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Insulin Pump and Bolus Insulin

Eating Pizza and Chinese Just Got Easier!

The diabetic insulin pump is known for its magic in helping BASAL or "background " insulin. But it  also offers different  ways of giving meal or BOLUS insulin. Things you wouldn't have dreamed possible, feasible or convenient to do with a syringe or insulin pen are possible with insulin pumps.  Let's review the conveniences that pumps offer people with diabetes when it comes to giving meal boluses.

Just a reminder that this site if for information only and not to be used as medical advice. Please read the disclaimer.  

Insulin Pump Information: Meal Insulin Made Easy

A typical insulin pump offers you these bells and whistles so giving meal insulin is easy, convenient and flexible:

  • "Beep" in your bolus. Since you're wearing the insulin pump you just have to reach down, or up to it and hit a few buttons.
  • Remote control the bolus in. Some pumps offer a remote control that you can leave on your keys or hooked to your belt loop etc.
  • PDM it in. The Omnipod insulin pump has a hand held screen/meter combo that you use to give a bolus (or to program any part of the pump).  (Animas is working on on one that you program with a special watch).  I believe the new Roche/Disetronic Spirit also has a handehld device.
  • Calculators and wizards - the newer pumps will calculate your bolus as long as you've input your grams of carb and have previously programmed in your insulin to carb ratios for the day. Of course you can over-ride the calculations if you want. 
  • Fractions - You can give a fraction of a unit. Yes, 0.1 or 0.5 units when using an insulin pump.
  • Extended boluses - to give you insulin over a longer period (see below)
  • Dual wave - to give you insulin now and over a longer period (see below)
  • Memories . Yes, you can quickly check back to see if you gave insulin for that meal or not. And how much you gave. And when you gave it. Easy.

Extended or Square-Wave Bolus 

You can program a pump to give an extended or square-wave bolus.  This gives insulin evenly over a small or large amount of time—anywhere from 30 minutes to numerous hours, depending on what you choose.  When might you do this? 

  • When you're eating continually at parties or weddings or movies. 
  • When you're eating something that gets into the blood very slowly and for a long period of time - eg. chili with low glycemic index beans. 
  • When you have gastroparesis or slowed stomach emptying. 

Of course you can change your mind and stop that extended bolus if you decide to do some serious dancing or get full or . . .whatever. All it takes is to press a few buttons.

Combination or Dual-Wave Bolus (Pizza!)

Here we go - this one makes diabetes easier. You can program an insulin pump to give a combination or dual-wave bolus. This is a normal meal bolus given immediately plus an extended or square-wave bolus added on. When might you program the pump to give this?

  • When you eat larger amounts of high fat carb - like pizza and Chinese food.
  • When you  eat a meal and want to  keep right on eating for night - like at parties. 

There are numerous ways of doing this with an insulin pump. Eg with Chinese you can  give 1/2 your bolus immediately and 1/2  extended over a number of hours. Or any combination really. Personally I find that people need to work with their diabetes team and experiment. What works for one person with diabetes is not likely to work for another without some tweaking.  Any playing around with meal boluses requires more blood glucose testing. But at least with the insulin pump you are able to tailor your insulin more to suit the blood testing results you find.

Bite Bolus using Insulin Pump

One of the insulin pump reps I know is a great source of pump information. He's interestingly sold 3 brands of insulin pumps and since he also has diabetes, he too wears a pump.  Anyway, he loves to use the term "Bite Bolus". It's now rubbed off on me. I used to just say "I beep when I need it" but "bite bolus" is cuter. 

One of the safest ways to eat at parties and munch through the night  is to give the insulin when you need it instead of programming in an extended bolus. For example, here I am chomping on a cookie.  I just beeped in insulin to cover that cookie. If in 15 minutes I find myself straying towards the kitchen to nab another cookie, then I'll beep in the insulin I need to cover that cookie. Or, if I'm eating a big slow meal, I might just give the insulin as I make my way through eating the carb food - but not before I've eaten those carb foods. I might beep my insulin pump 3 -4 times during that meal.  

The beauty in this is that I don't have to eat up to a big bolus of insulin that I might have given at the beginning of the meal. You know, when your eyes are bigger than your appetite and you can't finish the meal? Ever been there when you think - uhg - now I have to eat more carb because I gave all that insulin? 

Since the insulin pump is always with you and just requires the push a button to give insulin - the "Bite Bolus" becomes easy, quick and very accommodating. It could just be the tool you need to make your diabetes more "user friendly".

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