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Type 1: Splitting bolus

GBS_82_

Well-Known Member
Messages
70
Location
Croydon, London
Type of diabetes
Type 1
Treatment type
Insulin
Hi all

Quick question for those on (or previously) on MDI. I've seen some very helpful comments about splitting bolus dose when eating a fairly fatty meal. I can totally see the need to do this as I've had a few occasions where I hypo-ed and then went very high a few hours later.

However, can I ask - how long do people tend to leave it between doses. Do you tend to find it's always okay to take the second half an hour later (for example) or do you wait until the BG levels actually start to rise.

I recongise that we're probably all different but would really value hearing what works for everyone else.

Thanks so much!

Gareth x
 
If I'm having something both very carby and very fatty (a proper balanced meal!) that I know from experience will take too long for the carbs to act to take the whole bolus according to usual ratios pre meal, but will result in a much delayed spike without the whole bolus then I would split the bolus. Maybe 50/50 or 40/60 depending on the meal. Either take one shot before eating and one 20-30 minutes after, or (because I'm forgetful) take them both at the same time, but one in my tummy (quick absorption) and one in my bum check (slower absorption). Seemed to stop the hypo issue, but I'd usually have to do a little mop up correction bolus further down the line too.
 
GBS_82_ said:
However, can I ask - how long do people tend to leave it between doses. Do you tend to find it's always okay to take the second half an hour later (for example) or do you wait until the BG levels actually start to rise.
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It's a case of trial & error and what works for one person may not work for another, for a high-fat meal (on MDI) I would bolus half before eating and the rest 2 hours later, even then sometimes a third dose would be required depending on bg readings.

I've always found the usual I:C ratio goes out of the window when a meal has a high fat/protein content.
 
I don't split bolus but as have basal twice a day I'll increase my basal instead as protein kicks in with me 2-5 hours after but fat will kick in overnight if I eat at say 3-5pm.
My one and only treat I ever have is a cream eclair from Tesco.... the expensive ones.. at 37carbs each! They are the worst thing for me ever but once every few months I will allow mysel this one treat. Goes thru body horrendous and throws levels in to chaos but I know now to increase my basal that day at 6pm. I'm on 3 units and I'll up it to 4 to cope. Am fine initially with bolus though...

I am an odd one with slow dugestion though.....
 
I eat high fat but find it difficult to bolus for saturated fat much more than mono fats. I tend to eat more saturated at dinner and before b d I'm fine but fasting is higher. Conundrum.
If I eat more than 2 oz protein I split blouses or I will go low first.
 
I think it's best described as a trial and error approach, as we all digest food at different rates and have varying rates of carbohydrate absorption. Whilst there's a maximum rate that the intestine wall can transport glucose into the blood, the speed at which the glucose is broken out tends to depend on what the combination of foods is.

So, for example, highish protein, medium fat for me usually means I need to re-bolus 2 hours after eating, at about 50% of the bolus I had with the meal. Something high carb, high fat, like fish and chips and I can find myself taking multiple later boluses to manage the accelerant effect I see from this combination.

Armed with the information here, you really need to conduct tests of your own to work out what you need to do!
 
When I was on MDI. I used to split my bolus differently for different meals. With pasta, I had a gap of one hour, but with high fat meals, I sometimes had to split my bolus into three parts, over three hours.

Whatever works for you. It's trial and error unfortunately.
 
How does everyone determine what high fat is?
 
shivles said:
How does everyone determine what high fat is?
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By experience really. I have my pump now so I just choose an appropriate bolus type. When I was on MDI, I'd look at my BS after certain meals and then suspect it was the fat content eg fish and chips. Then next time I had that meal, I'd try a split.

For me, it's largely takeaway meals that are the issue so you may not have to worry about that for your daughter. I can eat home cooked meals with fats ok, it's just things like fish and chips, Indian, etc that I have to think about.
 
azure said:
By experience really. I have my pump now so I just choose an appropriate bolus type. When I was on MDI, I'd look at my BS after certain meals and then suspect it was the fat content eg fish and chips. Then next time I had that meal, I'd try a split.
Click to expand...

Apply the same logic, some meals are obviously high-fat like like a Full English Breakfast and Fish & chips like you say.
 

We've had it a couple of times with home cooked meals, I buy 20% fat mince and when I've made bolognaise or cottage pie it's been a problem, also with some restaurant kids meals. Just wondered if there was a percentage you look for or its just trial and error
 
No percentage - just trial and error
 
I find saturated fat (minced beef) or fried foods very hard to calculate. But mono fats not a problem.
 
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