The document provides information on using temporary basal rates and advanced bolus options on insulin pumps. It discusses when to use temporary basal rate increases or decreases, such as for illness, exercise, or changes in activity level. It also reviews normal, extended, and dual/split bolus options and provides examples of when each would be appropriate. The document highlights tools like basal patterns, alarms, and pump suspensions that can help manage insulin needs and support forgetfulness. It concludes with tips for pump use and answers to common pump questions.

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. When in doubt…
CHANGE IT OUT
BG Greater than 250 mg/dl Check for Ketones
POSITIVE Ketones
Correction dose using syringe
Change set and reservoir
Drink Sugar Free Fluids
NEGATIVE Ketones
Correction dose with pump
Wait 1 hour if number same
or higher take injection with
syringe
Change set and reservoir

4.  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

5.  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:

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

7.  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…

8. 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

9. 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

10. 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

11. 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

12.  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

13. 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

14. How many is too many?
Scheiner, G; Boyer, B. Diab Res and Clin Prac, 69 2005; 14-21

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. The dreaded… POP TART

25. 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

26. 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

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

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

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

30. Bolus Tipping

31. For the forgetful…
Check
your
blood
sugar

32.  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…

33.  Allows for temporary break from pump
 Consider using for…
 Trips to the water park or beach
 Cute little prom dress
 Summer Camp
 Out of supplies or waiting for replacement device
 Things you need to know…
 Total Basal Insulin
 Carb Ratio, Sensitivity Factor and Target Blood Sugar
 Things you need…
 Basal Insulin
 Rapid Acting Insulin
Pump-Cation

34. Basal Insulin Injection
24 units
Bolus Insulin Injections
1 unit for every 10 gm carb
1 unit for every 50 mg/dl
greater than 100
How to take a Pump-Cation
Remember to give 24 hours for Basal Insulin
to Clear before Resuming Basal Rate

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

36.  When in doubt change it out
 Always have a plan b
 Always pack extra supplies
 Always have your pump settings written down and/or
stored in you phone
 Change your infusion set every 2-3 days regardless of
how much insulin is left in the reservoir
 Check the time on the pump regularly
 Check your bolus history
Tips For Pumping

37.  How long can I be disconnected?
 Do I have to fill my pump up all of the way?
 What do I do with my pump at the airport?
 What is the best insulin for my pump?
 How long does a pump last?
 Why do I get bubbles in my reservoir?
 Where can I wear my infusion set?
Common Pump Questions