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[IP] RE: Need help with bolus for high fat meal

>From a Diabetes Interview article:

My son, who is 10, is now using the insulin pump with great results so far (a
less than 7% A1c).  But I know we can do better.  One of the biggest
challenges is bolusing for high-fat foods (pizza, chocolate candy bars, cheese
sticks).  I know these aren't the best food choices, but I give him a lot of
since he has to wear the pump 24/7.  Any advice for how he should bolus for
these types of food?


Bolus Options

There isn't a set answer for bolusing for these types of foods, there are
several variables to consider: serving size, grams of carbohydrate, other
eaten at the same time, activity level preceding or following ingestion of
these foods.  In a child of 10, delayed gastric absorption from autonomic
neuropathy would not likely be a problem, but the fats in the food items may
delay the
absorption of the carbohydrate portion of these foods.

Initially, the choice of bolus options will involve some trial and error to
see which bolus method works best for the food and the situation. What works
today, might not work on another day, depending on the variables.

Options include the "bolus as eaten," split boluses, combination, dual wave,
square wave or extended bolus, or temporary bolus increase, depending on the
brand and model of your son's pump. Bolus as eaten can be used with any pump.
Split bolus or temporary increased bolus would be used for pumps without
combination, dual, extended or square options.

If the food carbohydrate grams of the serving are known, (perhaps, the candy
bar) then = of the calculated bolus could be given when the food is eaten, and
the remaining = delivered over one to 2 hours. Test BG at the 1, 2, 3, 4 hour
intervals to see if this method works for this specific food.

Another option is to deliver all of the bolus over time, after the food was
eaten. This could be for 30 minutes to 2 or 3 hours for some high fat meals or

Pizza has its own variables. Is it thin crust, thick crust, double cheese,
extra meat? You could start with a thin crust cheese only pizza of known
size and grams of carbohydrate. An example: Give one-third to = when starting
to eat, and the remaining 2/3 to 1/2 of the calculated bolus for 2 to 3 hours
after the feast.  If the BG is still higher than target range at the next
meal time, then a correction factor bolus can be given. If corrections are
needed, then the next time the same food and serving size is eaten you could
the remaining amount for an additional hour and reevaluate it.

Cheese sticks are mostly protein, and might not need a bolus, unless you are
referring to something like cheese curl puffed snacks, which could be mostly
carbohydrate. Check the food nutrition label for this information.

Most importantly, these issues should be reviewed with the dietitian on your
pump team.
Let your son enjoy his snacks (within reason), and make corrections later, if
Remember, the method that works for one person, might not work for another
person. You will eventually discover the best method for each snack.

Good luck!

Barbara. A. Bradley, MS, RN, CDE
Independent Educator and Diabetes Management Consultant
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