Take advantage of books, labels & online resources to help you count carbs as accurately as possible.
Weighing (Perfect Portions scale) and measuring foods as well as using individually packaged items makes your first few weeks on a pump go a lot easier!
A dose of insulin needed to bring you to your target BG.
It is individualized and may change over time.
This “insulin on board” feature, subtracts unused insulin and keeps you from “stacking” insulin.
A normal, or standard bolus, is similar to giving an injection as the pump pushes the whole dose of insulin at one time.
This “bolus” of rapid acting insulin enters your bloodstream quickly at first, peaking in about 1-1.5 hrs and lasting until about 3-5 hours.
This rise and fall of action closely matches the rise and fall of glucose from the digestion of food/beverages.
A “normal” bolus will best match a meal/snack that is mostly carbohydrate (starch/sugar) and should be taken 20 minutes prior to eating provided your blood sugar is above 100.
An extended bolus will split your bolus into 2 parts. A normal bolus right away, and the rest given slowly over the timeframe you choose. You specify how much you want up front (X units or X % of total) and for how long you want the remainder delivered (over X number of minutes or hours).
For instance, if you need 5 units for your meal.
You could program “3” units now and 2 units to be delivered over the next hour.
Remember that your insulin will last 4-5 hours.
Splitting your insulin this way at meals does a great job of matching both the easy to digest carbs as well as the fats, proteins and higher fiber carbs.
Examples of when an Extended bolus may be beneficial
- High glycemic index carbohydrates as a part of a balanced meal → Try 50-75% up front, the rest over an hour
- Correcting a significant pre-meal elevation + a balanced meal→ Deliver all of the correction units right away, the portion for the carbs over 30-60 min.
- Eating a buffet or meal lasting over two hours or a slowly digested/higher fat/higher protein meal such as pizza, pasta, large steak → Try 25% up front, the rest over 2 hours
- Gastroparesis, where digestion can be too slow for normal bolus delivery
Palo Alto Medical Foundation: Pre Pump Education Packet