Tuesday, July 19, 2011

Combo Bolus Squared

Nablopomo ~ Day 19

When I first decided to go with two different pumps for the girls, I thought I might be taking on too much. Maybe I had lost my mind?  Well, I am pretty sure I lost it a couple years ago when Lovebug was diagnosed but I was thinking pretty clearly when I choose to go a different route for Princess then I had for Lovebug.

So, when it came time to choose a pump for Princess, I was immediately drawn to the Medtronic Revel with the integrated CGM.  I knew the CGM would befit her and if I could avoid her having to carry two devices around her waist like her sister, then I was going to go for it.  Of course I had some reservations about Medtronic's Guardian. The size and the insertion are a lot different then the DexCom and I was a little uncomforable at first.  I decided to call our endo and see if there was a trial like with the DexCom.  Thankfully there was and after a few days, I was hooked.  I knew we were going the right route with Princess and her pump.

Needless to say, there are A LOT of things that I LOVE about the Medtronic Revel.  One of my favorite is what they call the Square Wave Bolus.  At first I was a little "scared" to use it, but I was like that with the Combo Bolus on the Lovebug's Ping.  Are you wondering what the heck a Square Wave Bolus is? Well here you go:

Square Wave Bolus: delivers a bolus evenly over a period of time (30 minutes up to 8 hours). This bolus can be used for insulin delivery when you have eaten a long meal with extended snacking (commonly called grazing!) It can also be useful for delayed food digestion or (my favorite) meals high in fat (hello Pizza!) A Square Wave bolus can be useful if a normal bolus drops your blood sugar too rapidly.  

Can I hear a WOO HOO! I LOVE this bolus!  It works GREAT with ice cream, pasta and pizza. (for Princess anyway)  All the foods with fat or slow adsorbing carbs.  It has worked SO well for Princess that I found myself wishing that Lovebug's pump had that feature.

Cue the "aha moment"!  One day I was thinking about the Combo Bolus and how it works on the Ping. Remembering that you can give a certain percentage of insulin upfront and a certain percentage of the bolus of a period of time. Then it hit me...I bet I could do a Square Wave bolus using the Combo Bolus on the Ping.  How, you ask?  Well let me explain.

Remember that a Square Wave gives you your entire bolus over a set amount of time. It drags it out, so to speak.  Well, I figured with the Combo Bolus if I gave 0% up front and 100% over a certain period of time, wouldn't that be the same as a Square Wave Bolus on the Medtronic?  A couple weeks ago I got brave and tried it when we had pizza for dinner.  And you know what? IT WORKED!!!  Lovebug didn't have a delayed spike from the pizza!!  She stayed nice and steady!  I was super excited!! (yes, I have used it numerous times since then and It's still working!)

Another common problem we have with Lovebug is that she will be low before a meal, we will wait to bolus her until after she is done eating (yes, we typically bolus before meals, for both of the girls) and then a couple hours later we check her (or Dexie is beeping at us) and her blood sugar is HIGH.  Then we do the big, "oops" I forgot, yet again!  Ugh, I hate it when I forget and she suffers for it!!

So another conclusion I came to was, why not use a Squared Combo Bolus (as I call it) for Lovebug when she is low before a meal? (I am talking  between 60 and 80 here) I can still bolus her (because she isn't getting any insulin up front) and then by the time her blood sugar is back up and her food is starting to kick in, the insulin is starting to trickle into her system. Hence no low blood sugar and no rebound spikes from the low either. And guess what?  I tried it and IT WORKED!!  It works wonderfully!

Needless to say, I am VERY happy!  These two little "discoveries" were a God send to me. It has made managing Lovebug's crazy numbers a little easier.  Anything to make this disease a little easier to handle makes for one (a little) happier mama!!


Valerie said...

It's awesome that you are figuring all that out AND that it's working!

Tracy1918 said...

All I can say is that you are amazing. Two different pumps?

You are THE woman!

Denise aka 'Mom of Bean' said...

WooHoo! Love discoveries like that!
We started using the 'extend' function on Bean's pod (similar to the combo bolus) when she needed to test and dose for her after school snack before the hubbub of pick up started and no one was able to supervise her. Worked like a champ to do the 0% and then extend the rest.
Would have been really tricky for her to do after school activities without that feature!

Lora said...

Justin has to have some up front for pizza or he will go high. We were doing okay with the combo bolus, but not as well as I wanted. I think it was Lorraine the mentioned the temp basal... so I pulled up my big girl panties and gave it a shot one night.

It has been good so far. Especially for pizza. We are still working out the "details" with pasta.

Amy said...

Holy crapolina! I actually f-o-l-l-o-w-e-d what you said! In the past when I would read posts like this all I would hear was the Charlie Brown teacher "Wuh Wwa wuh wa whaw". Either you are REALLY good at explaining things or I am actually getting used to this stuff! Hopefully both ;)

Alexis Nicole said...

That's awesome! I may try that for movie theatre days. I hate the combo is some here and some there not even. This is a great idea!

Misty said...

We do love both the Square Wave and Dual Wave (combo) bolus on our MM Revel too! I think you are so brave for taking on two different pumps...but in the future you will really be able to speak about the two and compare them. When people are asking for pump advice, its hard because I love the Revel, but that's also all that I know.

Dana said...

Thank you so much for sharing what you've learned!!! We usually have the same problems with Caleb and we've used combo boluses for pizza and fries but it's hit or miss. It never occurred to me to use the square bolus (or on the Ping 0/100) when he starts a meal low and of course we always get the delayed high. It's so aggravating. I'll definitely be trying this new method. Thanks again :)


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