|Cheat Sheet # 1: Bolusing
The following are "tips" on bolusing.
There is no one "right" way to bolus, each person must learn their own responses and patterns. Only through faithful recording and trial and error will you learn what is the best way for you! Assuming that you are already matching your foods and insulin through accurate carbohydrate counting, these suggestions may help you iron out some questions. Your pump team may not make the same suggestions.
- Bolus after the meal for people who's "eyes are bigger than their stomach"
- Bolus before the meal for what is on the plate if you are sure it will be eaten, then bolus again after for any "seconds or extras"
- If your blood sugar is low when you check right before the meal, calculate a "negative correction" which is simply subtracting a certain amount of bolus from the insulin dose needed for the meal. Try a 10 - 25% decrease in the meal bolus.
- Do not correct between meal high blood sugars too readily. Ofteog of the bolus (the way it is delivered) is as important as the amount of bolus itself. How will you know? Blood sugar is high 2 hours after the meal (>12)
- Corrections taken at this time cause low blood sugar before the next meal.
- Changing the timing of boluses can be done using the extended and dual wave bolus features on the pump
- Or try - bolusing 10 - 15 minutes before the meal.
- Using the extended or dual wave feature of your pump is a good way of solving problems such as high blood sugars3-4 hours after a meal high in fat, or in the case of slowed digestion.
- Try a calculation of 70% "Now" and 30% over the next 1 -2 hrs. Check blood sugar 2 hours after the meal to see whether this is working for you.
- Try varying the length of time the bolus is extended, and the percentage of "up-front" bolus. It may be that you need 50% now and 50% delivered over an hour. Make sure you have the correct bolus amount before you start changing the timing.
- You have taken too large a bolus if two hours after the meal your blood sugar 5 mmol or less. Better have a snack!
- For kids at school: don't bolus for snacks of 15 - 20g eaten before recess.
- Also for kids: find out what time gym time is. If it is first thing in the morning or right after lunch, the meal bolus just before class will have to be decreased by about half (50%)
- Humalog lasts 3 - 4 hours. After 2 hours, half to 2/3 of any bolus has been used up.
- A "corrections" is a change in bolus insulin dose based on blood sugar not carbohydrate.
Cheat Sheet # 2: Exercise
The following are tips for pump users to manage exercise or activity mainly to avoid post-exercise hypoglycemia or hyperglycemia. Each type of sport or activity demands a different level of effort and each pump user responds to exercise in a different way. Only through accurate and dedicated recording will you be able to gauge your particular response to exercise. Talk to your pump team for individual advice.
- You can be off your pump for up to 2 hours while you are active - as in exercise. Removing the pump during contact sports is wise.
- You may need to give a "catch up" bolus when re-connecting. Do this by adding up the basal that you have missed and give half of that amount as a bolus. How will you know?: Blood sugar is OK right after the exercise, but quickly rises within the next hour or so.
- Use the temporary basal rate after strenuous exercise such as hockey. The timing of the temp basal is key. It may be that it does not need to be turned on until 2 - 4 hours after the game. How long the temp basal is extended and the rate are also variables.
- Start with a temp basal of 50% of whatever rate is used at that particular time of day and extend it for 4 hours.
You can set up another basal pattern as well. Set the alternate pattern for 50% of whatever patterns are set up in the standard or usual basal rate.
- You may need to decrease the bolus for meals eaten after exercise. A 30% reduction along with a temp basal may do the trick! (50% if there is no reduction in the basal rate.)
- Have carbohydrate containing drinks or snacks during exercise in 15 - 30g carb portion sizes. Your body will need some amount of insulin to use this carb. Usually, there is enough basal but if not - your blood sugar will climb due to stress hormones. A tiny bolus during "half time" when the snack is eaten may suffice.
- Some people need to leave the pump on during activity because their blood sugar usually climbs due to adrenaline. For these people, an early increase in basal followed by a sharp decrease in temp basal after the sport may do.
- The effects of exercise can last up to 24 hours.
- The time of greatest risk of hypoglycemia is 6 - 9 hours after exercise. This is when the liver takes sugar out of the blood stream to replenish what it provided during exercise.
- Stress hormones during competitive sports can raise blood sugar