In this section, you will find information on:
Extended bolus
What is it?
An dose of bolus insulin delivered over an extended period of time instead of being given all at once.
What can it do?
When eating foods that are high in fat or protein, or if you take pramlintide with a meal, you are at risk of having a low blood glucose soon after eating because your digestion is delayed but your mealtime insulin is still working and is exerting its peak effect. This is often followed by a high blood glucose in the late post meal time period as the food is finally digested and absorbed, but your peak insulin effect has passed. Using an extended meal bolus can help prevent the low blood glucose and subsequent high blood glucose values.
The insulin pump or continuous subcutaneous insulin infusion device (CSII) continuously administers rapid acting insulin into the fatty tissue beneath the skin. The insulin pump is especially suited to covering different patterns of insulin resistance or sensitivity throughout the day. The pump also has multiple bolus profiles including standard, dual, multiple and extended boluses.
Dual bolus
What is it?
A combination of immediate bolus insulin delivery, plus an extended bolus. This is no longer an option with hybrid closed loop systems.
What can it do?
A dual bolus provides insulin coverage for foods that contain both high fat or high protein with simple carbohydrates.
Insulin-on-board (IOB)
What is it?
IOB is a program that keeps track of how long a bolus of insulin is working, so you can adjust your next insulin bolus to prevent overlapping insulin effect from multiple boluses. You set your IOB for a certain amount of time. Depending upon the dose of rapid-acting insulin (analog insulin), it is usually set for 3-5 hours. Individuals with especially high bolus doses. i.e. over 15-20 units per bolus, may need an IOB of 5-6 hours.
What are the benefits of using the IOB feature?
- Helps prevent “stacking” insulin, or excessive correction of a high glucose, that can result in hypoglycemia
- Helps avoid giving too little insulin in treating high glucose for fear of hypoglycemia
Example
- 2 p.m. glucose: 250 mg/dl (entered by user)
- IOB shows: 2.3 units still effective (from previous bolus delivered at lunch)
- ISF: 1 unit per 50
- Target glucose: 110 mg/dl
- Calculation: 250 minus 110 = 140
- 140 divided by 50 = 2.8
- 2.8 minus 2.3 = 0.5
- Recommendation: 0.5 unit for a high glucose of 250 at 2 p.m.