# Multiwave bolus



## heasandford (Jan 11, 2015)

I always use my meter to 'tell' the pump to deliver insulin. I have been using the Multiwave setting on my Roche pump without thinking that I could alter the settings, because I have had some really good results - for example Christmas day, when I had no spikes at all!

However yesterday I went out for a meal that I didn't think was particularly large or carby, so I gave a very similar amount of Multiwave dose. But - 5 hours after I had eaten it was still a bit high, then I got another spike which took ages to come down following the correction. So what should I alter the Multiwave settings to?

I am trying to find out what the 'standard' settings are for the Multiwave (although I suppose my pump could have been pre-set for me?) - it looks like 70% of dose up-front, then an extended delivery of the rest within 2 hours. 

It looks like I can alter these levels on the pump, but can I alter them on the meter as well? 

So, maybe  20% more insulin, still 70% up front but extending the rest for up to 3 (or even 4?) hours? Thanks anyone for all answers!


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## HOBIE (Jan 11, 2015)

I use this function all the time on my Medtronic. It depends what I have been doing & what I am eating to what % I give myself. Good luck but I love that feature


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## heasandford (Jan 11, 2015)

Do you have a range of % or time - promise I won't blame you if it goes wrong!!


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## HOBIE (Jan 11, 2015)

% & time.  Normally 30mins in-between & depends what the food is. If it was pizza definitely more % later on. I am not a pizza fan though but they make me spike & full of carbs. I eat a lot of Noodle meals & works for me 40-60 % & 30mins between. That's a fare bit veg & 35grms carbs. I would not like to not have that system.


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## Sally71 (Jan 11, 2015)

I don't think there are any "standard" settings for multiwave on the Roche pump, it just remembers what you did the last time.  E.g. We most commonly do 50% up front and then spread the rest out over an hour.  But if I change it for any reason then I have to remember to change it back again next time!

Actually I've never tried to do any sort of bolus on the pump itself, I ony ever use the handset.  Enter your carbs, select multiwave, check the parameters and change if necessary, then when you press Deliver it sends a message to the pump itself to tell it what to do.


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## trophywench (Jan 11, 2015)

After the meter works out the dose, it says 'Standard' just under the amount (can't recall which LOL)  So go onto that word with the down button, press the middle button and it opens up a list of bolus types.  Choose the one you want with the down button, confirm it with the middle one.

It then opens up a screen which tells you what it's put in as standard - it will base the split on whatever  you did last time, so if you did 50% upfront with the rest over 4 hours - that's what it will show.  Well the timing definitely is the same as the last one, but I think the upfront may be a pre-set percentage.

If I need a correction with the actual bolus, I usually find I want to increase the upfront amount to more than what it says - but that of course is individual.  The timing, varies depending what I'm about to eat - is it greasier than chilli and rice? cos I do that over 2 hours and it seems to work well - if I ate more rice I think it would need to be longer than 2 hours for me.

Play about with it for individual meals and WRITE IT DOWN and keep where you write it handy!  You'll soon get into the swing.


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## heasandford (Jan 12, 2015)

Thank you all so much - dared to play with the meter last night, and although it didn't work(!) at least I know what to do now!

Its the spike after 4+ hours that's the shock, but at least I have the tools to try to get it right next time.

Thanks again!


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## HOBIE (Feb 1, 2015)

Good luck   I like this feature alot


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## HOBIE (Feb 15, 2015)

heasandford said:


> Thank you all so much - dared to play with the meter last night, and although it didn't work(!) at least I know what to do now!
> 
> Its the spike after 4+ hours that's the shock, but at least I have the tools to try to get it right next time.
> 
> Thanks again!



How is it going now hesandford ?


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## heasandford (Feb 15, 2015)

Thanks for the follow up!

