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On average, how many adjustment boluses would you estimate you manually give yourself in a day? For the purposes of this question, these “adjustment boluses” do not include insulin automatically dosed by an algorithm without user input, and exclude doses given when also bolusing for food.
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I chose 3-4 although some days it’s definitely more. I am my own algorithm.
I could say exactly the same thing (though I would never have come up with being my own algorithm!) you haven’t copyrighted that, have you? 😉
Lately it’s been 3 or 4 per day, but I am adjusting my settings, again. Hopefully, we’ll get them right this time and I won’t need to bolus as often.
I have CIQ, but it is not fast nor aggressive enough, so I often supplement with little doses in addition.
3-4, my pump isn’t aggressive enough when correcting highs. It also won’t bolus for more carbs after a carb bolus is already taken. If I decide on another serving or dessert I have to manually enter it sometimes.
I have spoken with two diabetes educators and they encourage several “micro boluses” throughout the day.
I do the same thing as far as “microboluses” although think of it as “bumping and nudging”, which is a phrase I picked up from the Juicebox podcast.
Honestly, the algorithms do their best, but they just aren’t there yet. Believe this is secondary to the pharmacokinetics/pharmacodynamics of even our fastest acting injectable insulins…
Paul Hanson: This poses the most interesting and intriguing question — Is machine perfection (algorithms) ever able to achieve biological perfection? I suspect not, but artificial intelligence (AI) may prove me wrong. ¯\_( ͡° ͜ʖ ͡°)_/¯
I will take a short walk or do a bit in the yard to deal with a BG spike.
I don’t keep a running record of when this happens, but some days I don’t need to do this at all, while on others it’s 3 or 4 times, so I said “2.” Unfortunately it’s impossible to predict where the blood sugars will go in response to either food or insulin. — too many surprises.
I can’t say I have a typical day so setting a basal or bolus rate that will work everyday for me is impossible. Some days are zero adjustments but some days can be 3 to 4, possibly more.
Like others I override algorithm and manual bolus 1 or 2 unit to bring higher than I like BG down faster and allow the algorithm to turn off pump/basal if it predicts low and I don’t go low with this approach.
I – like many others – am very aggressive in my T1D mgt. I also don’t tolerate bg’s above 140 very well (heartburn et al). So I mini-bolus often, pay attention to the trend arrows and at times use temp basal increases as well. I use Tandem BIQ (CIQ isn’t aggressive enough and the target is too high for me)
When I am active during the day I turn CIQ off cut my basal to 50% and do manual bolusing if needed. If I move around at all during the day CIQ will over-bolus and make me severally hypoglycemic even in exercise mode. For me I can only use CIQ when doing office work and at night. CIQ needs the option to decrease basal when active otherwise it is too little too late.
It can vary a lot from day to day, but usually have to do correction boluses every day.
Great question, as it brings up the need to let the algorithm do its work without a lot of human intervention. I recently had this spelled out to me by my endo, and have been trying really hard to give the pump a chance to work its magic. With 68 years of chasing blood sugars, it became second nature to bolus often, but
now that I understand the system better, I’m trying really hard to allow the algorithm to work. This is a very recent endeavor, so wish me luck. Better understanding of how it all is supposed to work would have eliminated my having to wait for the algorithm to gain its sea legs. I hope there will be more discussion on this.
how does your time in range compare to before you let the machine handle it?
My time in range was well within the hoped for span before I started doing it in the Tandem preferred manner. Will have to wait a little while to see if there is an improvement with the recommended method. If newer questions pursue this discussion, I’ll be glad to let you know.
I tried to let Tandem Control IQ do its thing without interference, like my CDE wants me to, but it just wasn’t working well with my exercise routine. “Stealth” boluses brought me too low during vigorous exercise even in “exercise” mode, with its higher BG targets. Now I’m staying in “sleep” mode all day to avoid automatic “correction” boluses and bolusing corrections myself if/when needed. That’s working well so far. t:connect tells me that I’m in range (70-170) 96% of the time this way with far fewer lows. I’ve heard that Tandem is working on an option for a more vigorous exercise mode and I’d love to try that when it’s available.
I was very glad this question was asked. I answered 3-5 because that is the maximum, although there are days when none is needed. Typically my time in range is 95% or better. I had been wondering if others beside me take this approach.
