Sarah Howard
Sarah Howard (nee Tackett) has dedicated her career to supporting the T1D community ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
Sarah and her husband live in NYC with their cat Gracie. In her spare time, she enjoys doing comedy, taking dance classes, visiting art museums, and exploring different neighborhoods in NYC.
Sometimes when fat content is high and may cause a delay in the bg peak from carbs – though I don’t do that often. Must often is because I’m headed to hypoglycemia and may be over treating because I don’t have quick access to the right (small enough) amount of carbs. I may extend all or only some of the dose, and only for about 29 minutes – to avoid dropping my bg even more, but to make sure my bg doesn’t spike from the fast acting carbs.
20 minutes to up to 2 hours extend the bolus. Gastroparesis [known as “roll the dice” for when or even if your digestion is going to kick in, grrrh! (ง︡’-‘︠)ง ]. The extended bolus can even out the high or lows. However, the opposite can also occur. The insulin can stack up and hit like a sledgehammer. ⛏
I use it for high fat foods (pizza) which due to the issues with high blood sugars I rarely eat, and occasionally if I know I’m going to be “grazing,” like at a party.
Extended bolus too much of a wild guess. Thanks to CGM I just bolus for carbohydrates and correct later, rarely necessary.
I give extended if I eat a high fat and/or protein meal which is not often. When I was younger it was a bit more often, like for pizza, or lasagna. Dont eat pizza like that very often now.
I do not use a pump, no longer trusting them to deliver insulin, and have switched back to pens, which I happily use.
I said other because it all depends. You have to learn how your body reacts. When I go out to eat, I know I automatically have to bolus for 90 carbs. Any higher and I go low. Then about 1.5 hours later, I need to add 1.8 units of insulin. Then, I may up my basal rate. There are no hard clear answers when dealing with T1D. It’s about knowing your body and how it reacts, and even then you can be like: how/why did THAT happen?
My current pump, the Medtronic 550G, doesn’t have the extended bolus option, but my previous pump did. It was an Animas model, and the term they used was “combo bolus”. I used it for carb-heavy dinners: pizza, pasta, Chinese, etc. It was very helpful and the one thing I miss about that pump.
Every time I eat pizza!
Because I’m on a Medtronic closed loop system, specific extended boluses aren’t necessary because of the continuous updating of my insulin based on the sensor readings. When not in auto mode and I bolus, I would dual wave (usually for two hours) since I bolus for proteins as well as carbs.
Honestly, I almost never used my extended bolus, except for a rare slice of homemade, gluten free pizza, or eating dinner out at a restaurant (which is also a rarity). However, recently, I’ve used the extended bolus a few times per week (when I remember to use it) because my Endocrinologist suggested that I use it with my supper meals because of lows I have after that meal. I still forget to use the extended bolus most of the time. I also deal with the gastroparesis problem, so I never know how or when my digestive system is going to work.
Only Rarely now I’m using CIQ on my Tandem
With the Medtronic 770G in Auto Mode, the extended bolus option is disabled. I would use it if available. For those rare times when I am not auto Mode I do use it for pizza and kettle cooked potato chips.
I do it almost every time I’m bolusing more than 2 units and I’m under 90. I also do it every time the carbs might take a while to hit because of fat. So it’s almost every day, because the Tandem CIA is good, but it’s not THAT good if I’m 85 and I give 2.34u. I’ll drop like a stone.
I’m sure it would benefit my daughter more than not bc we have foods like: pizza/pasta/starch, etc quite a bit but I haven’t done extended boluses when dosing my daughter bc I don’t understand how to go about doing it/when to do it, etc.
Based on fat content of food
I eat steel cut oats every morning. Bolus 75% and extend 25% over 1.5 hours. Took a month to get it right!
Following a renal diet. Rarely have enough meat and fat to warrant an extended bonus.
If you’re referring to a dual or square wave option for extended boluses then yes I have used this option. If I use this option it’s based on what I’ll be eating.
I do an extended bolus if my sugars are low at mealtime. Also of I am eating a low glycemic food like bean soup.
I use the 2 hr. extended bolus if I’m eating pizza or a meal with rice. Because 2 hrs. is the longest I can extend the bolus with my Tandem pump, the Control IQ app is usually very busy adjusting the basal rate for the next 4 hours. Although I no longer eat pizza very often I do enjoy Thai and Japanese recipes and miss the longer extended bolas that was available on my Animas Vibe pump.
