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If you use an insulin pump, on average, how often do you bolus an amount that is different from the suggested dose from the pump’s bolus calculator? (I.e., entering a number of insulin units without using the calculator at all, editing the bolus calculator’s suggested dose to be higher or lower, etc.)
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After I’ve had my pump on for a couple days the insulin I bolus with it doesn’t bring my blood sugar down, or prevent it from going high. I have to inject using a syringe and needle to bring it down. The insurances say to change your site every 3 days, but between that 2nd and 3rd day something seems to happen, where it isn’t being absorbed as well. So the blood sugars go up, and I have to bolus the old fashioned way, with a syringe.
Ask your doctor to write a new prescription that says to change every 2 days instead of every 3 days. Not every insurance will go for that, but sites sometimes don’t last 3 days for everyone.
I sometimes have that issue as well, but it’s not consistent. If I see the insulin not working as well, I will adjust my bolus amounts up by 0.1 or so.
You need to change your carb ratio or insulin sensitivity to fix those issues. Carb ratios and sensitivity vary widely throughout each day.
I don’t think the tandem’s calculator is aggressive enough when my BG is rising and arrows are pointing up. I will often over bolus.
I often make adjustments for exercise, other physical activities, which works out to most days.
My pump will do this but I chose not to use that function. I feel I can calculate the necessary bolus better than my pump.
I sometimes have a few days or a week when the insulin seems to be less effective. When I see that happening, I will raise my bolus calculation a bit. I don’t change my settings because it always goes back to normal. Less often, the insulin seems to be supercharged and I have to back down bolus for a couple days. And it varies by time of day, sometimes lunch insulin doesn’t seem to work, other times it supper.
I normally don’t but I’ve been fighting a combination antibiotic resistant bacterial and fungal infection in my sinuses and throat since the beginning of April and with this stubborn illness I’m having to usually increase the Bolus amount as much as double what the pump calculates I need.
If I’m struggling with an illness or on a prescription that causes high BG, my doc or edu will give me instructions on a temp setting for basal. The only time the bolus changes take place is when there’s a trend change and A1C goes up.
I will often give less insulin if I know that I will be working out in the next 2 hours.
My Dr. Did write me a new prescription for every 2 days, as I have the same problem. I am on Medicare and they accepted it.
Often, for lots of reasons. Pump doesn’t know some things that I know: what I’ve already eaten to deal with a low or otherwise without bolusing, the walk I’ve just taken or exercise I am planning, come to mind. And, for correction boluses, I have the correction amount set to work fine for some bg variations, but for readings above maybe 200, or even lower if long lasting ones, I also have to consider a decrease in sensitivity. And, sometimes, if I know what I want bolused, it’s just easier to just plug in the amount. (though can’t use info about percentage basal/bolus then).
I do at least a few times a week as sometimes my insulin isn’t working because of the infusion site may not be as responsive to insulin as other sites. I may not plan on exercising as I usually do at a certain time. I may bolus more for high fat foods or bolus less for an activity that I am about to do. The reasons are endless.
I am very aggressive in my T1D mgt. For meal boluses, I take into account any FOB (food on board – as best I can guess), I also pay attention to trend arrows. As another response said, only I know what is ahead for the next couple hours. While I do have different settings for about 9 different time zones throughout the day, I also titrate up (or down) based on the bg reading (if bg is under 130, I use the correction setting in my pump, if I am between 130-160, I increase by 10%, etc). I also have this “lovely” symptom of rising bg (lovely, because it comes in handy) – I get heartburn as my bg rises. I use what I can!
OMG: I have just started experiencing this when I am high. It feels like I need to burp. It can’t.
The pump wizard does not know if I’m exercising or factor in other life issues.
my system doesn’t have an exercise setting/profile either, so I have to adjust manually for this (or even if I’m at work where I’m active and walking around, vs sitting on the couch at home)
I add fat ‘carbs’, if eating food high in fat, pizza or pumpkin pie
My pump does a good enough job estimating with all the factors included in the pump. If the factors are wrong they are reviewed with my doctor.
Some stuff you just get a pretty good sense of after you’ve been at this long enough. Things I eat frequently I rarely bother with the Wizard for, and stuff that’s unusual or hard to estimate b/c of fat content I’ve just built up a routine of my own for (pizza, Chinese). Of course it was very different before CGM, when it was much riskier to guesstimate things.
Since my pump doesn’t read minds or calendars I often need to change the suggested bolus amount.
I don’t really count carbs. It is difficult when eating low carb. I have my carb to insulin ratio set at 10 to be able to easily calculate insulin I need for a meal due to protein, fat for resistance and yes, some carbs, type of activity level, stress, health condition, etc. The estimate I give may need to be corrected later or maybe not.
I respond to upward trend arrows by taking a 1-2 unit bolus
I adjust the carb estimat based on the fat content and my experience with certain meals. Must dinners average 50 g of carbs…
I lower it sometimes with fresh insulin but have started lowering my basal for that because it is very consistent. Every Sunday I visit my dad. Even though I eat the same thing most mornings, when I go there my BG always goes low so I have been lowering my bolus a couple points.
Except when I’m sleeping, I always self-Bolus. Control IQ is too slow to react. I have no patience with Control IQ. Some time when I used it, it would take 4 hours to bring down my numbers. Good for new kids, not me.
After reading some comments it evident that we use different Insulin pumps. and delivery systems. Most likely we cannot compare their action.
I chose 2-3 times/month because I only recently started doing this. I have found that when my BG is over 250mg/dl the calculator doesn’t deliver enough insulin to bring me down.
There are specific situations where I override a bolus calculation or enter a manual insulin-only bolus.
1. My Tandem pump will occasionally ignore the IOB in the calculation. If my BG is NOT high, I will override the suggested bolus to the ‘correction calculation.
2. Manual extended bolus if the site is getting bad and I cannot immediately change it. Extended bolus will act like an aggressive basal rate and absorb better.
3. Intended exercise after a bolus….. I often reduce the meal bolus if the exercise will be moderate, heavy or of a long duration.