I can now actually use the meter/pump facility properly! Mixed success with the results though. 
For instance, last night I went to a quiz-night, with fish & chips provided. Not something I often eat, but... at 8pm I set the meter to give 7 units up front, then the remaining 2.8 over the next 2 and a half hours. I then watched my Libre climb very slowly (with a few downs as well) until 11pm, slight adjustment to reduce BG down from 8. But I then spent the rest of the night making adjustments to get it down from a horrendous sharp rise to 14, down to 11 by 3.30! Even put TBR to 200% from 12 to 3am! Woke at 8.15 to 4.1!

Back to the drawing board! Any suggestions?


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## HOBIE (Feb 15, 2015)

I am never the same ! So many variables. Exact carbs on Fish & Chips ? Was drinking involved ?  It sounds like you have done things good. Nothings perfect but I do love this & it makes a lot of sense to me. Good luck with trials


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## everydayupsanddowns (Feb 16, 2015)

I absolutely agree with what TW says about writing it all down and keeping that scrap of paper/phone note handy so you can check/tweak/adjust.

Here are just a few of the things that have worked for me over the past 3-4 years (not suggesting they would work for anyone else!):

_White Basmati:_ Square wave over 30mins or 1hr
_Brown Basmati:_ Dual Wave 60:40 over 1 hour

_Wholewheat pasta:_ SW over 30 mins worked initially then regularly failed
Eventually became dose as if +10g CHO and add extra 1.7u all up front

_Tagliatelle/Spaghetti:_ Too many variations to note here. Current strategy is dose +1u as 60:40 DW over 2.5hrs. Tagliatelle (for know known reason) needs an extra 2u added to the dose, even if CHO is identical

_Pizza: _Again has been many things, including 40:60 DW over 3-4 hours and 60:40 DW over 2 hours, but often needs a percentage added to the dose. Current strategy is 115% of dose all up front.

Most of these meals tend to have a pretty regular carb count. Something between 55-70g CHO.

Essentially, keep working at it, and don't worry if it doesn't make any sense (why does white spaghetti take so much longer to absorb that wholewheat pasta shapes!). Experiment (_cautiously!_) with adding/removing insulin* to the 'normal' carb counts for problematic foods to effectively give you a tweaked ratio for that meal and keep watching the results. Just because something worked last year doesn't mean that it will still behave in the same way now  

* I kept noticing that I needed similar levels of correction for meals we ate fairly often, so began to add some or all of that correction earlier to offset the spike and/or delay the insulin to avoid the dip.


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## heasandford (Feb 16, 2015)

What excellent support, you lot - thanks for asking me how I got on!

The fish and chips was high carbs, around 80, and I had a glass of wine, but mostly stuck to fizzy water as I was driving. 
I do seem to be getting a lot of these late spikes after 5 hours when eating out, the early spike having been prevented. So I've work to do I think -  perhaps slightly less up front and more for longer, clearly there are still carbs around. How long can a Multiwave last for? Think I'd better get back to the manual!


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## trophywench (Feb 16, 2015)

I still have trouble with the uber late spikes if I eat more than 70g total, and the easiest way of dealing with it frankly for moi is to limit the portion as well as doing a multiwave.  Esp since I got on the scales yesterday and they said 9st 6 ....... I had slightly noticed (and so had Pete) that I had started to look errr, more cuddly round the middle .......


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## heasandford (Feb 16, 2015)

Oh dear! Although I'd hardly say 9st 6 is heavy! By the sound of it you are like me, I was 8st 5lb for all my adult life, even after having my 2 girls. It was only diabetes much later that caused any weight increase, I now hover around 9 stone, crept up from 8st 12lb. But it's how youfeel with the added weight, isn't it, even if it's only a small amount.

I mostly only have the late spike problem when eating out, but I have to say that has got more frequent with retired husband around! I have just checked my manual and I see that you can extend the bolus delivery for up to 24 hours (why would anyone want to do that??) which I suppose means I could go up to 5 hours - have you ever tried that?