Whenever I have a large meal.
I use temp basals rather than extended boluses. Temp basals are more than enough for me and feel more manageable.
I don’t know if I have the start of stomach issues but almost every meal I eat, no matter the fat/protein content, I have to give as a dual wave or else I’ll go low as I’m eating.
Sometimes it is difficult to know when I should do an extended bolus or not, but I definitely do for obvious foods like pizza or lasagna and some fatty desserts. I also do extended boluses for eggs as they raise my blood sugar fairly quickly and my blood sugar will stay in the 160’s for hours on end unless I do an extended bolus. Because eggs do not let my blood sugars come down, I find eating an egg before exercise very beneficial.
I use an extended bolus or temp basal and sometimes both. I use it/them for pizza and anything fatty. After dinner I almost always have some CarbSmart ice cream and take 3-4 units with 50% extended for 1-1 1/2 hours. Usually works great. I’m on an Omnipod pump and Dexcom G6 CGM.
If I’m eating something that can cause the BG to go high, and remain high (eg. some pizza), I’ll use the extended bolus. Generally, I may use this option once a week, but there have been other times where I’ve used it more frequently… Just depends on what the meals are going to be over the week.
I always use an extended bolus for pizza, and i use it when I am going to eat and my test is on the lower side. I give myself a small percent and then the rest over 1/2 hour or 45 mins, depending on what I am eating. I usually do this because if I don’t I forget to bolus and then of course go high!
I don’t use the extended bolus on mine because I don’t know how to use it or I probably will use it just don’t know when to use it
Dual wave boluses definitely comes in handy for pizza and burger/fries. I miss it when I’m in automode with my Medtronic 670G.
I do it almost every meal for protein because it usually the highest macro for me. I have a formula in a spreadsheet that has fat and protein as inputs and it tells me how much insulin (in addition to the bolus for carbs) over how many hours. Tonight it was .8 over 3.5 hours.
I have stopped using extended boluses, since my boluses don’t impact my BG for 2 or 3 hours anyway.
Multiple times per week with higher fat foods like pizza or lasagna, or where the food will raise the BG but not based on carbs- like cheese + chicken as main part of meal- few carbs but raises BG slowly.
I also do a lot of split boluses- for pizza, 70% now 30% in 2 hours to prevent a delayed otherwise inevitable spike-rise
I definitely use dual wave for pizza or restaurant meals, which means I must disable Auto-Mode. I hope future Medtronic pumps will have an option to combine the two, rather than having to choose one or the other. My endocrinologist stated that future hybrid closed-loop pumps will check sensor glucose every minute instead of every five, so maybe we won’t even need to use extended boluses. I hope she is right!
Pizza & anything else with high fat content.
Always if eating pizza and frequently for my breakfast high protein meal to prevent a spike several hours later.
Depends on my BG and what I am eating. Similar to what Dr Nick and others have shared I use it for pizza and pasta with cheese meals, and with rice, veggie and protein combo meals. Based on experience gained from experiments with how my body processes and digests various foods, I may use a 25/75, 70/30, 60/40 or a 50/50 extended bolus.
Depends on if eating a large amount of carbs
Since Control IQ, we don’t extend boluses for my daughter anymore. CIQ seems to work better if we DON’T. On Medtronic (minus any of their CGMs) and Basal IQ, we used extended boluses quite often; whenever she ate a high carb/high fat meal like pizza or mac & cheese. Control IQ has made it so that the micromanaging that we used to do isn’t necessary anymore. CIQ keeps her in excellent control – as long as the settings are tweaked to suit her needs.
I LOVE Extended Bolus!! I selected “Multiple times per day”, but it really depends on my carb input and current BG. If BG is low or dropping rapidly, I do an extended bolus with carbs over a 15 or 30 min period. For pizza, its 50% now 50% over 45min or 1 hr. Complex carbs is a good use for the “dual bolus (Medtronic term)” – some now some later. Extended bolus is extremely valuable to correct extreme (< 60 pts) lows so the insulin takes effect after the BG is rising.
I use the extended bolus primarily when eating a meal that includes higher fat content because the fat slows down the digestion process. (I am on a modified keto diet, so this occurs fairly frequently.)
I also use the extended bolus when my blood sugar is really too low to bolus for my carbs at the time, but I don’t want to forget to bolus later on.