Pumpkin pie, candied yams, potato latkes, lots of turkey with gravy, holiday cookies, fruitcake, heart cookies and long meals. Have we made you hungry yet? What do these foods make you think of? Hard to manage blood sugars!

Fall and winter bring some wonderful holidays and special memories, but they may also bring memories of blood sugar readings you’d rather forget! If you are on an insulin pump though, you can work on better blood sugars by using one of the advanced features: extended or combination bolusing.

Some of the meals we eat at this time of year might take longer to eat. Typically, they are also higher in fat and/or protein. Fat slows down digestion and blood sugars can stay high for a longer time. The extended bolus and combination bolus could work more like a pancreas when you eat a meal that goes on for a long time or a big, high-fat meal.

How do extended and combination boluses work?

Different insulin pumps use different names for extended and combination boluses but they work the same way.

Square wave or extended bolus

An extended bolus gives the insulin dose over a longer period of time.

How does it work?

You choose the dose and the time interval to give the bolus. This is best to use if you’re eating over a long period of time or grazing.

For example, if a holiday dinner takes two hours to eat, you can determine how many carbohydrates you will eat during that time and deliver the bolus over 120 minutes. You can always give an additional bolus if you eat more carbohydrates than you originally bloused for. This saves you from bolusing when the salad comes out, then five minutes later for bread, then 10 minutes later for the turkey and stuffing.

Dual wave or combination bolus

This type of bolus gives some insulin right away to cover some carbs at the beginning of the meal. It gives the rest of the insulin over a set period of time to cover carbs that may affect blood sugar later.

How does it work?

You give a percentage of the bolus at the start of the meal and the rest over a set duration of time.

For example, you are having turkey, gravy, stuffing, potatoes and cranberry sauce. The cranberry sauce will raise your blood sugar quickly and therefore needs immediate insulin, but the higher fat foods will affect your blood sugar later. You might give 30 percent of insulin right away then the other 70 percent over the next two hours.

For more information on how to split the insulin dose over 2, 4 or 6 hours, check out our education sheet.