The idea behind TAG is that besides bolusing for your carbs, you also bolus a percentage for the fat and protein that you consume and then spread that bolus out using the dual wave or extended bolus (or combo on Animas pumps) feature on your pump. There are some people doing MDI that belong to the group so don’t think that you can’t use this system if you don’t have a pump. Whether you use MDI or a pump, you definitely need a calculator if you want to use this system!
I am putting this post under the gastroparesis section on my blog because although I am just now starting to use it, I really think it is going to help with some of the gastroparesis issues. Since fat really slows down the digestion process for people with gastroparesis, it makes sense to have some insulin working to help when food finally starts to digest. Up until this last week, I have been doing with my pump what I was doing with MDI but I can definitely see an improvement using TAG.
On the TuDiabetes TAGgers group, Danny started a thread with some sample spreadsheets. Here is the link to that thread:
Danny used 58% for protein and 10% for fat. In that same thread, Cheri posted her spreadsheet and she uses 40% for protein and 10% for fat. Both of them made wallet size cards to carry. Cheri also had a food bank that she listed her favorite foods and listed the carbs, protein and fat. Cheri is the one that mentioned TAG to me in the Animas group on TuDiabetes. You will have to play around with what percentages work for you and you will also have to play around with what the amount of time you want to extend your bolus for. It looks like 3 hours seems to be an average place to start – customize that to suit your needs.
Here is also a link to the thread with some meal samples that people posted:
This is what I normally eat for lunch:
|Peanut Butter, 2 tbsp||6.0||7.0||17.0|
|Hamburger, 3 oz 90% lean||0.0||16.5||5.1|
|x 40%||x 10%|
My carb ratio for lunch is 1:12 so I would take 2.85 units of insulin up front to cover the carbs in my lunch. There are 27.5 grams of protein, so if I multiply that by 40%, I have 11 grams that I need to cover for protein. There are 37.1 grams of fat, so I multiply that by 10% to come up with 3.7 grams that need to be covered for fat. I then add the 11 grams from the protein and the 3.7 grams of fat to come up with 14.7 grams that need to be covered for my extended bolus. Since my carb ratio is 1:12 for lunch, I need an additional 1.25 units of insulin that I extend over a 3 hour period. Again, your percents and time periods might vary. You will have to play with what works for you!
Monday afternoon, I ended up going low and had to cancel the extended bolus before it finished. My BS was 71 when I started and according to my Dexcom, heading south anyway. That probably was not a good day to play with trying this. Yesterday was a better day and I hung out in the 80s and 90s all afternoon until about 5 then started going up. I am thinking of trying Danny’s 58% and then spreading it over 4 hours instead of 3. I would have 19.66 grams to cover instead of 14.7. My theory in changing the percent in addition to the length of time is that I did good for almost 5 hours. I don’t want to take less insulin during that period by extending the time and I don’t really want to take more. If I add the extra insulin, I should extend the time so I am getting that extra insulin over a longer timeframe.
I am using it for both lunch & dinner also, but lunch is my hardest to digest meal and also has the largest amount of protein and fat so I figure I will concentrate on getting that one right first.
TAG has made a difference in the little bit of time that I have been playing with it. I wish I had actually tried it back when I first joined the group!
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