I answered “one time per day”. However, that may not be accurate. I don’t pay attention to how often I manually adjust my boluses. As others have said, some days not at all, other days 3-4. It all depends on where my blood sugars are, and what I’m doing that day. I do use the Tandem Basal IQ, but often, it just does not give me enough insulin to get my BS where I want it to be.
I apologize. I do not use the Tandem Basal IQ; I use the Tandem Control IQ.
I don’t have a closed loop yet, so any adjustments are done by me. The number of adjustment boluses depends on what I eat and how well I guess the carbs. Lately, any fat at all in the food delays the BG rise by several hours. So I do delayed bolus. Even with that, I sometimes have to bolus again to cover something like pizza or lasagna.
I micro dose because I prefer my blood sugar lower than what my tandem has set. So 110 while a fabulous blood sugar I prefer lower and so I micro bolus to keep me there.
4 or 5 on ovation more, would be wonderful
To never have too do any
It varies. LADA for 18 years. The amount of insulin I produce, and therefore the amount I need to inject, varies. But I note when and how much I correct, and that information determines my future basal and bolus amounts.
4 or more some days, I believe doctors encourage higher higher numbers then they should, they are more scared by lows than highs then were are, you will never be close to normal with that approach. Yes I go low more than I like but I keep trying. I hate Any thing over 140 after a meal.
Me as well. Highs make me feel awful. Lows I just eat. They don’t bother me. I’m lucky.
I’m with you on that. However, my doctors have told me that the word has been given to medical folks about the dangers of low blood sugars because of diabetics getting into car crashes. So, to counter that, I always check my blood glucose before I drive, and I keep a constant eye on my BG while I am driving.
I run T:slim in Sleep 24/7 so I do my own adjustment boluses throughout the day.
How much time do you all wait before giving a bolus? They say to wait 2 hours before “correcting”, but I don’t always wait. But then I sometimes go too low.
Hi anneyun: I wait 2.5 hours so everything is mostly digested. I know I will need more but if I bolus too early, I will go low.
Exactly. Hard to wait when a high is stubborn.
I expect my blood sugars to go up somewhat after I eat. But, if it goes up too much, I go to the bolus screen, without waiting, and let the pump algorithms figure out how much more I need, or on some occasions, make an educated guess.
Used to wait several hours until I learned confidence in my CGM. My “upper” alert is now set for 130 , the alarm goes off at 125. If there are arrows will add at least 1/2 unit, 3 arrows maybe 1-2 regardless of the timing. My levels are practically straight just after meals now (I bolus 20-25 minutes before eating lunch, 15-20 minutes before dinner) so if they rise I try to stop that rise.
ie: Bought a huge lunch yesterday, maybe 30 minutes after eating the alarm went off 126 – 2 arrows, took 1 unit. Another alarm at 144 maybe45 minutes later? another unit, stabilized close to 120. ( After 20 years in mid 6-low 7 my 30 average on my CGM reads 112, my glucose meter 117. Possible a1C at mid to high 5 with fewer hypo episodes +lowered basal as well).
Wasn’t quite sure how to answer this question. I override suggested boluses/corrections depending on the arrow of the CGM, if I’m eating foods that I know require less/more, trying to bring down a stubborn high, etc.
I also don’t use either BIQ or CIQ.
If you’re referring to the arrows on a DEXCOM CGM – don’t. Being kinda crippled, I’ve had the time and inclination to track by every 5 minute reading, the numbers and arrows – they numbers are accurate, the arrows fluctuate all over the place. I’ve tracked the numbers staying the same for 3 readings – all with 45 degree down arrows. Vertical up or down arrows while the numbers change by 3 or 4 and more. That’s watching the display closely for over 6 months. Hundreds of examples. Trust the numbers and the chart.
Not using a pump so I manually adjust everything.
I’d say anywhere between 1 and 3 a day, but usually i leave it to automode
Can you tell us what brand of pump you are using?
I answered Two (2). I find my Tandem Control IQ is too slow, so I give myself a correction Bolus. most of the time I’m right on target!!
Wish I didn’t have to, but glad the option is there. Blood sugars have been wonky. Two wks ago all was golden. Now that previously great basal rate needs 150% temp. Or higher/lower.