One of the best ways to start getting acquainted with counting carbohydrates (the most commonly used way to bolus for the foods we eat) is to simply start looking at the labels of all the foods you yourself eat. How many servings are there in a package? Is this something I can eyeball, or do I need a measuring cup? If this is a prepackaged food, is it truly 1 serving per package, or are the food people trying to trick you and it’s actually 3 servings per package?
Here comes a curve-ball: look at the fat, fiber, and protein. All of these components of food can slow down the digestion rate and make blousing a bit more complicated. The more protein, fat, fiber in a meal, the slower it generally gets into you to start raising the blood sugar. In order to work these more complex foods such as pizza, high fiber granola, or high protein steak with a baked potato into our diets, we can use different types of boluses on an insulin pump. With injecting insulin, there is really only one kind of bolus, and that is the “normal” bolus. If an insulin pump is the method of infusion, there are THREE kinds of boluses that you have in your arsenal.
The “NORMAL” bolus. This is just like if you inject fast acting insulin. All the insulin goes in at one single time, and gets in and out of you rather quickly. This is the most often used bolus type for many people. If you are eating simple carbohydrates, or a meal not complicated with loads of fat, fiber, and protein, this is a great bolus to use. This is also generally the bolus type that is used for correction boluses for high blood sugars.
The extended or square bolus is one that takes the bolus amount and extends it out over a longer time period. This is my personal favorite bolus type for days like Thanksgiving and Christmas where you end up grazing all day. You are eating food over a more extended time period, and the insulin is matching that and going in over a more extended time period.
The third type of bolus is the combination or dual wave bolus. This combines the square wave or extended wave and the normal bolus into one package. With this bolus type, you get a higher amount of insulin up front, and the remainder of the bolus spread out over a longer time period. This type of bolus is great for meals that have parts that will get in you quicker, and also fatty parts that will be delayed in the digestion. Pizza is one prime example of where I personally use this kind of bolus.
Based on 10 units of insulin over a period of 5 hours, the following explains how these boluses would work. The normal bolus infuses the insulin all at one time, right at the start – all 10 units in hour 1. The square / extended bolus takes that 10 units (or however many units are needed) and spreads it out over whatever length of time you choose -in this case, 5 hours, which would result in 2 units of insulin each hour for 5 hours making a total bolus of 10 units. The combo / dual wave bolus is just like it says – it is a combination of the normal and the square wave. There is a portion of the total 10 units given up front, say 6 units at hour 1, and the remaining amount of the bolus is extended out over 5 hours which would result in 1 unit given at hours 2, 3, 4, and 5.