MDI and splitting bolus

[e||ement]

For those of you on MDI...what foods do you split a bolus for?

And how do you split your bolus, generally? How far apart are the injections, and what ratio do you use to split dosage, etc?

Very curious!!!

[jenb]

I always split my boluses. Generally speaking, I do 2/3 of it 20 to 30 minutes before eating and the remainder 20 minutes or so after starting a meal. If a meal includes starchy carbs or loads of fat, I may also add a little "kicker" at 1 to 1.5 hours, depending on BG. This scheme sort of mimics 1st and 2nd phase insulin release. I've been pretty successful with it, although I still get the occational (and vexing) surprise.

Jen

[lorilei]

I am now a bit less mathematical with my split bolusses...they tend to occur when i am in an unexpected meal situation..such as eating out...I may bolus right after ordering say a standard safe dose for me like 2 or 3 units..then recalculate after the meal taking into what account what i actually ate and finishing the dose.

Kinda remember this discussion before...if I do my second bolus more than an hour late i always try to get a handle on where my numbers are headed with a test...in this way, i recall jen and I being very much alike. i think i am a little bit more liberal than i used to be though as experience builds.

Going off of my usual food habits for a lunch or dinner out, i just naturally test more b/c you just never know that the actual ingredients are....i can say i rarely go low as i encounter those sneaky hidden carbs!

[e||ement]

thanks guys.

i think i need to start splitting for some foods/meals. i pay attention to GI and tend to bolus according to that (pre-meal, post-meal, etc.) but i seem to be building a "tolerance" to food that was previously in my "safe" range, so i'm now spiking higher, and longer at times.

i'm a little nervous to do this, but as you say lori, confidence comes with experience.

[jenb]

i seem to be building a "tolerance" to food that was previously in my "safe" range, so i'm now spiking higher, and longer at times.

i'm a little nervous to do this, but as you say lori, confidence comes with experience.

This is what lead me to start splitting boluses. Frustrating, isn't it? I say dive right in! You might find it helpful to do some extra testing at first, say every 20 minutes after you eat a suspect food, to determine an optimal 2nd bolus time. It probably goes without saying but I'll do it anyway: When you're calculating the bolus timing don't forget to take into account the lag time between injection and the time your insulin actually begins working.

In fact this week I've had to do a lot of testing because all of a sudden milk (even 3 ounces) is making me spike quite high. I've tried several different bolus amounts and timings, and it sadly appears that milk is about to disappear from my menu. Darn it!

Good luck...let us know how it goes.

Jen

[e||ement]

wow.

in the past week i've been splitting some boluses, and my 7-day average has gone from 7 mmol/l to 6.2 mmol/l.

also my highest 1 hour or 2 hour pp has been 7.2 mmol/l.

this is amazing! i was spiking in the 9s and even 10s for a few weeks prior to splitting (with food i could formerly tolerate and get an under 8 reading with).

thanks for your help :D i'm very excited about this!

[jenb]

Great results - glad you gave it a try. Splitting boluses really can make the biggest difference!

Jen