Replies to This Discussion

Permalink Reply by Sophie on February 19, 2012 at 8:38am

I do this all the time--every day, actually. I'm often hungrier than I realize! It's basically like a dual-wave or square-wave bolus (or combo-bolus, depending on what type of pump you have). You just have to be super vigilant and not forget the second bolus! (which of course, can be known to happen to me!)

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Permalink Reply by still_young_at_heart on February 19, 2012 at 11:11am

I agree with Sophie that splitting a single bolus doesn't stack anything. I always defer about 1.25 units of my breakfast insulin for two full hours to better match the time the food hits my bloodstream. I would be cautious eating very high glycemic foods if you are splitting your bolus since that might cause a bad spike.

Maurie

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Permalink Reply by Brian (bsc) on February 19, 2012 at 11:18am

You can do this, but the preferred way would be to use a dual wave or extended bolus as Alan recommends. I believe the problem is that the current generation of pumps does not correctly incorporate insulin on board and carb on board into the calculations. Most pumps account for insulin stacking in correction calculations, but most don't handle accounting for it in carb boluses, and none as far as I know handle carb stacking. This means that depending on the pump, you will a variety of different carb bolus calculations, none of which properly account for stacking.

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Permalink Reply by FHS on February 19, 2012 at 12:26pm

+1 for dual wave/extended bolusing on a pump.

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Permalink Reply by Jacob's mom on February 19, 2012 at 12:48pm

I agree adding an extention on to your bolus also helps to cover the fat or protein in the meal, while this is out there i have been wanting to add a question. how important do you think it is to bolus 15 mintue pre meal with a pump, i have been more vigilent about making my son test while i'm cooking so he can bolus before the meal, esp if he is higher i think this really helps, though when i am not home i'm sure my husband and son are not doing this. any thoughts? thanks and good luck tom, sometimes the best info comes from fellow pumpers! amy

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Permalink Reply by still_young_at_heart on February 19, 2012 at 1:56pm

I think it depends on whether your son tends to spike or dip in the first hour or two. I have more trouble with 2 hour lows than 2 hour highs and almost never bolus more than 5 minutes before I eat. Others have a different pattern and tend to do very well with a pre-bolus. I'd say experiment a bit and let experience be your guide.

Maurie

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Permalink Reply by Jacob's mom on February 19, 2012 at 5:26pm

thanks! he tends to creep up the first 2 hours especially in the morning,
(cereal) all input is appreciated, so many variables.... amy

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Permalink Reply by christy on February 25, 2012 at 7:48pm

I tend to drop really low within 2 hours as well if I'm not careful, I never bolus more than just a few minutes before I eat. This usually works out pretty good for me, but everyone varies. I agree with Maurie experiment and let experience be your guide.

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Permalink Reply by Super_sally on February 19, 2012 at 5:30pm

Absolutely can. As long as you are dosing for the carbs you are eating... I often do this if I eat more than originally planned, or if I am snacking instead of only eating every 5- 6 hours, I will bolus after each snack, regardless of when the last snack or dose was.

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Permalink Reply by Ann on February 19, 2012 at 5:42pm

I'm on MDI and only use insulin for meals because my fasting BG is pretty good, so far, and my endocrinologist doesn't think I need a basal insulin yet.

I divide meal boluses all the time, especially in the morning when I eat mostly protein and almost no carbohydrate for breakfast. I find I have to cover for protein and fat, so I calculate the insulin based on 58% of the protein and 10% of the fat, then take about 2/3 of the bolus when I finish the meal and the remaining 1/3 about 90 minutes later. This keeps my PP BG from spiking and also helps with the slower digestion of protein. When I have carbohydrates in my meal--usually for dinner--I calculate the insulin needed for the carbs as well as for the protein and fat. I take 2/3 of the bolus just before the meal, and the remainder about an hour later. If it happens that I don't eat everything I expected to eat, or decide to eat more than I'd originally planned, I can make adjustments, reducing or increasing the top-up bolus. This has worked very well for me so far.

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Permalink Reply by Tom on February 20, 2012 at 7:20pm

So how should i do an extended bolus for my regular meals? I've never used the extended feature before.

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Permalink Reply by Jacob's mom on February 21, 2012 at 6:31am

Hi tom, i'm assuming you are still an omnipoder? we ussually do and extended bolus for a fatty meal or maybe one with alot of protein, you have to make sure the exetend feature is on, if you are confused you can check with omnipod support but it is really just a matter of turning it on, once it is on everytime you do a bolus you have to option at the bottom of the screen to extend, if you press it is asks how much you want to deliver now say 50% then how long, we ussually extend for a 1/2 or one if it is really fatty, restaurant food or icecream out, then if you dont eat everything you can cancel the extention if necessary.. i'm by no means an expert, jacob has been podding for a year, we ussuaaly just give his whole bolus at once and if he wants more we add on, ussually more than what the recomendation is because the pdm is thinking i just gave a big bolus why whould i want to give much more... so many variables, who knew pumping would be so difficult but it beats shots and the flexibility is wonderful... good luck! amy

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