Splitting bolus for big meals

[Skater P]

Recent T1 diagnosis, does quiet a bit of sport, lost 7 or so kg before diagnosis which I'm trying to get back on and staying active for my (and my wife's) sanity*.
So I'm back on carbs (after mistakenly cutting them at diagnosis) to fuel activity and try and get muscle and power back, I also used to eat a lot before I found out (which I may have to cut back on to aquire some portion control.)

For big meals with higher carb quantity My dietition mentioned splitting my bolus, I see others here have mentioned it too. Any advice, timings and ratios etc?
I'm assuming the idea is to delay/widen the insulin spike to time it with the longer BG spike of a big carb meal?

 

[Wendal]

Hi SkaterP
Am sure others may offer different bits of rationale behind split dosing but I don’t do it a lot but will consider it on a number of occasions.
So if I have a meal with a lot of carbs or one which is difficult to estimate/ calculate for eg an Indian meal or a buffet or involves several courses. Then I will often split bolus but this is done by judgement and will,take into account my readings pre and post meal and how much insulin is being “ stacked”.
I will also on occasion and this is not to be “ recommended” in some ways take a split dose before eating a restaurant meal before ordering the food ( it may be that for a particular reason I don’t want to inject at the table or at the event) and then follow up with another dose after my meal.
However there are a couple of caveats which make me happy about the foregoing comments.
In general I don’t actually take a lot of insulin so if I split a dose then in general I am not worried about stacking or potentially going low if having to wait for my food.
Also I don’t have any hypo anxiety especially overnight so again do not worry about stacking insulin.
I manage my diabetes by making judgements all the time and am pretty confident in my ability to manage my levels re insulin,exercise and diet and split dosing firms part of YJ is judgement.
So in summary I do feel there are circumstances when I really feel it is a good tactic but would counsel that you would only experiment with it incrementally and in line with understanding and experience in how your body responds to carbs,exercise,insulin etc.
Good luck

 

[Inka]

I also don’t split my bolus much. It’s more useful for low GI/slowly absorbed carbs/high fat meals. How many carbs are you talking about @Skater P ?

 

[mashedupmatt]

Takeaway Pizza is something that many split their bolus for - it has a high amount of carbs but also a high amount of fat content which slows it all down - half and half is usually done (2nd half an hour or so later) but personally I don't do it as a rule but it does help some people

 

[Skater P]

How many carbs are you talking about?

A Thai curry with rice 60cg for the rice and about 14cg for the curry

 

[helli]

A Thai curry with rice 60cg for the rice and about 14cg for the curry

Unfortunately, the best advice is try and learn as we are all different.
Maybe start with 50% before eating and the remainder 2 hours later. Then see how it goes and tweak next time,
Same insulin to carb ratio as usual.
I tend to find high fat meals are more likely to need splitting than high carb.

 

[Inka]

A Thai curry with rice 60cg for the rice and about 14cg for the curry

Ah, now that might depend on the rice! Some people split the bolus for basmati rice. I find I don’t have too unless it’s brown, but it will depend on the individual. 74g carbs isn’t a large meal for an adult really, so it might well not need a split. It will also depend on how much fat is in the curry bit.

Generally, I personally find I don’t need to split my bolus unless one of these applies:

- there’s going to be a gap between my carbs or the meal will be a slow one
- I’m unsure of the carbs so err on the side of caution with my insulin initially, topping up later if needed with another bolus
- I’m eating pasta. I split that 1/3 then 2/3, or 1/2 and 1/2 depending on the sauce, amount of pasta, etc
- I’m eating a trickier takeaway with a reasonable amount of fat
- I’m eating a lot of carbs (this will vary depending on your weight and size, but I’ve read 120g carbs before. For me, it would be less because I’m petite and slim)

It’s all a case of experimentation. I used to keep notes. It’s easiest if you keep the food/carbs the same for each meal trial, eg if you get your Thai meal wrong, next time eat exactly the same again inc same amounts/carbs then tweak your bolus as needed.

 

[SimonP]

I split for large meals and because I tend to need to split anyway I will also correct in the same way for slowly absorbed meals (which are always big in my case). I almost never inject more than 6U of bolus (Novorapid) and even if I need a correction dose I don't recall ever taking more than 8U in a single dose (I tend to take a correction an hour before I eat - I don't care about another injection and would prefer to get the IoB and working ASAP.)

