Medtronic Minimed 780G Insulin Pump with Insulin Bolus in progress

Understanding Insulin Bolus: A Key to Effective Diabetes Management

In the journey of managing diabetes, the term “bolus” often takes on a crucial role. It’s a word I learned in human biology class, where it was defined as a “soft mass of chewed food.” It can, however, also mean a single dose of a drug. In the context of insulin therapy, a bolus refers to a dose of insulin delivered to manage blood sugar. For example, a person with Type 1 Diabetes will bolus for the food they are going to eat at mealtime. This can be done with an insulin injection, using an insulin pen or syringe, or with an insulin pump.

In the above photo, my insulin pump is delivering a bolus for the food I’m about to eat. I’m about to eat a grilled cheese sandwich and I’m bolusing for this meal as the sandwich finishes cooking. Often, administering a bolus just before eating works out best. That way, the insulin starts working as the food is being digested. Getting the insulin amount and timing right is the continual challenge. I bolus for the meal, and if the stars are aligned, I won’t spike too much, nor will I drop too low.

What is an Insulin Bolus?

An insulin bolus is a precise dose of rapid or short acting insulin administered just before meals to counteract the rise in blood glucose levels that comes from eating. This is in contrast to basal insulin, which is the background insulin needed to cover the body’s insulin needs at times when you are not eating.

How Does an Insulin Bolus Work?

Administering an insulin bolus has become more streamlined and less intrusive thanks to advancements in technology, such as insulin pumps. Here’s a simplified breakdown of the process I follow with my insulin pump:

  1. Initiating the Bolus: When it’s mealtime, I interact with my insulin pump, a small device that holds insulin and delivers it through a thin tube inserted under the skin.
  2. Calculating Carbohydrates: I enter the estimated number of carbohydrates (carbs) of my meal into the pump. This could be based on nutrition labels, portion sizes, or, often, educated guesses. For my meals, common carb counts range from 20 to 50 grams, depending on what I’m eating. (Note: Meals can contain way more carbs than that, but I follow a diet that limits carbs to make insulin dosing easier.)
  3. Confirming and Delivering the Bolus: With the carb count entered, I confirm the action, and the pump calculates the required insulin dose based on predetermined settings such as my insulin to carb ratio. It then delivers this bolus dose subcutaneously (just under the skin). The process is usually painless, although occasional slight stinging can occur.
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It’s a Delicate Balance!

For those of us living with diabetes that requires insulin, for example Type 1 Diabetes, managing our blood sugar levels is a delicate balance. Eating carbohydrates increases blood sugar levels, requiring insulin to metabolize the glucose effectively. The challenge lies in estimating the right amount of insulin to match the carbs consumed without causing blood sugar to spike or drop too low.

Limiting carb intake and planning for physical activity are strategies I use to reduce the risk of dosing errors. It’s a personalized approach, reflecting the unique responses our bodies have to insulin and carbohydrates.

Happy Bolusing!

Do you use the term “bolus” in your every day life? How do you talk about diabetes and insulin treatment? Please share your thoughts and experiences.

Lin May

About the Author

Lin May has a decade of experience living with LADA diabetes and is the author of Success with LADA Diabetes: Achieving Optimal Health with Diet, Exercise, and Insulin. She is dedicated to helping others learn about diabetes.

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