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Choosing the Right Tool for the Job

There’s a saying that goes: “always choose the right tool for the job”.

Well, when it comes to managing my blood sugars during the “busy season” between Halloween and New Years’ Day (or, for that matter, any other season), the right tool – the one I was born with – stopped working over thirty years ago. But that doesn’t mean I am limited to finding just one replacement.

I have a whole belt full of tools. Frequently, I re-familiarize myself with the tools I haven’t used lately, and try to re-evaluate ways to make my apparatus work best for me.

One of my biggest challenges during this time of year is dealing with the pre-meal: the smorgasbord of appetizers, snacks, and finger-foods that are presented before the ritual feast. Though I’m pretty good at making an educated guess of the number of carbs on my plate before a meal, I’m lousy at dealing with large community-bowls of chips, and if someone walks by with a tray of mini hotdogs wrapped in pastry dough, I just can’t say no.

When I was sold on switching from multiple daily injections (MDI) to an insulin pump, they told me how easy it would be to bolus for small snacks; just a few button pushes and that was it. If my snack called for 2.3 units, I could take precisely that amount, easily, rather than size my snack to fit a whole-unit amount.

That sounded great in theory, but in social situations, taking a separate micro-bolus for each kernel of popcorn that I ate, and interrupting conversation to do so, (not to mention stacking an incredible amount of insulin) didn’t quite work. So, for a period of time, I just didn’t do it. In my mind, I rationalized that the teeny tiny snack was insignificant, and that I didn’t need to bolus for them. But, I learned quickly that those small, but repeated morsels, ultimately did add up, and then I was left with a high blood sugar (and unaccounted-for carbs) before the festive meal. This made dealing with the actual meal quite difficult.

(Also, I learned that I should always interrupt conversation to bolus. Administering insulin requires concentration, and the potential for error due to distraction is just too great.)

How could I get the insulin in my body – when I need it and in the amount I need it – without the risk of running too high or too low? That was the question I asked myself. Ideally, I’d skip the snacks altogether, but I knew, in my world, that wasn’t realistic.

So I looked in my tool belt, and found what I was looking for.

The Square Wave.

Though the Square Wave bolus is known as being used for meals that are eaten quickly but digested slowly over time (such as high-fat or high-protein foods), I wondered if it could also be used for fast-acting carbs that are consumed more slowly over time. It’s different, but in a way it’s the same. I pondered this approach and decided to try it out at the next party.

Now, when I walk into a pre-meal situation, such as this one, I’ll quickly take inventory of the food that’s available and try to figure out what I might choose to eat. I’ll tend to gravitate toward the cheeses and veggie platters, but I know carbs will be a part of the indulgence, so I’ll allot myself a reasonable but realistic amount. Twenty-five or thirty grams of carbs.

Then, after confirming with my blood glucose meter that it’s safe to do so, I’ll Square Wave bolus those grams of carbs over the length of time before the meal, say, one hour. Then it’s time to socialize.

Throughout the hour, I’ll keep a mental tab of how many carbs I’ve eaten and how many I have left. If it looks like I’ll go over, I can take an additional bolus. If I’m so wrapped up in conversation (or if I find the appetizers unappetizing) that I’ll go under, I have plenty of time to cancel the bolus.

And the other tool on my belt, my CGM, will show me how I’m doing as I’m doing it. This helps me avoid surprises. At all times, the CGM is so vital to helping me understand what’s happening inside my body.

Now, when meal-time hits, I’m not starting out with a higher-than desired blood glucose level and a pair of “up-arrows”.

Please don’t misunderstand me – the point of my story isn’t about how to eat square meals, how to use a Square Wave, or what temporary basal to use when square-dancing. It’s about knowing just what that tiny little insulin-loaded box on your belt (or wherever you wear it) can do, and learning how to be comfortable when using those features. We’re all different, and what works for me may not work for you. Your healthcare provider or diabetes educator can teach you about your pump’s features, and can help you understand when and how they may work best for you. Though they may look daunting at first, they really do make things easier.

And in the end, it’s up to you to each one of us to (press) ACT, scroll through that toolbox, and pick the best tool for the job.


– Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems.

– Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms.

Medtronic Diabetes Insulin Infusion Pumps

– Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day.

– Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.

Medtronic Diabetes Continuous Glucose Monitoring (CGM) Systems

– The information provided by CGM systems is intended to supplement, not replace, blood glucose information obtained using a home glucose meter. A confirmatory fingerstick is required prior to treatment.

– Insertion of a glucose sensor may cause bleeding or irritation at the insertion site. Consult a physician immediately if you experience significant pain or if you suspect that the site is infected.

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