Meals & Bolus Types For Insulin Pumps

Please always consult your Diabetes Specialist Team before making any alterations to your Diabetes Care Regime.

Meals and Bolus Types

Different carbohydrate foods release their glucose at different rates - some are fast acting and some are slow acting. This is also known as high glycaemic index (GI) (fast) or low GI (slow). Sometimes the fast acting insulin given at a meal works too quickly for the food eaten, and glucose is still being released from the carbohydrate after the insulin has finished working. This may be seen as a rise in blood glucose 3-4 hours after a meal.

Protein and fat delay the digestion of carbohydrate, and so slow the release of glucose. Most main meals contain protein and fat with the carbohydrate.

Insulin pumps can be programmed to better match the meal bolus with the release of glucose from carbohydrate foods with or without protein and fat. It is recommended that these types of boluses are used at least with every main meal to prevent high blood glucose after a meal.

Carbohydrates that are naturally slow acting (low GI) are:

Oats, granary bread, pasta, most whole fruits, pulse vegetables and milk products. It is a good idea for everyone to include some of these healthy foods in the diet to stabilise blood glucose levels.

Some foods are very slow acting because of their fat and protein contents and may be less healthy, but would benefit from a different type of bolus. E.g fish and chips, pizza, curry

Normal bolus

This should be used with fast acting carbohydrates without protein or snacks

Examples:

Non oat breakfast cereals

Toast (white or wholemeal)

Other bread products - crumpets, bagels, bread muffins

Tinned soup

Snacks

Dual wave/multiwave/combo bolus

This should be used with a meal that contains different types of carbohydrate (some fast and some slow) and protein and fat

Examples:

Sausage, mashed potato, baked beans

Fish fingers, chips, baked beans

Spaghetti Bolognese

Jacket potato with beans or tuna or cheese

Roast dinners

Stir fry and rice or wraps

Meals with sweet puddings

Square wave/extended wave bolus

This should be used when most of the meal contains naturally slow acting carbohydrate, foods with a high fat or protein content, or foods eaten over a long time such as a buffet.

Examples:

Pasta with a cheese or cream sauce

Porridge made with milk

Vegetarian meals with pulses and cheese

Granary bread sandwich with crisps, fruit, yogurt

Curry (meat or dahl) and basmati rice

Fish and chips and mushy peas

Pizza

Pie and chips

‘All you can eat’ Chinese or Indian buffet

Party buffet

How you split the bolus or extend the bolus is a matter of trial and error. Main meals should all be extended for at least 1-2 hours, and may need as much as 8 hours if they have lots of fat or protein. If you are using the dual/multi/combo wave the usual combinations are:

30:70 - more slow acting carbohydrate than fast

50:50 - use if not sure about what type of carbohydrate or a mixture

70:30 - more fast acting carbohydrate than slow

Experiment with different bolus types and check blood glucose 2 hours after the meal (and every 2 hours after that) to see if it has worked. Extended boluses can be cancelled if your blood glucose goes too low.

You could also consider an enhanced temporary basal rate after a large meal containing fat and protein, as an alternative to a dual wave bolus

Please always consult your Diabetes Specialist Team before making any alterations to your Diabetes Care Regime.