Inspiration And Expert Advice: Expert Columns

Pumping Like a Pancreas (continued)

Not all boluses are created equally

Two main types of bolus options exist (and based on the pump manufacturer may be called differently).
1. Normal.
2. Extended (with sub-categories of dual-wave and square wave or combination bolus).

Normal bolus gets delivered immediately. Extended bolus delivers insulin over a length of time from 30 minutes to 8-hours. It is helpful for high fat meals (like pizza—the gift that keeps giving) or situations where you are likely to be eating over a long period of time (Thanksgiving is right around the corner!). These advanced features allow you to have a portion of the bolus now (to cover the immediate rise in glucose) and span the rest of the bolus over a few hours (to cover fat content).

Technically speaking, the dual wave is 2 types of boluses: the normal bolus plus an extended bolus (helps when you eat food that will cause a spike in glucose along with food that will stay in your system a while, like fruit with cheese and crackers, then a nice creamy pasta). The square wave is an extended bolus consistently delivered without a spike of insulin (particularly helpful for people with gastroparesis, a condition where the stomach takes longer to digest food as a result of nerve damage).

In addition to working with your team to find the right pump settings, which do need adjusting from time to time, consider checking out the books “Smart Pumping” by Dr. Howard Wolpert, and “Insulin Pump Therapy Demystified” by Gabrielle Kaplan-Mayer. Both are excellent resources that go into great detail about mastering the insulin pump.

There are no absolutes in diabetes. If your A1C is not quite at the mark of less than 7%, the advanced bolus features can help reduce post-meal spikes and be the missing component to overall diabetes management. And the pump gives you the freedom to fine-tune much like that of a pancreas.

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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.