Designing the Perfect Bolus

July 1, 2024

The writers of this blog, Matt Luttrell and Shannon Greenlee, are employees of Insulet Corporation. The authors’ opinion is their own. This article is informational only and is not a substitute for medical advice and/or services from a healthcare provider (HCP). This article may not be relied upon in any way in connection with your personal healthcare related decisions and treatment. All such decisions and treatment should be discussed with a healthcare provider who is familiar with your individual needs.

By Matt Luttrell, RN, BSN, CDCES and Shannon Greenlee, MS, RD, CDCES

We ran a poll last fall asking some of our Podders what they want to learn more about, and without a doubt, the community voted for how to nail the bolus. We were not surprised. Since life these days is hectic and never 100% planned, developing bolusing strategies for different life scenarios is key to helping keep your blood glucose levels in range.

We decided to dig into this more and share some tips from the Omnipod® Clinical Product Specialist Team. Matt and Shannon are both Certified Diabetes Care and Education Specialists (CDCES) living with type 1 diabetes that are passionate about helping others with diabetes. Here are some of the strategies they use personally and professionally to help control their glucose levels.

1. Start strong

Pre-bolusing for meals can be an effective strategy to manage post-meal highs. It's normal for the blood glucose to rise after eating because insulin takes time to reach the bloodstream. By pre-bolusing at least 15-20 minutes before you eat, you can limit that increase.

PRO TIP: Consider your pre-meal glucose level when deciding on timing of your bolus.

If your glucose level is lower than your target before your meal, you may not need to wait as long to eat after your bolus.
If your glucose is higher than your target before your meal, you may need additional time between when you pre-bolus and when you eat.

2. Consult your calculator (no math required)

Both Omnipod DASH® and Omnipod® 5 come with built in bolus calculators that use your insulin-to-carb (I:C) ratio, Correction Factor (CF) and glucose value to calculate your bolus for you. Keep in mind the suggested bolus may be reduced if you're below your target, and alternatively, the bolus may be increased if you're above your target.

One of the biggest questions we get is when to use your glucose value in the bolus calculator.

On Omnipod 5 you can do this by pressing the “Use Sensor” button located on the bolus screen.

Omnipod DASH Bolus Calculator - Use Sensor - screen

On Omnipod DASH you can do this by manually entering your glucose value on the bolus screen.

Omnipod DASH Bolus Calculator Add to Calculator step

Omnipod DASH Bolus Calculator Final Step

You may have noticed that if you try to bolus for a second serving or dessert using your glucose value, that the suggested bolus is lower due to insulin on board (IOB), which may lead to an unexpected high glucose from an inadequate bolus. Oppositely, the suggested bolus may be higher if your new glucose value went up, which may lead to an unexpected low glucose.

If you have already bolused for carbs using your glucose value, we recommend entering carbs only (when bolusing for a second serving).

3. Activity

Some users find it helpful to reduce bolus amounts leading up to and right after being active. You might also want to consider not adding additional corrective insulin for elevated glucose levels or only bolusing for a portion of the carbs before exercise. Since everyone's diabetes is different, you should discuss appropriate timing and duration of use of the Activity feature with your healthcare provider (HCP).

Note: Added IOB from meal boluses can contribute to hypoglycemia related to activity and increased insulin sensitivity. Monitor your IOB prior to any activity.

We recommend utilizing the Temp Basal Rate (Omnipod DASH) or the Activity feature (Omnipod 5) and turning either on ahead of time to be the most effective. Alternatively, you can treat with a small amount of carbs before or during the activity.

To learn more read: Using Omnipod® to Manage Exercise & Other Activities.

4. Consistency is Key

Always bolus for all meals and snacks, unless you’re treating for low glucose or you're about to be active. Accurate carb counting can be helpful for reducing post meal highs. Omnipod 5’s SmartAdjust™ technology is designed to increase insulin automatically for rising glucose levels however, it’s still important to bolus for carbs which will lead to less variability in your glucose levels.

If you don’t feel knowledgeable or comfortable with carb counting, you may want to reach out to your healthcare provider or a dietitian for more education. You can also learn more and download our carb counting guide here.

PRO TIP: Helpful resources to estimate carbs include apps like MyFitnessPal or the Omnipod DASH CalorieKing food library.

5. What now?

Have you ever noticed that some types of meals can wreak havoc on your glucose levels despite delivering that pre-bolus we talked about? You might notice that your glucose drops quickly at first prompting you to treat a potential low, followed by a delayed and sharp rise in your glucose up to 4-6 hours later — this is commonly known as the “pizza effect”. Be sure to check back to learn all about bolusing for meals and tips for navigating high fat or protein meals.

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