Sitting down to a meal after a Type 2 Diabetes diagnosis takes some extra thought, planning, and know-how. Here's how to know when a bolus can help, and how to best manage your blood sugar at meals.
1. Take a walk.
Did you know that when you exercise after taking a bolus it could help your body use the insulin more efficiently, therefore lowering your blood glucose faster? This also means you might need to take less insulin to lower your blood glucose after a big meal.
2. Spend your carbohydrates wisely.
Think of it like a bank account. You can “spend” your entire carbohydrate allowance on stuffing and mashed potatoes or forgo the potatoes and spend more on extra turkey and vegetables. Choose your favorite carbohydrates to eat and be sure to also have plenty of veggies and protein.
3. Eat your veggies first.
Vegetables are very low in carbohydrate and high in fiber, and will help to fill you up, not to mention they are full of vitamins and minerals.
4. Use the Dual Wave Bolus for meals higher in fat.
The Dual Wave Bolus consists of a normal bolus, followed by second wave of insulin, which is delivered in a square over time. The Dual Wave Bolus should be used for high fat, high carbohydrate meals. This includes fast food and meals that are common in many Mexican and Italian style restaurants. Often times, it also includes holiday meals.
Whenever we eat foods higher in fat, it takes our bodies longer to digest those foods. Therefore, we do not need to take the bolus all at once, but to spread the bolus out over time to mimic the time that it is taking our bodies to digest the
food.
You may need to increase the total amount of bolus delivered since insulin is delivered in two waves and some of the fat will break down into glucose. You can use your continuous glucose monitoring (CGM) and blood glucose meter to monitor glucose levels and to determine the total amount of insulin and percentage split to cover the meal. You can typically add 25-30% of total insulin to the bolus amount to account for the higher fat.
When setting a dual wave bolus, take a blood glucose reading, and enter your current blood glucose level and grams of carbohydrates you are going to eat into the bolus wizard. Then, there are two decisions to make:
- What percentage do I want in the first wave of insulin vs. the square? Your insulin pump’s default setting is a 50/50 split, meaning 50% of the insulin is delivered in the first bolus, and the remaining 50% of insulin is delivered in the square wave bolus. You may adjust your dual wave bolus split depending on your current glucose level and target range. For example, if your blood glucose is in target range, you may set your dual wave bolus to a 60/40 split, having 60% of insulin delivered in the first bolus, and the remaining 40% of insulin delivered in the square wave bolus. If your blood glucose is above target range, you may adjust the split to 70/30 or 80/20, so 70 or 80% of insulin is delivered in the first bolus, and the remaining 20 or 30% of insulin is delivered in the square wave bolus. Whatever setting you choose, the pump will automatically do the math for you.
- How much time do I want to spread this bolus over? Typically, you will set this between two and four hours. The heavier the meal, or the more fat that is in the meal, the
longer you will set the time duration.
5. Separate the meal from the dessert.
Instead of eating in one large sum, eat your dessert separately from your meal. This will help to spread the carbohydrates out throughout the day. It is easier on your body and blood glucose if you eat several smaller meals, than to eat one large amount of carbohydrates at a time. And with pump therapy, it is easier to bolus again later for dessert than if using injection therapy. Be sure to talk to your healthcare team before using a dual wave bolus so you can work together to find the best settings that work for you and your diabetes management.
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