I know I have heard that with foods very high in fat, the combo bolus is something to consider. I am relatively new to pumping and have never tried it. Anyone have any suggestions on where to start?
Definitely use the combo bolus! My advice is not to be afraid to play with it. I'm fairly new to pumping myself (been pumping less than a year), so I don't have a ton of sage advice to offer. Here's what my CDE told me during my pump training. First make sure you check your BG two hours after eating--if your BG went up about 30 points, you got the right amount for your initial dose. Then check every couple of hours or so for a while to see how steady your BG's stay. It does get complicated since you have to figure how much to take upfront and how long to stretch out the rest of it. But do try it!
I use the combo bolus when I eat pizza. I had a hard time figuring out how to use the combo bolus at first. I use my meter to first figure out my bolus and then switch to combo bolus and enter the full amount. Then I fiddle with the percentage and time. I have tried 50-50 over 4 hours. But it totally up to how you are feeling, what you are doing, are you making a correction as well etc.. It does help to try it out and see what works and eating pizza isn't too bad of a price to pay! :)
We have experimented a lot and have been able to use the combo bolus pretty well with pizza most times. One thing that was VERY helpful was the following video by a CDE who has diabetes. There's a website called Type 1 university he runs. The homepage has a free video in which he talks about strategies and approaches: https://type1university.com/. He also gives some really good heuristics for estimating carbs for different size pizzas using your hand as a measuring tool. It's very informative and rang true for us.
Based on his lesson, there are two issues at play with pizza beyond carb counting. My son often eats 3-4 slices, so there's the issue of delayed digestion. Since it takes a little while for the body to process the food, his BG will rise later than for a typical meal. The other issue he raises has to do with fat content. The fat in the cheese (and any meats) raises triglycerides, which cause the BG's to go up. So, in addition to combo bolusing for the pizza, he does a temporary basal increase of up to 30% for 8 hours to handle that element. When I make my own pizza, I use low moisture skim mozerella cheese, and so the whole fat issue is less pertinent, and I exclude the temporary basal increase.
What helped us figure things out was, once armed with these strategies, we kept a pizza log. Record your pre-meal BG, how much pizza, and what type/brand/pizzeria, and how you configured your combo (%now, % extended, duration), and make sure to do follow-up bg's every 2 hours or so afterward. After a few pizza meals, you'll hone in on the best approach for you. Time of day may also be relevant. When my son has pizza at school, it's less of an issue because (1) physical activity helps wear it off, and (2) we correct his BG before dinner later in the day. When he eats pizza for dinner, it requires more vigilance afterward because the BG's can spike 3 to 6 hours later! (We has a doozy the other night!).
Hope this helps. Good luck.