Yes, we plan to make full use of the extend bolus function on the Omnipod. We’ve learned what it does, what it means, and it definitely will make sense to make use of that capability - perhaps not for every meal, but definitely many of them!
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I’m a big fan of the extended boluses. I use one for every meal. It picks up the protein/fat component over a few hours. I count 50% of protein and 10% of fat grams as carb equivalents to calculate the extended dose size. Experimenting with extended boluses is forgiving . The errors are mild.
You’re learning a lot quickly and doing well!
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Your son is still on injection therapy, is that correct?
You may find that when he starts pumping and you no longer use a long lasting insulin, that the GI will be even more important than when on injection therapy. When Caleb was younger, we tried to pre bolus for every meal he had. He was much more sensitive to insulin and carbs when he was little. We have since changed to using Apidra (from Novolog) and that helps a great deal as well. We find that it’s quicker to act and quicker to leave his system. The pre bolus has become less important.
Caleb is now 13 and we have a good sense about what kind of foods he needs a pre bolus for. For example, if he eats cereal, it’s a definite bolus-ten-minutes-before-eating situation.
Something else you may want to consider as you are testing out approaches, is using the extended bolus feature as a pre bolus. If someone is about to have a very high GI or just really high carb meal, you may want to get insulin working sooner rather than later. But, particularly in the case of a large meal which can be slow to digest and affect blood sugar, you don’t want to get into a situation where all the insulin is hitting at once. If you give a pre bolus over a half an hour (or even just a portion of it over a half an hour) you have insulin working early, but avoid a crash when it all peaks. Another way to accomplish this is to give a partial pre bolus. We often do that because we don’t know what the final amount of carbs Caleb will eat. Or if we are in a restaurant and don’t really know what the plate will look like so can’t estimate carbs until the food is presented.
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That’s actually an important rule for any insulin regime, pump or no pump. The ideal we aim for is to have the insulin start actually working as glucose hits the blood stream. That’s as close as we can get to the behavior of a normal, healthy pancreas with current technology. And of course it has to conform to what you know about how individual foods are responded to, as Lorraine says.
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I’ve been testing the GI theory for the past couple days now and, maybe testing while he’s sick is a bad idea because his BG’s are all over the place. 
Frustrating, but I have to realize that sometimes are good times to test theories and others aren’t. I will probably abandon testing this until he’s better. We will definitely be using extended bolus beginning next week when we get him hooked up. I think it makes sense to give a little up front, and let the rest run the course of another X amount of time after he eats…at least for a lot of meals.
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I was a tester and logger and analyzer. I had spreadsheets out the wazoo. It was helpful and frustrating. There are so many variables in play, it’s hard to isolate them to spot trends and develop plans. We found our way, but it took some time, and experience and gut feelings have ultimately prevailed.
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Linked below is an interesting article defines how to handle high fat meals. I sometimes struggle to adequately inject for wine and cheese parties, that includes dips and vegetables, and because of the low glycemic aspects of both fat mixed with vegetable and crackers, I get a very late rise in glucose. This article discusses how to handle that case:
Carbohydrate Counting at Meal Time Followed by a Small Secondary Postprandial Bolus Injection at 3 Hours Prevents Late Hyperglycemia, Without Hypoglycemia, After a High-Carbohydrate, High-Fat Meal in Type 1 Diabetes
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Thanks for providing this study for us to consider, @JamesIgoe. It’s interesting to note that the study used a second (MDI) injection at +3 hours following a high fat, high carb meal with good results.
I use an extended bolus on my pump for this purpose but I would rarely, if ever, consume 68g of carbs at any meal. My extended bolus is delivered concurrent with my immediate bolus before I eat. I pre-bolus 60 minutes for breakfast and 30 minutes for dinner.
Successfully eating pizza while keeping post-prandial numbers within the stratosphere is often seen as the holy grail of living well with diabetes. Most of us have given up that challenge. Perhaps this study’s conclusions may provide some guidance on how to do the pizza challenge well. Any takers?
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After I was diagnosed with type 2 in 1998 I decided I did not want to go on any medications. So I went on a low GI diet combined with walking after every meal. Worked perfectly, with hba1cs in the low 5 range.
The main benefit of low GI is that it delays the release of BGs.
Gives you time to get walking.
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