Meaghan Anderson, Medtronics

1. Meaghan Anderson MS, RD, LD, CDE

2.  How to use the temp basal and advanced bolus
options
 When to use these options
 Why to use these options
 Learn the other bells and whistles on your pump
Objectives

3.  What is it?
 Allows you to immediately increase or decrease your
basal rate, for the temporary time you set
 Set for 30 minutes to 24 hours in 3o minute increments
 Can be canceled
Temporary Basal Rate

4.  Percent of basal
 a percentage increase or decrease of current basal
rate(s)
 Rate can be reduced to 0% and increased up to 200%
 Max sure you max basal rate is set to be double your highest
basal rate
 Insulin rate
 a fixed basal in units per hour (U/H), which is
independent of current basal rate
Temp Basal Rates can be set based
on preference:

5. When to use…
Increase
 Illness
 Menstrual cycle
 Steroids
 Decrease in activity
 Stress
Decrease
 Exercise
 Increased activity
 Fasting labs
 Surgery

6.  There is a decreased need for insulin when we are
more active, basal rates are set for a “typical day”
 There is an increased need for insulin when we are
stressed, ill or less active
 Keep in mind the peak action of insulin when setting a
decreased basal rate
Why to use…

7. Basketball Practice
 George has a 2 hour
basketball practice
 His blood glucose 1 hour
before practice is 136
mg/dl
 He has noticed a trend in
low blood sugars during
practice
 Recommendation…
 Reduce basal rate to 50%
for 4 hours
 Set the reduction to start
1 hour before practice
 Monitor hourly to see if it
is working

8. What if…
Hour BG
Pre 136
1 hr 122
2 hr 167
3 hr 184
4 hr 192
 Consider reducing
percent decrease…
 Temp basal set for four
hours and reduce to 65%
of usual rate

9. Sick Day
 Kate has been ill for the
last 24 hours and blood
glucose is consistently
>200
 What could she try to get
blood sugars closer to
normal?
 Increase basal by 20% for
four hours, continue to
increase in 20%
increments until blood
glucose levels are closer
to normal
 Monitor frequently

10. Sick Day
Increase basal by 20%
Hour BG
1 226
2 208
3 215
4 234
Increase basal by 40%
Hour BG
1 195
2 187
3 154
4 142

11. 1. Normal
2. Square/Extended
3. Dual Wave/Combo
Three Types of Boluses…

12. NORMAL BOLUS
 Bolus amount delivers as
soon as amount is
confirmed
 Used for meals with
average fat and carb
content
 Also used for correction
boluses

13. Square/Extended Bolus
 The bolus amount
delivers evenly over the
period of time you set
 Primarily used by those
who have delayed
digestion (gastroparesis)
 Used when eating carbs
over an extended period
of time

14. Dual/Extended Bolus
 Bolus amount is split
 Used for meals both high
in fat and carb, which
may delay digestion (ie
pizza, Chinese or Mexican
food)
 Percent you set to deliver
now and as a square
wave will vary based on
meal content as well as
premeal blood glucose

15. Mamacita’s
 Frank has added up his
carbohydrates and he is
going to eat 105 gm of
carb (fajitas, rice, beans,
chips)
 His premal glucose is 110
mg/dl
 What should Frank do?
 Program a dual/extended
bolus
 50-50 split for 2-4 hours
 Monitor frequently so he
know next time if this
was the best way to
deliver the insulin

16. Results
Hour BG
Pre 110
1 70
2 110
3 145
4 170
 Since one hour post meal
BG is low consider giving
less insulin upfront (25/75
split
 More insulin delivered
later should also help 3
and 4 hour BGs be closer
to target

17. FRUIT LOOPS
 Sara is going to eat 70
grams worth of cereal
with milk.
 Her current glucose is 105
mg/dl
 What is her best bolus
option?
 Normal bolus
 Remember to take insulin
15-20 minutes prior to
eating to prevent abrupt
spike in blood sugar

18. Results
Hour BG
Pre 105
2 155
4 116
 Perfect!
 Two hour post prandial
glucose is expected to be
40-60 points higher the
pre meal glucose

19. The SUPER BOLUS
 Basal insulin is stopped or partially reduced and is
delivered as additional bolus insulin on top of a normal
carb or correction bolus
 Creates a larger bolus that can have more impact in
situations where more insulin is needed quickly
 High glycemic index foods
 Large volumes of carb content
 Speeding the return of an elevated blood glucose to normal

20. The dreaded… POP TART

21. Reduces exposure to
hyperglycemia…
 Pump Settings
 Basal 1.0 units per hour
 Carb ratio 1:10
 Sensitivity 1:40
 Bolus amount
 74 / 10 = 7.4 units
 Basal
 3.0 units
 Deliver 10.4 units
 Temp basal 0% for 3 hours

22. THE SUPER BOLUS
High GI Food
3 units from basal
7.4 units for Pop Tart
1.0 u/hr 1.0 u/hrBasal Suspend 3 Hours

23. The Super Bolus
Image From: http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus

24. The SUPER Correction Bolus
Image From: http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus

25. Prevention of a Low
Image From: http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus

26. For the forgetful…
Check
your
blood
sugar

27.  Alarm clock
 Set it for normal eating times to remind you to check
blood sugars and bolus
 Missed Bolus Reminder
 Eat at noon
 Set reminder from 1130 to 1230
 BG Reminder
 Available on both pumps and glucose meters
Tools for the forgetful…

28.  A great tool for those who have varied lifestyle for
greater than 24 hours
 Examples
 Sleep in on weekends
 Active weekday, couch potato weekend
 MWF Schedule for T/Th
 Menstrual cycle
Basal Patterns

29. WEEKEND WARRIOR
Standard (Mon-Fri)
 12 a.m. 0.700
 3 a.m. 0.850
 7 a.m. 0.800
 2 p.m. 0.700
Pattern A (Sat-Sun)
 12 a.m. 0.600
 3 a.m. 0.750
 7 a.m. 0.600
 2 p.m. 0.500

30.  Average blood sugar
 Carb intake
 Total Insulin
 Basal units and percentage
 Bolus units and percentage
 Number of correction and food boluses
Daily Totals