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## Sally71 (Feb 16, 2015)

DSN told us a neat trick for dealing with children's parties, which are basically just massive carb overload.  I find trying to carb count such things properly always results in disaster, I.e. BG of 20ish for 4-6 hours afterwards no matter how accurately I count the carbs or how many correction doses I give.  I think the theory is that the more carbs you eat in one go, the more insulin resistant you become or something, which makes your normal carb ratio not enough any more.

To get round this we now don't bother to carb count at parties any more, just put in a large number e.g, 150-200 g on a 50:50 multiwave over 3-4 hours.  This then gives the extra you need to cover the carb overload, and if you do misjudge it and start to go low you can stop the remainder of the bolus.  I've never yet had to do this though.  The last time we tried this trick was at the school Christmas party, all daughter ate was a big pile of cakes and biscuits (no savouries at all!), and BG approx. 3 hours later was 7.0 

Could you try something like that maybe, if you have such a meal again bolus for a little more than what you have calculated and spread it out a bit longer?  It's all trial and error, eventually you'll find something that works!


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## heasandford (Feb 16, 2015)

I have tried something similar - nice slow rise, then drop to low, have to stop Multiwave, then steep rise much later. Perhaps I gave too much up front as I have a tendency to spike early usually. Maybe with bigger or 'richer' meals I digest more slowly? I shall keep trying, thanks for your suggestion!


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## trophywench (Feb 16, 2015)

These are evening meals for me, so I'm in bed when I spike!  (or immediately before bed) in the case of the latter, OK I'll correct, but it's very hit and miss whether I get up next day with an acceptable BG or not.

I wouldn't really want to go to bed with a multiwave still running.


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## everydayupsanddowns (Feb 17, 2015)

I'm another that finds they need significantly altered ratio for larger meals. On MDI I developed a technique of 'adding a third' - essentially dosing for around 30% more carbs than I thought I was eating.

Like you say, when the rules change so dramatically it hardly makes it worth it counting to the last 5g of carbs, which I find rather eases the stress of the situation (since I don't expect it to work all that well, certainly not reliably anyhow!)

I don't often go to bed with a DW/multiwave still running, but after a takeaway curry I'm relatively (!) confident to go to bed around 6.x with 2u still IOB  because I saw when I had Libre sensors that my BG just rocketed in the early hours afterwards. I blame all those lovely lentils and ghee-filled sauces


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## trophywench (Feb 17, 2015)

Well a Libre could sort out a good many conundrums like these, for a good many people.  Let alone do your basal testing for you, I admit I'm a bit OTT when I do it and like to test every hour but often it just passes me by and I don't remember until +3 hours or something - at least you'd know where you were then and are now without having to move hardly - just grab the scanner and pass it over your arm without even looking that much.  Supposing here I'd keep the scanner immediately to hand, so I wouldn't have to move myself hardly - so even if I'm in the middle of eg washing up or haven't got my glasses on, I could do it.


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## everydayupsanddowns (Feb 17, 2015)

trophywench said:


> Supposing here I'd keep the scanner immediately to hand, so I wouldn't have to move myself hardly - so even if I'm in the middle of eg washing up or haven't got my glasses on, I could do it.



When I have had sensors I've found space for the reader in my pocket next to my phone. So easy to fish out and 'keep an eye on things', especiually if waiting for a correction to kick in or whatever. I have ended up scanning 30-40 times a day on average!


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## heasandford (Feb 19, 2015)

I went for a 'Nordic Walking' session, taken by a friend yesterday, and the Libre enable me to feel confident I was OK, despite setting off lower than I would usually like. Turned off all basal for an hour and a half then ate small amount of glucose tablets - it worked!

I do have to own up to the fact that I skim 3.8 more than I should in my increased ability to try to get it all right! I still don't seem to be able to dramatically reduce the range of results (Standard deviation)which means I still get well out-of-range highs and lows - I continue to work at it!


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## HOBIE (Feb 19, 2015)

The Libre is a brill tool that gives you confidence to climb mountains. Sounds good Hesand


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