I tend to eat between 60 and 120g of carbs for supper - which theoretically means 6 to 12U of Novorapid on a normal (not just got back from riding, but have ridden/done some reasonable amount of exercise in the past couple of days) sort of day.

In the days before splitting bolus I'd end up needing to eat pudding (which I never do) then going high later and wondering why. I do quite a lot of exercise too, and therefore insulin sensitivity can be very high, but depending on work meetings/school runs/etc., the days that I can ride to work are variable, so it's sometimes hard to work out whether it's a case of the insulin working too fast, or just having high sensitivity. The thing that probably doens't change much is carbs absorption, which is one of the reasons that XDrip+ is quite nice as it shows you estimated CoB (as well as IoB and a prediction of BG - not always very accurate but you get a feeling for how to use it as a guide)

If I can see that there are likely still carbs on board then I probably need more insulin.

 

[everydayupsanddowns]

I’ve used split boluses for bigger meals for years.

My trigger was the BG-crash-then-later-big-rise frustration, and I think I found the suggestion via John “pumping insulin” Walsh

I wrote this at the time

New big meal strategy: thirds

Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.

www.everydayupsanddowns.co.uk

Spreading the action of the insulin over a longer period worked really well for me. My basic approach generally settled into roughly a 60:40 over 1.5 - 2.5 hours.

Though this had changed over the years, as diabetes does like to change the rules from time to time!

Hope you can find a system that works for you 🙂

 

[PhoebeC]

Recent T1 diagnosis, does quiet a bit of sport, lost 7 or so kg before diagnosis which I'm trying to get back on and staying active for my (and my wife's) sanity*.
So I'm back on carbs (after mistakenly cutting them at diagnosis) to fuel activity and try and get muscle and power back, I also used to eat a lot before I found out (which I may have to cut back on to aquire some portion control.)

For big meals with higher carb quantity My dietition mentioned splitting my bolus, I see others here have mentioned it too. Any advice, timings and ratios etc?
I'm assuming the idea is to delay/widen the insulin spike to time it with the longer BG spike of a big carb meal?

Have you given it a go yet?

I find it useful if I don't know if I will like what I am eating, how much I will eat etc. Say we get takeaway and I know I am hungry but then we have all had those moments where you suddenly get full, its tricky if I've had my insulin. So sometimes I spilt.

Eating out, that can be helpful, have a bit as it arrives, the rest during if I know its good and I am eating it all.

 

[Skater P]

Have you given it a go yet?

I find it useful if I don't know if I will like what I am eating, how much I will eat etc. Say we get takeaway and I know I am hungry but then we have all had those moments where you suddenly get full, its tricky if I've had my insulin. So sometimes I spilt.

Eating out, that can be helpful, have a bit as it arrives, the rest during if I know its good and I am eating it all.

I did thanks Pheobe

I went out and had a fixed price menu with a starter, stake and pudding (but went for icecream rather than sticky toffee pud with custard I was craving but had a 100+ carb rating 😳)

I found out most of the values in advance and basically jabbed as it arrived. Saving the last one for later as I'd been flat all through the meal and worried about the scenario Mike mentioned above (BG low or flat that then climbs and climbs a few hours later)
Which is basically what happened, nothing then it all arrived (all be it slowly) once I got home, the last bolus didn't sort it so I went on a bike ride that did... 😎

To be honest I was a bit of food dustbin since I can recall (the family called me "hollow legs") so I'm not too aware of the "suddenly get full" most of my issues will be the other way.

 

[everydayupsanddowns]

Sounds like a great first experiment @Skater P

I tend to need a ‘stronger’ carb ratio for bigger meals (anything above 80g of carbs in a single sitting), so if I am estimating 100g, I may dose for more like 120-130 to strengthen the ratio without having to faff about with settings!

But the bike ride was a good idea!

 

[SB2015]

I am another that split bolus for high fat meals such as pizza @Skater P
I also found that I needed a bit more insulin for meals over 60g carbs (for me).

When I eat out, unless I am very confident about the timings, I will do a conservative bolus as food arrives, and then add more if it is sweeter than expected or if I fancy a pud.

As other have said it is a case of trial and improvement, and if you like a meal then try it again and see if you can make it work better for you with different splits.

En joy the experimentation.