# Extended bolus



## stephknits (May 23, 2017)

Apologies if this has been covered lots before, but I wondered whether you lovely people could let me know what type of meals you would do an extended bolus for? 
Pizza is an obvious one, but what about my breakfast porridge?  
Also, what sort of percentage do you do up front? 
Many thanks ☺️


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## m1dnc (May 23, 2017)

I tend to use a dual wave for most meals, unless they have a very low fat content. I let the bolus wizard worry about the split: the Medtronic algorithm seems to suit me well enough. I vary the square wave time portion a little to account for food that I know gives me grief - like pasta (I might extend that for up to 1.5 hours).

Pizza is definitely square wave territory for me - again a long extension.

Can't help with porridge. Can't stand the stuff.

Everyone is different. It's trial and error I'm afraid.


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## SB2015 (May 23, 2017)

Hi Steph

Don't worry whether the question has been asked before, it helps all of us when new pumpers ask questions.

I use an multiwave bolus for breakfast and for porridge I make sure that the upfront bit includes any correction doses needed and 40% of the rest.  This has been found by trial and improvement but if it helps to have a starting point that is mine.  My release from porridge is even slower as I have yogurt with it so it has fat in it.  I do the extension for 60 min (but remember to have your shower before breakfast!!  I have delivered the extension to the bathroom floor on a number of times)

In general if there is fat in the meal I extend, if I also need a correction or there is also some quick acting carbs I use a multiwave.  Not sure what they call it on Omni but there will be both options.


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## everydayupsanddowns (May 23, 2017)

I found it helped to keep a little note of splits and timings on my Phone for the first year or two until I had a vague idea of the sorts of approaches that worked for me. I only ever use them for evening meals, because I find I need to significantly pre-bolus for breakfast and lunch.

Here are a few that I use regularly:

BG between 4-5 before any meal:
Ease the dose in gently with a 30 min square wave

Regular shaped pasta (whole or white):
All up front

Spaghetti, tagliatelle or noodles:
40:60 or 30:70 dual wave over 2-3 hours. Yes I know this makes no sense since it's the same stuff as the other pasta, but it's what works

Supermarket pizza:
All up front

Takeaway pizza:
60:40 dual wave over 1-2 hours (less reliable this as we so rarely have it, sometime have to cancel mid-way if dose is late)

Fish and chips, indian takeaway, chinese etc.
Dose to include approx extra 25%-30% over the carbs I *think* I am eating and DW 60:40 or 50:50 over 2 hours.

So as you can see, these will almost certainly not work for you. They make no sense to me, but repeated experiments have suggested that these are more or less the ones that work for me, most of the time.


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## stephknits (May 23, 2017)

Thanks all - who knew about different shaped pasta and different shaped waves! A whole new world.  

It is very helpful to have some we experiences from you experienced people, as you say everyone is different, but still very valuable to have ideas and knowledge (as I lack both at the mo!)


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## trophywench (May 23, 2017)

If I was 4.0 before eating - Novorapid even 'extended' would send me hypo before the carbs get there (ie hypo while I'm still eating) so I have to bolus AFTER I eat and no pump lets you deliver a bolus in eg 10 minutes time AFAIK.

Providing there's a safety margin upfront - if there's sufficient fast carb there and not masses of fat - I can do approx. 60% (plus any correction) upfront and the rest over an hour.  If it's very fatty - eg 99% of pizzas or chipshop fish and/or chips or macaroni cheese - well the spike happens separately 3 or 4 or 5 hours later anyway - and again no pump covers that.

As I'm not fond of high carb high fat meals they don't happen very often so I still wing it when I eat them - and deal with it later/next day as I've always had to.

Pumps are excellent - but a pancreas in full working order - they ain't !

Just have to try whatever you think and see for yourself, Steph.


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## Radders (May 23, 2017)

I rarely need them as my problem is usually the food hitting my system before the insulin, even with Apidra and a pre-bolus, but I do find I need an extended bolus for meals with a lot of protein and fat and not much carb especially in the evenings. Lidl protein rolls are a case in point. It doesn't always work, but I have had some success by bolusing as if it was 20g carbs (it's actually about 9) with half up front and the rest over four hours.


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## trophywench (May 24, 2017)

Pete decided he wanted mac cheese last night - oh joy LOL.

Started eating at 19.30 with a pre-meal 7.0, 21.30 I was 2.3, 21.50 5.4 and pre-bed - 19.1.  That was always going to happen unfortunately after the amount of Lucozade I need to correct a low 2 - unless I have more than I need when I'm that low - I stay low for far too long and feel ghastly all night - so I now over correct deliberately to shorten the duration.  The bolus had finished delivering - but it would be almost midnight before the insulin tailed off eventually.  Probably had c 50g dry weight of pasta plus a piece of toast which according to packet info means the total bolus was correct.  As I mentioned - I need a gap between the upfront and the balance.  TBH - because we have it infrequently - I can't be bothered to experiment to get it right, so there's no-one to blame but me.

However - it's stuff like this that nobody knows or can predict for anyone else, before they try it on themselves ! - and deal with the consequences after, LOL


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## Ref (May 29, 2017)

I dual wave everything except high GI stuff.  I vary the % up front according to the GI and whether I'm about to drive.  I can't agree enough with @everydayupsanddowns to keep a record of what you eat and bolus.


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## HOBIE (May 29, 2017)

I like this feature of the pump so much. I too always use


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## stephknits (May 29, 2017)

Glad to know it is commonly used.  My DSN says evidence suggests that those who use this have significantly better control, so well done all.  I'm afraid it will remain something of a black art to me for a while yet!


