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A new way to manage mealtime insulin—the extended bolus

BY CHRISTIN S. DARNELL MS, RD/LDN, CDE

Many people who have diabetes take insulin to manage their blood sugar, using insulin in various ways throughout the day. With an insulin pump, your body receives a steady supply of basal insulin throughout the day, and you program additional bolus doses to cover the carbohydrates in food you eat.

By estimating the amount of insulin you need to balance the carbohydrate in your meal, you can keep your blood sugar from going too high after eating. You can take the dose by injection or bolus with an insulin pump—it's the same thing, just using different methods.

While this is often an excellent way to manage mealtime insulin, there may be times when it doesn't work the way you'd like. For example:

  • If you're grazing at a party, your meal may take place over a couple of hours
  • You may have eaten a high-fat or high-protein meal
  • Gastroparesis, which delays the emptying of your stomach, can be caused by diabetes1

In any of these situations, your blood sugar might rise later than what you'd typically expect, and matching your insulin dose to your meal may not have the same effect on lowering your blood sugar.

If, for example, you ate a rib-eye steak with a small loaded baked potato, your blood sugar might go up 4 or more hours after your meal.2 While our bodies readily break down carbohydrates, fat and protein typically slow down the process. So even if you took the right amount of insulin to cover the carbohydrate in the meal, you might still need more later.

Fortunately, there is an answer—the extended bolus. This is one of the great benefits of wearing an insulin pump.

If you have an Accu-Chek® insulin pump, you can program an extended bolus to deliver the bolus over a specified period of time that better matches the rise in your blood sugar. Giving an extended bolus on your insulin pump is easy, but very individualized. Work with your healthcare team to determine how to give yourself an effective extended bolus when you need it.

Christin Darnell is a registered and licensed dietitian and Certified Diabetes Educator®, and has served on the board of her local chapter of the American Association of Diabetes Educators. Christin has spent most of her career doing what she loves—teaching and motivating people with diabetes to take care of themselves.

1National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/. Accessed April 6, 2016.

2GBell KJ, Smart CE, Steil GM, et. al. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care. 2015;38(6):1008-1015. Available at: http://care.diabetesjournals.org/content/38/6/1008.full. Accessed April 6, 2016.

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