# reduce or increase extended bolus time?



## lesley1978 (Sep 13, 2010)

hi all,

Not been on for ages but have to save having been on my pump for nearly a year now I have got a bit complacent! 

I have weetabix, milk and banana for brekkie (about 70g carbs) on a normal day when sugars are ok I have 1.2 units per 10g over 1 hour.  when I test 2 hours later my sugar has risen slightly but then drops rapidly over the next couple of hours.  Am I right in thinking that if I drop the time to 30 mins this might help???

I always get confused of how the amount of time will affect my sugar if I am using the correct dose for what I am eating!

Any help??


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## Andy HB (Sep 13, 2010)

Welcome back Lesley! Long time no see. Well, long time never seen before, in my case because I joined in 2010! 

Anyway, I hope the happy pumpers can give you some answers soon.

Andy


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## Steff (Sep 13, 2010)

Lesley Lesley nice to see your smiling face back on the forum hun been ages xx
Hope some of the pumpers come along soon and hel you out x


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## Northerner (Sep 14, 2010)

Hi Lesley, nice to see you again! Don't stay away so long!  I'm afraid I can't answer your question as I haven't reached that part of my advanced theoretical multi-dimensional quantum mathematics course yet. 

Where are all our qualified pumpers to answer Lesley's question?


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## Twitchy (Sep 15, 2010)

Hi Lesley - I'm sorry no one else has replied - I'd love to help but haven't got my hand set or been allowed to tinker with my pump menus yet - I'm still on a 'basic' setting til the next training session, so I haven't a clue about extended boluses etc!!

Could you maybe call the manufacturers helpline & get some ideas from them?

Hope you get some help soon! 

Take care,

Twitchy xx


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## rossoneri (Sep 15, 2010)

Hello Lesley

I am unsure why your question has dropped under the radar of the pumpers.  Anyway here is my attempt to answer your query, albeit I should start by stating the caveat that I am slightly underqualified to respond!  Although I use a pump I do not tend to use the extended bolus facility very often for myself, the control I get from a standard bolus is generally sufficient for my purposes.  But I have an idea of the theory so here goes.

As you probably know the purpose of delivering the insulin over a period of time, called an extended bolus, is so that you have less insulin delivered at the beginning but then insulin continues to be delivered for the time period you select.  The effect of this is that you do not have all the insulin active at the beginning and at least some of the dose is active for longer.

What you describe for your weetabix and banana breakfast - with the BG rising slightly after two hours but then dropping significantly in the next two hours - suggests that your initial dose is maybe a little too low and the dose is active for too long and maybe the overall size of the dose is too high, hence the end result is that your BG drops too much.

I think the reason for the drop is that your breakfast is unlikely to raise your BG for a period beyond two hours (technical term it has a medium glycaemic index - the banana is slightly low, the weetabix slightly high so together they are probably medium) so delivering your insulin over one hour probably extends its effectiveness beyond the time that your breakfast carbs are in your system, hence with no carbs to consume the insulin causes you BG to drop.

Basically if you reduce the delivery time then your initial dose rises and the time the insulin is active is reduced.

So in answer to your specific question yes reducing the bolus time to 30 minutes should help.  In fact I would seriously consider delivering your full dose in one go for this breakfast.  If you find that your BG still drops, as I suspect you will, then I would also consider changing your ratio so that you have less insulin for you breakfast, try say 1.0 units per 10g.

Blimey, this turned into a bit of long explanation, hope it makes sense and I have not confused you even more!  These things are not easy to explain!  

It would probably help if one of the other pumpers who use the extended bolus could also provide you with the guidelines they use for delivering the insulin over a period of time e.g. what type of foods they use this facility for and how they decide on the time period etc.  As I said I do not consider myself an expert on this subject so it would be good if someone else could also give this a sanity check.


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## bigpurpleduck (Sep 15, 2010)

I'm a pumper but have never used the extended bolus facility. Been on it for over a year and still don't think I'm used to all the other ins and outs without adding duration to the mix yet! So basically, I can't really advise.

Just wanted to let you know that I used to have the same thing for breakfast - weetabix, banana and milk. It caused a pretty big spike for me and despite several attempts at fiddling around with bolus ratios and even my basal, nothing was working. So I eventually gave up. The GI was just too high for me first thing in the morning.

I would recommend Special K if you're up for trying something different. It's low GI and since the banana is also fairly low you could have that with it too.

Good luck!


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## Patricia (Sep 17, 2010)

Hi Lesley!

We use ext bolus or dual waves all the time for pasta, rice, pizza, chips, lentils, potatoes dauphinoise etc... And we have often had exactly the same thing as you describe, particularly w the big drop once the bolus is done. 

It's incredibly confusing, but my instinct would be to change the balance of how much is delivered when. The big drop can indicate too much at the end OR missing the peak. But if you are a little too high (how high? You can't stay rock solid even w food digesting.), it may be worth giving a little more up front to catch the peak, so less later to avoid the drop (eg move it from say 50/50 to 60/40 or whatever) 

Failing that working, then yes I would try to shorten the time, but remember that this will intensify the latter bit of the bolus (eg have same insulin over less time), so if the problem is missing the peak it may make things worse....). 

Hope this is a start? In some haste....


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## tracey w (Sep 18, 2010)

Hi Lesley, nice to see you posting!

Are you giving extended or multi wave for weetabix? I dont tend to eat weetabix unless hypo during the night as I otherwise get a big spike. It is very high gi food! 

Because its high i would tend to go for a normal bolus, only using extended and multiwaves for longer duration foods, ie low gi. such as fatty foods, pasta, rice etc. If I have special K in the mornings i tend to give full bolus or if i have the time before getting ready i will multiwave it for 15 mins as can take longer to digest.


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