# Extended Bolus/ Combo Bolus



## Monica (Oct 15, 2011)

Tonight's dinner will be Gratin (pan haggerty?). I have calculated the carbs as 52g and the fat as 42g per portion

I thought I could try out the combo bolus for the first time, as Carol isn't going out for a change. When I got the instructions out it said not to do a combo bolus until you've discussed it with the DSN. So now I'm not sure whether I should do it. On top of it all, I don't really know the ratio for it. The book suggests 30/70.

Help please


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## Hanmillmum (Oct 15, 2011)

Hi, 

What book suggests this for you ? Could do with one of those ! Never had this meal for Millie but it sounds high fat which does delay things abit so your combo (which I assume is the same as our dual wave) would be ideal. Can't really advise on ratios as probably all a bit different and it is working out what is right for your daughter through a bit of trial and error, as well as what her pre meal BG is. Did the book suggest over what time to extend the bolus for ?


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## Monica (Oct 15, 2011)

Hanmillmum said:


> Hi,
> 
> What book suggests this for you ? Could do with one of those ! Never had this meal for Millie but it sounds high fat which does delay things abit so your combo (which I assume is the same as our dual wave) would be ideal. Can't really advise on ratios as probably all a bit different and it is working out what is right for your daughter through a bit of trial and error, as well as what her pre meal BG is. Did the book suggest over what time to extend the bolus for ?



It's the manual that came with the Animas pump. Yes it's like a dual wave. The book suggested over 4 hours. 

I didn't do the combo in the end. Carol was 22 .  And she decided she wants to go out now.


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## Hanmillmum (Oct 15, 2011)

Sorry wasn't much help. She would have needed quite a bit up front anyway with that reading. I am going to re-check our info/bumf we got with the Medtronic veo, what a good guide having something like that ! It's the pastas and pizzas we have utilised the dual wave for, and depending on the fat and protein would go up to 4 hrs with some things too


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## Ellie Jones (Oct 15, 2011)

Sorry I didn't see this early..

I hang my head in shame as I didn't asked/speak to my DSN about if I could start using my other two bolus's 

The bolus's does take a bit of experimentation to work out what the best split is, for what type of meal being eaten.. 

I generally find for me that my splits are the other way around, more up front...  But again it's very much depends what I'm eating and what my starting BG is..


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## shiv (Oct 16, 2011)

I definitely don't run anything by a DSN when I need to do things. I've found that the best way to learn is to experiment!

If I'm having something new before and think I need to split the dose, I usually begin at a baseline of 50/50 over 2 hours and then adjust next time as necessary. 

Hope she is down now - I hit 25 earlier


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## Phil65 (Oct 16, 2011)

shiv said:


> I definitely don't run anything by a DSN when I need to do things. I've found that the best way to learn is to experiment!
> 
> If I'm having something new before and think I need to split the dose, I usually begin at a baseline of 50/50 over 2 hours and then adjust next time as necessary.
> 
> Hope she is down now - I hit 25 earlier



Snap Shiv! I was 25 yday....unusual for me....cannula problem I think, back in range now.

I usually Multi bolus 75% up front and spread the rest over 2 hours, but does depend on fat content the higher the fat, the longer I need to bolus for, pasta is 2 hours for me.  Never asked the DSN.... only 'you' will know what is right for you through trial and error.


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## Monica (Oct 16, 2011)

Thank you all for your messages.

That's the big problem, experimenting. Carol always wants to go out after dinner/tea. I wouldn't want to experiment unless she's home. I guess as winter is approaching she'll go out less and I'll get the chance to do it.

Anyway, she was 12ish before she went out (2hrs after food), 9ish at 10pm (I told her to correct), again 9 at 2am, corrected again and she was 4.2 at 10am


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## Mel (Oct 16, 2011)

We have an Animas using the combo, definatley never run it past the DSN, jsut experiment We tend to find for us with eg pizza, or lentil based meal a 40 /60 split over 1-2 hours because she is on humalog which has a peak action at 3/4 hour.
Parties and resutrants usually 50/50 we find this works for grazing as she sets what she wants in carb  and eats until she has had it .
Hope this helps


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## Monica (Oct 17, 2011)

thanks Mel


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