Don’t Just Bolus, SUPER BOLUS

Not entirely new, but totally worth revisiting: pumping aficionado John Walsh’s “Super Bolus” method for smacking down high post-prandial glucose levels even before they hit.

The idea here is to combat the effects of high-carb (high glycemic index) foods by taking BOTH the necessary bolus AND the amount of basal you normally get for the next few hours up-front. To prevent going low, you just slash your basal for the next 2 to 3 hours.

Super_bolus_2

I think of the concept as a little bit like “pay it forward” for diabetes: do the good deed in advance and your body will respond threefold.

Check out John Walsh’s latest slideshow presentation on the subject HERE.

I know at least one D-blogger who’s tried it (on her son), and was very pleased with the results. A while back, Martha O’Connor reported on a candy encounter:

“Normally these 3 candy canes would send my child’s blood sugar skyrocketing! But not with the Super Bolus. All I did was give the insulin for the carbs and for any correction we needed to do, and then ADDED UP the basal insulin that my child was going to receive for the next 2 hours. My son gets 0.45 units/hour, and for 2 hours that makes 0.90 units. I gave the 0.90 units as upfront insulin (remember, in addition to, NOT instead of, the insulin I would normally give according to my child’s insulin/carb ratio as well as the insulin I would normally give as a high blood sugar correction).”

“Then I SET A TEMPORARY RATE of ZERO for 2 hours. I was giving the same amount of insulin, just having it “hit” differently so as to attack those spike-causing carbs in the candy canes. 1.5 hours after the candy canes we had a bg of 126, yeahhhhh! And it stayed stable until we checked again around dinnertime!”

I’m working up my nerve to try it myself soon. I promise to report back. Meanwhile, I’ll just keep up my
usual blue-skying (brainstorming) routine here…

10 Responses

  1. Sarah
    Sarah May 4, 2007 at 3:14 pm | | Reply

    Thanks Amy for posting this! I have been doing something similar. If I’m eating something high GI, I bolus a lesser amount and wait for a bit, and increase my basal for 1.5 hours. I also increase my basal in addition to a bolus when high. It brings me down MUCH quicker.

    If my blood sugars are normal and I still have excess insulin on board post meal, I decrease my basal to 40% for the remainder of the time I will still have insulin on board, minus 30 minutes. It works perfectly more often than not.

    Any other ratio or basal and no such luck! You need to find what works best for you.

    Thanks again for making people aware of how to do this and similar alternative dosings.

  2. Scott K. Johnson
    Scott K. Johnson May 4, 2007 at 7:03 pm | | Reply

    I too have been working up my nerve to try it – I think it sounds like a great concept and coming from Walsh I’m sure it works well too.

  3. Tesney
    Tesney May 4, 2007 at 7:15 pm | | Reply

    I may have to try that tomorrow during my son’s one-year birthday party…I’ve been worried about having cake AND ice cream…that would typically mess up my BG level for hours. I’m going to read up on it and I’ll let you know how it goes.

  4. Bernard Farrell
    Bernard Farrell May 4, 2007 at 9:12 pm | | Reply

    I’ve tried this approach several times since first learning about it. Generally I use it to correct very high readings.

    It’s never caused me any issues with lows, and given how the insulin is being delivered I have to believe this is a way to get highs down to normal faster.

  5. Living With Diabetes
    Living With Diabetes May 4, 2007 at 10:40 pm | | Reply

    Diabetes Mine: Don’t Just Bolus, SUPER BOLUS

    Amy is writing about the Super Bolus. I freely admit, I’vejust never gotten the Super Bolus– but then I also have problems with extended boluses. Not entirely new, but totally worth revisiting: pumping aficionado John Wal…

  6. Wendy
    Wendy May 4, 2007 at 11:04 pm | | Reply

    I use this super bolus when I am super high also. It works like a charm. I find if I am up above 300. I superbolus if I remember and it works fantastically.

  7. julia
    julia May 6, 2007 at 8:47 am | | Reply

    I’d forgotten about the super bolus. I’m going to have to try this with O next time she’s really high. She gets some really stubborn highs and it’s so tempting to rage bolus her – I sometimes have to walk away from the pump for a second before treating because I get so frustrated. I don’t want to do something stupid and send her low.

  8. Doug Burns
    Doug Burns May 7, 2007 at 3:48 pm | | Reply

    Hey Amy/everyone,

    I agree – using a super bolus is an ideal method for both dropping an elevated blood glucose and covering a carb-laden meal.

    I’ve had T1 diabetes for the last 35 years… so long ago the syringes used back then were the size of nails! :( I know the pain diabetes can create in daily life but I also know that with the obstacles presented it becomes our decision to step above them. From my experience, the pump has been a far more consistent and acurate way to control my eating as well as my exercise and life in general.

    This is my first posting to this site btw, and I think what you’re doing is very important, Amy. So important, in fact, that I’ve focused my life right now to creating an online community based on these issues. I’m also based in the Silicon Valley, not far from you. Keep it up! Thank you.

    Sincerely,

    Doug Burns

  9. Dave
    Dave May 9, 2007 at 1:44 pm | | Reply

    I have read this post and I have read John Walsh’s Power Point on Super Bolusing. How is this different than doing a dual wave bolus using a Minimed 522 or 722? I use a dual wave for carb laden meals or I could use it for highs if it were needed. Can someone please explain?

    Dave

  10. Eureka! The experiment worked! « Rolling in the D

    [...] I mentioned earlier. I talked to my endo about how I’m worried about suspending a basal for a super-bolus, and he said that there’s no reason to be. Novolog has about a four (or more) hour duration [...]

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