CHEESEBURGER COMBO BOLUS: Did I Do It and When Do I Collect My Prize?


1. Too much insulin with dinner; 2. Result from too much juice in response to low; 3. The period of the fatty lunch in question

No school today. Major errand = purchase trumpet. Trumpet shop near miracle Diet Coke machine. Not able resist lure this machine. Unfortunately, Diet Coke machine housed inside Five Guys Burger & Fries.

12PM Before lunch. Trumpet shop parking lot. Secretary of State John Kerry discuss Syria on special NPR coverage while scribble-scribble BG/insulin notes on back of hand: 110mg/dL-ish; Dexcom straight arrow. Pre-bolus 3u for 45g CHO (Know fatty bacon cheese burger lunch will be at least 45g. SWAG: bun 20, ketchup 5, french fries 20, diet coke 0.)

12:30PM After order lunch, look up actual carbs on Five Guys nutrition page. Small bacon cheese burger = 40. Regular french fries = 78. 78 divided by 4 = approx. 20. So real total Bubs’s lunch = 60. Plus ketchup’s 5 = 65. Plus Diet Coke; Bubs choose cherry vanilla: 0. New SWAG total = 65.

65g minus 45g already covered= 20g more. Requires 1.35u more. Plus 1.5 bonus units for fatty food insulin resistance. (<—this is new territory. Always afraid take this step.) Bravely dial in combo bolus 3 units (because 1.35 + 1.5 = 2.85, with extra 0.15 units for Syria anxiety) @30% now, 70% over 3 hours.

3 hours over @3:30PM. BG normal. (!)

It work? For real?

Zoom in on après lunch time:


The combo bolus is over, but is the wrath of the bacon cheeseburger/ white potato fries over?


OMG. I think I did it. Did I do it? After five hours, is the bacon cheese burger no longer a factor?

OMG. I think I did it. Did I do it? What is the half life of a fatty lunch’s power to muck up a person’s blood?

If this really work, must remember try again next time cheeseburger:

1. 30 minutes before eating: Test. If in range, pre-bolus for SWAG carbs

2. Upon ordering food: add on for more carbs if inadequate pre-bolus; then calculate 33.33333% (AKA one-third) of the carbs bolus (eg 1.5 bonus units on a bolus for carbs of 4.5-ish units) and program a combo bolus at 30% now, 70% over 3 hours

3. Collect MacArthur Genius Award


26 responses to “CHEESEBURGER COMBO BOLUS: Did I Do It and When Do I Collect My Prize?

  1. Impressed, party of one.


  2. Ann

    So, did you get a horn?


  3. The lasting effect of fries for me generally goes til the next meal. If I have it for lunch, it’s still working by dinner. If I have it for dinner, it’s still haunting me by the next day’s breakfast. If I have it for breakfast….mmmm….bacon-cheeseburger and fries for breakfast…. never tried that. That said, I never can limit myself to 20 carbs of fries. And the amount of fries you get with an order can vary dramatically from what was used when they published those carb counts anyway.

    As for SWAGging the burger — I’ve always used the “slice of bread=15 carbs” guideline, ever since I used an exchange diet (and one bread slice = one bread exchange, simple math). So, since a burger has two “slices” and is usually a bit thicker, I always SWAG more than 30, The tiny burgers from White Castle don’t follow this rule, but if you’re eating there, you might subscribe to the “who cares — I’m gonna die eventually anyway” philosophy.


    • Oh, look at me. I try to be all educational and stuff and forget to congratulate you for, despite all the craziness, keeping it between the yellow and red lines. I feel like such a fool. Nicely done! Your McArthur Genius award is in the mail.


      • until *breakfast* the *next morning*? this is insane. this whole scene.


      • Yeah, I’m an odd case like that. It seems that my body’s digestion of food “freezes” when I go to sleep, and resumes where it left off the next morning. So if I’m trending up before bed, I hold steady overnight and trend up again in the AM. It’s why I try not to eat too soon before bed. But as I said, I’m just weird.


  4. Jennifer

    Wow, you’re fancy!

    And what is this extra bolus for fun fatty food thing? Why do I not know about it? Tell me tell me tell me!


    • This is what I think I learned from a Gary Scheiner’s talk: fat makes people temporarily insulin resistant AND slows down the release of carbs/glucose into the blood (I picture it as the glucose/carbs having to claw their way through waxy, sticky fat to reach the blood.) So if you eat a bowl of jelly beans, you’ll get walloped right away. But it you eat greasy pizza/cheeseburgers, you’ll get hit a little bit right away and then hours later as well, once the effects of the grease wear off.

      One respected source (for pizza only) doubles the bolus, and gives 50% (which would be the same as the normal bolus to cover the carbs) up front, and 50% over the next 4 hours. It’s one ton of extra insulin! It’s terrifying! But works. (For them.)


  5. I laughed at this, “with extra 0.15 units for Syria anxiety” and then felt horrible for laughing about Syria.

    Nice work, rock star!


  6. Anonymous

    YAY! Awesome… we do temp basal, but same result, I think…? we will do 2-3 hour temp basal up 25%, set same time as bolus. Me too, scary pre-bolus, but really does work, right!!?!?


    • oooops, not anon, Dina here….


      • I was wishing I had done a temp basal instead, because I know how to cancel that if it gets out of hand. I don’t know if I can cancel a combo bolus-in-progress. I assured myself I could just reduce the basal if the combo bolus was too much, but that’s so complicated.

        So I think temp basal = same thing (increased insulin over time), with a drawback: more complicated to do the math to set it up, and an advantage: easier to tweak as things unfold.


      • He’s on the Ping, right? You can cancel a combo bolus, I’ve done it many times. The screen should say BOLUS ACTIVE. If you select Menu—>Bolus—>Combo Bolus It will tell you what’s been delivered and allow you to cancel. :o)


      • Linda

        You can cancel a combo. Just hit “suspend” = done.


  7. if you suspend pump for a sec I think it also cancels combo. Found that out in a panic recently. Tried combo for spaghetti & did too much up front. he was 56 & sound asleep


  8. Pancreastic Mom

    I experience the fatty food thing with my sweet girl every time she eats her Nanny’s biscuits (is it the Crisco?) and if she eats more than about 45 carbs of the fast food type stuff..fried chicken of some sort, fries, etc. I’ve heard of the combo bolus but that usually makes me want to cover my ears and run screaming from the room…just because I don’t understand it …even though I have read Think Like a Pancreas. You’ve inspired me to sit down and figure it out. That graph was NICE! Congrats!!


    • Katy

      i feel the same way. it’s too hard and scary.

      and it just sort of crams it in your face that humans should not be eating that kind of food at all ever, ever, ever. celery with peanut butter for all.


      • You are so right. What used to be an occasional indulgence type of food (once it was invented not so far back in history)has somehow become the norm. Like people eat this stuff every day. And if it is so hard for us to control with this mechanical pancreas, I can only imagine the stress that it puts on a naturally functioning one.


  9. Pingback: Up and down and all around. | a1-Conceive!

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