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Wednesday, January 12, 2011

The Super Bolus

Ugh!!!!  Today I'm talking about the ugly little critter that often haunts people with Type 1 Diabetes.

No...not the lows.
Not the insurance hassles.
Or the pharmacy arguments.
Or the school dilemmas.
Or the extra hundred pounds of stuff to lug around.
Not the cost of supplies.

Nope.  Not those critters.

Today I'm talking about that dreaded post breakfast spike!!!!!

Awhile back, I read about this thing called the Super Bolus.  Lorraine discussed it in one of her posts.  I remember thinking there was no way I'd be brave enough to try it.

It goes a little something like this:  You give 2 hours of basal with the meal bolus (and correction, if necessary) 15-20 minutes before breakfast (Sugar is on Novolog.  Not sure of the pre-bous "rules" for Apidra) and then set a temp basal of zero for the 2 hours that follow.

TWO HOURS OF BASAL???? ... ummmm ... that's a full extra unit ... just sayin'!!!!!


I need to sit down.

I'm feeling a little lightheaded.

Okay.  So, anyway....

In early December, Laura posted about her Super Bolus trial....followed by another post from Lorraine....

And then my brain started thinking that during Christmas Break I just might be able to work up the nerve to try it myself.  So I did.  And here's how it went...

Before I continue, I need to say something.
Remember this is NOT medical advice.  I'm simply sharing our experiences.
OKAY...that's all.

I wanted to make sure we were starting after a nice, flat night.  

Here goes!
(But I have to admit that I skimmed a little off from the extra unit...
beginners nerves, I guess.)

1 HOUR...

2 HOURS...

3(ish) HOURS...

So...I didn't see a nice little "hump" with a return to baseline at the 2 hour mark...
but, remember, I also didn't give the full extra unit either.
Honestly, I considered the fact that she didn't spike over 200 to be a major victory.

Until lunch, anyway...

By the way, that Dexcom 7 Plus sensor was on her belly.
We get MUCH closer readings when the sensor is in her arm.
Here's an example...

With a new sensor in her arm, we then had a Super Bolus that looked like this....

And a full 24 hour period that looked like this...

In fact, we started doing the Super Bolus every day!
(Sorry, but I didn't snag pictures of each one)

With school starting back up, and because I'm all scientific (that's a joke!)
I decided I MUST do a control to prove to myself that all of this wasn't just a fluke.

So I decided NOT to administer the Super Bolus one day.
You know...just to see what would happen.

With that, I've incorporated the Super Bolus before breakfast every morning.
The good news is that now she rarely spikes over 200 after breakfast!

Here's the bad news...

Now she's spiking higher more often after lunch.
It's not always this dramatic, but it's still a heftier spike than before.
So bring it on, because I'm totally open for suggestions!

After posting that last pic on Facebook, 
the consensus was that it totally looks as if D is flipping us off.
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  1. Okay so I know nothing about Dex and all the graphs were making me think I was back in a math class I failed terriably... BUT I am all for learning new things and trying them. I think you are an awesome mom for trying the super bolus and so proud it worked out!! It does look like D is giving you the finger though... ouch!

  2. Ok, first off, BEAUTIFUL!!!
    I may just have to try the super bolus.

    Without much info or ability to get anything D related right, just my first thought....could the super bolused breakfast/lunch spike mean that she needs a higher I:C ratio and a lower basal overall?? So you would almost be super bolusing lunch too?

  3. OMG this is so timely. I've been pulling my hair out with post breakfast spikes in the 400's that last for hours this week! I have been upping basal rates 30% and drastically upped her I:C and can't get rid of it. I am going to try this in the morning. It will make me SO nervous to give that much extra insulin at once, but Ruby will catch it if we crash and burn. I love the much more helpful that any CDE I've met... :)

  4. Wow! I love the picture documentation. Way to tame the breakfast spike!! I've tried the super bolus a couple times, only to have The Bean sky high afterward. But without the cgm, I have no idea what happened in between. We need a cgm.

  5. Wow, this sounds awesome. Problem is that we are on a Medtronic pump with no CGM and I have absolutely no idea what you're talking about, haha! I tend to assume from the behaviour post-breakfast plus the few times I do test after one hour that Isabel regularly spikes after breakfast, then crashes, but I'm at a loss as to how to deal with it. Currently she gets a dual wave bolus. Would our equivalent of a super bolus be to give extra at breakfast as her normal dose (i.e. up her ratio) and then lower her basal for the rest of the morning until 10.30 snack time? What do you think?

  6. WOW! I'm loving how the super bolus is working for you! Ok - I'm a little jealous but you've inspired me to keep trying. For the record -- true story -- seriously --- if by chance Nate doesn't spike after breakfast --- we get the post lunch spike. WTH?

    D - flipping us off. I totally see it.

  7. WOW!! What a great graph with the super bolus...Ok Now you have my attention!
    Thanks for sharing!

  8. Yep..."D" is flipping us OFF! Love it.

    We have had some luck with the super bolus too. I am slightly jealous of your beautiful Dexcom graphs. Ours always looks like it has been through a hurricaine...Hurricaine "JOE" that is.

    Awesome post.

  9. Oh My Gosh!!!!! I am a bit behind reading blogs, so I missed Laura and Lorraine's post about the Super Bolus. BUT I'm VERY INTRIGUED!!!! I have been going nuts with the post breakfast spikes. I would like to try it on a non-school day so that I can watch her closely...that does make me nervous to give that much basal up front. Very interesting. Can't wait to try it!

  10. Yay for the Super Bolus and thanks for the shout outs.

    Hmmm. Spiking at lunch time. Hm. Hm. Hm. Could it be that the basal that was turned off lasts longer than we realize? Maybe try turning it off for only an hour and a half? Just making a stab. It seems like a wrinkle in the sheets you're trying to smooth out, no?

  11. Hehe . . . D flipping the bird . . . hehe. YEP!

    Nice job on the super blous, my lady. That is sosme serious advanced Pancreas 3,000 or something I am totally not ready for, but it made for a fun and interesting read! ;)

    Choosing Joy in 2011, Amy

  12. I didn't even know anything about a post breakfast spike. I think I really need to find some blogs of people with older kids because, well, quite frankly, the issues are different. I'd like to help him bring down his A1C but I am so darn proud of the way he takes care of himself, and I honestly, teens are touchy when you correct them too often. It's a balance I am still learning. Great Research and nice job!!!

  13. I'm glad SOMEONE has got the super bolus working...not for us sadly. I tend to keep basals higher in the morning and work around it. Shoot, I haven't checked a breakfast spike in.....months!! Ack!!

  14. Damn.. it does kinds look like its flippin you off. What kind of shit is that?

    I may have to check out that super bolus... but I will need to insert dex to grow the hair on my balls first.

  15. Thanks for suggesting this. We'll see if it works. It's definitely not an age thing...I've had post breakfast spikes for the past 22 years but didn't realize they were a regular thing until I was on a cgm. :O) Now I know they are worse when I have milk, donuts, pancakes, etc, and it's just a matter of figuring out what to do about that. The super bolus makes me nervous (I'm afraid I'll have highs later on from the missing basal during the hours I decrease my basal rate), but I won't know what works best if I don't try.


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While I'm happy to share our experiences with what works, and what doesn't work, for the management of Type 1 Diabetes and Celiac Disease in our house, please do not mistake anything you read here for medical advice. Decisions regarding your/your child's health care should be made only with the assistance of your medical care team. Use any information from this blog at your own risk.