortly before bed - this scares me.
I use dual wave boluses whenever I eat foods that have a higher concentration of fat content, such as pizza, chips (French fries), icecream, etc.
I do this because fats slow down the absorption of glucose, which we get from the breakdown of carbohydrates during the digestive process.
When I bolus I tend to estimate the total amount of carbs that I’ve imbibed and give two thirds of the bolus as the first part of the dual wave, and the second third of the bolus over a period of 1.5 hours.
The option of dual wave bolusing was incorporated into various pumps as this simulates what happens in a ‘normal’ functioning pancreas.
Just joined this site, thus my late response. I always dual-wave bolus when eating high carb food (Pizza, Bagels, etc.). For me, one piece of Pizza is about 40U w/ Humalog. Upfront bolus of 58. This is different for everyone, but the dual-wave definitely is helpful when eating something high carb
58 for one piece of pizza??? I use less than that for a whole day. But the extended dual wave is the right approach. If I eat pizza for dinner, I have to eat early to avoid hypoglycemia in the middle of the night, because my amount of exercise that day is a huge factor in the digestion of fat.
Works great for stuff like that, or if you are high and won’t eat for an hour or two. If you refer to Medtronic pumps, it has a suggested amount for the immediate bolus based on your glucose level, and the rest as as the slow bolus. I find the first number to be different than if I enter no carbs for a meal and just the glucose level. So I have begun to take two boluses, the first based on current glucose level, and the second based on the carbs. That second bolus can be a dual bolus for the long acting carb foods.