The Fine Art of the Extended Bolus

Hi all -

After 2 years of using the OmniPod, I'm now ready to learn the fine art of the extended bolus. Since Will was diagnosed at 15 months, we've always tested him every two hours - therefore, there was really no need to use the extended bolus since I could just correct him when we needed too. Now that Will turned 4 years old, I'm thinking it's time to start using the extended bolus. I've tried using the extended bolus with pizza - 50% up front and 50% over the next three hours and it works like a charm. I've also used that same formula with white rice and it works great. My question is, what other foods are foods that need extended boluses? I suspect that granola bars are something that I need to use the extended bolus because he goes quite high after eating them. Any words of wisdom?


I have found that any higher fat food needs an extended bolus…cheesy or fried, for instance. Like your thoughts on granola bars, I was wondering if it would work for cereal and real milk.

Does he go high right away after the granola bar - at a 2 hr. post meal check? My thought is that an extended bolus would work on any food which is slow to digest, or more than the 2 - 3 hour average. A food which gives you a good reading at 2 hr post meal, and a high at 4 hour post meal would be one to look at an extended bolus.

Highly refined foods digest very quickly, going into the bloodstream quicker than the insulin, causing a high shortly following a meal that comes down when the insulin kicks in. For example - a large bowl of Lucky Charms. In this instance, an extended bolus would delay the time for the insulin to kick in even longer. A better choice would be to give extra time in between the bolus and the food.

I play a lot of tennis and during play , for some unknown reason, my BG gets VERY high. I can tell when this is happening. My coordination gets messed up. I have to stop the game, and give myself a bolus.
It was suggested I use the Extended bolus, but it doesn’t seem to work for me…I am insulin sensitive and I’m afraid to give myself too much so I am not having much luck with the EB…
With aerobics I get too low and tennis I get too high… by high, I mean in the high 200’s or higher if I don’t bolus.
I can leave the house with 100 on the meter.
Thank goodness I play with great people who are patient and understanding…

I never really see any issues with cereal - he usually eats Cherrios and sometimes Lucky Charms. The granola bar thing is he gets very high and it takes a long time to come down - I normally bolus for the bar - usually 19 grams and then he goes up to around 300-350 and then takes about 3 hours to get back to normal - I usually end up bolusing to correct about an hour after he eats. By snack time at preschool, he’s normal or in the 200s (remember, toddlers are supposed to run around 150-250), which is a good number.

I just thought that someone out here would have a list of all the foods they usually use the extended bolus for. But, like everything with diabetes, I’m sure it depends on the person…yipes.

Spooky, this sounds more to me like an increased basal need than an extended bolus. Anything that you have to do EVERY day (night) should be covered in the basal so it’s just automatic. Bolus’s should mostly be for food and extended boluses for foods that don’t get converted into sugars as quickly. (there are of course also correction bolus’s to fix any high bs readings!)

I agree with Rebecca 100%, Spooky. Have you talked to your endo about what you’re doing? Sounds to me like you’ve got dawn phenomenon (most Type I’s do, from what I’ve read) and an increased basal is the “standard” way to compensate for that.

Along similar lines, I recently saw my endo after doing a 3-day CGMS trial, which he prescribed when he saw that my basal/bolus ratio was out of whack. He said my basal percentage was to high and my bolus too low. I wasn’t convinced since I’ve found that my 1/12 IC ratio seemed to do a good job as long as I was confident in my carb counting. But I went with his recommended changes and so far it’s bee pretty good.
What he saw from the CGMS was that I was gradually creeping down in mornings (I don’t usually eat breakfast) and that I had big roller-coaster spikes & valleys after eating with a “normal” bolus. He assessed that the both of those were a symptom of a too-high basal and too-low I/C bolus ratio. When I’d eat and bolus, I’d see a short spike followed by slight over-correction because the bolus was too low and the too-high basal was essentially “stacking” the bolus a couple of hours later.
Anyway, my point is that an endo, a good one, has a lot of experience and knowledge that we need to make sure we leverage. I thought he was crazy changing my parameters the way he did, but once he explained it and have now seen the evidence for 2 weeks, I understand.

Hi Eric -

Since Will’s participation in the CGM study, we too are seeing things like that. I really think all Type 1s should try the CGM, even if it’s for a short time to make these corrections. Our endo changed a bunch of things this last visit and I actually went back to most of the old settings because I couldn’t tell what was working and what wasn’t. So now, I’m slowing making his recommended changes and seeing big differences too.

I know that certain foods will last longer. But here’s the problem, last night Will had pizza. Normally, I’ll bolus 50% upfront and 50% over 3 hours. I didn’t last night - just bolused regular amount because the kids had a pizza/movie night that included popcorn so I bolused again about an hour after the pizza for the popcorn. All was well. Around midnight, his numbers went significantly up - 300s and I corrected and then he stayed in the high 200s all night - in the morning, around 4 a.m. started dropping. I think this tells me that even if I had done the extended bolus, it wouldn’t have accounted for the rise at around midnight - 2 a.m. Could it have been the popcorn?

On the days he eats regular meat, starch and veggie, his numbers remain constant all night long. It’s these nights when we eat junk food that really screw everything up. As you can imagine, it’s hard to keep that kind of food away from a kid (think every birthday party has pizza…) But, I do try to limit this.

Any ideas?

I think it’s reasonable to think that you were dealing with a double whammy of high fat and carb foods. The spike at midnight might’ve been residual from pizza, with the popcorn effect coming later because of the fat. I don’t know, but maybe the extra fat in pizza also delayed digestion for the popcorn. I find both of those foods to be difficult to bolus for in general, and your munkin was dealing with both at once - not an easy bolus situation.