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## HOBIE (May 31, 2017)

stephknits said:


> Glad to know it is commonly used.  My DSN says evidence suggests that those who use this have significantly better control, so well done all.  I'm afraid it will remain something of a black art to me for a while yet!


Try it for just 15 mins then keep increasing, the more you use the better you will be. Even on MDI I always injected 30mins before I ate. Good luck Steph.


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## curlygirl (Jun 1, 2017)

trophywench said:


> If I was 4.0 before eating - Novorapid even 'extended' would send me hypo before the carbs get there (ie hypo while I'm still eating) so I have to bolus AFTER I eat and no pump lets you deliver a bolus in eg 10 minutes time AFAIK.



I might have misunderstood what you are saying @trophywench, but it sounds as though the Insight does this exact thing... on the multiwave setting anyway, not sure about extended as I use multiwave more as DSN said I should when I started on pump.

If my blood is lower than I can eat and not go hypo before the food gets going then I just put the lag time facility on that is on the screen with the amounts and timings on. This can be set in 15min blocks so 15 minutes or 30 minutes later I then hear the pump delivering the bolus, but I have already eaten by then.

If this is what you meant then I hope this is of help.
Curlygirl


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## trophywench (Jun 1, 2017)

curlygirl said:


> I might have misunderstood what you are saying @trophywench, but it sounds as though the Insight does this exact thing... on the multiwave setting anyway, not sure about extended as I use multiwave more as DSN said I should when I started on pump.
> 
> If my blood is lower than I can eat and not go hypo before the food gets going then I just put the lag time facility on that is on the screen with the amounts and timings on. This can be set in 15min blocks so 15 minutes or 30 minutes later I then hear the pump delivering the bolus, but I have already eaten by then.
> 
> ...



No it doesn't leave a gap - it asks immediate amount (so what you want upfront which if hypo would be Nil) then asks for the delayed amounts (the balance between total and the immediate bit) and delayed time.  However the delayed time is how long it delivers the balance over so however long you set it, it will drip in the balance over the next however long you said.  It's no sooner delivered the upfront, than it starts dripping in the rest.  If you look at the handset as it delivers the first part, then carry on looking at it, by the time it's got to the end screen with the horizontal line showing the dose going in, it will already be showing less left to carry on delivering, than the total delayed amount.

There is no gap between the two parts of the bolus - just that the second part is delivered much more slowly than the upfront bit..


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## curlygirl (Jun 1, 2017)

I thought the best thing might be to photograph my handset when I was doing my lunch bolus today. This way I can illustrate what I mean.

If my blood is low before bolusing and I want to set up the bolus before my food, but not have it delivered until after my food then I use the 'lag time facility'.
The photos show that nothing was delivered for 15 minutes (you can increase this in 15min sections).
After those 15 minutes have passed with no insulin delivered that is when the multiwave bolus begins, on this occasion with 1 unit straight away and then 1.95 throughout the next 30 minutes.
Like I said maybe extended is different, but this lag time works on standard and multiwave for sure and is very useful.

I have not uploaded a photo on here so hope this works ok...apologies for the reflections, they should still be ok to read.]


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## trophywench (Jun 2, 2017)

There is no 'Lag Time' on my meter ???? - I was saying this yesterday - I need that !  I have literally never seen that appear.  As I am self taught on the Insight, maybe there are some instructions in the manual - I'll have to try and find it.

Otherwise I'll ring either DSN or Roche and query!


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## curlygirl (Jun 2, 2017)

trophywench said:


> There is no 'Lag Time' on my meter ???? - I was saying this yesterday - I need that ! I have literally never seen that appear. As I am self taught on the Insight, maybe there are some instructions in the manual - I'll have to try and find it.
> 
> Otherwise I'll ring either DSN or Roche and query!



I have found out how to do it. I looked on the handset first as I thought it would be on there, but it is not. It is on the pump. You go to 'settings' then 'bolus settings' then 'therapy settings' and then down to 'lag time'. You can then chose to have it on or not.

Hope this helps @trophywench.


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## trophywench (Jun 2, 2017)

Meanwhile - not being able to find it on the handset or in the handset manual I rang Roche and spoke to Nathan on the helpline.  He didn't know either so asked a colleague who said exactly what you said, but which I didn't know.

I told him it was bloody daft !  Why the hell should it be in the pump settings when you'd normally do it on the handset?  I mean - a lot of the settings which they both have use of, you set on one and the other one picks it up anyway providing the devices are paired properly.  You know like when the clocks change - you change the pump and next time you turn the handset on - it picks it up.  That doesn't work the other way round though.  However the facility to do that is still there on the handset anyway - so when you do it the pump alarms and tells you the times are different and when you look at the handset screen, it's gone back to whatever the pump itself says - from which you gather first time you do it, you should have done the other one first.

Said to Nathan - I was always led to believe years ago that all computer stuff was sposed to work on Logic - hence most likely why I don't understand quite a lot of it - but some of the things on this, seem to defy Logic !

Thank you for your help because I absolutely will find it very useful from now on - 2 years later than I could have !  We get there, eventually, if we keep persevering - certainly is a marathon not a sprint, ain't it!!  LOL


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## trophywench (Jun 2, 2017)

curlygirl said:


> Hope this helps @trophywench.



That's exactly what the Roche Helpline have told me in the interim  LOL  (Mind you the chap I spoke to didn't know either and had to ask someone else - so it's helped Nathan @Roche too!)

I will defo find it very useful - just a pity it's taken me two years to find out it even exists!


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## SB2015 (Jun 2, 2017)

Now I am wondering whether this is also on the Combo.  Some finding out to do.


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## trophywench (Jun 2, 2017)

I don't recall it being a feature of it - the Insight does have more bells and whistles.


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