Tools & Techniques

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Technique 1: Bolusing when you have a diagnosis of gastroparesis

Keeping your blood glucose levels in good control can positively affect your gastric emptying problems. However, matching a bolus to the variable absorption time of a meal can be challenging. Use of the extended bolus feature or utilizing a temporary basal rate increase of the ACCU-CHEK^™ Spirit insulin pump system could successfully provide the solution to this complicated issue. Keep in mind - you should always consult your health care team for personalized therapy recommendations.

An extended bolus can be given in any amount to the tenth of a unit up to 25 units; then, the bolus can be extended over a time period of 15 minutes to 24 hours. The goal is to match the insulin required to cover the meal with the length of time needed for the meal to be digested. This could be achieved by infusing the entire amount of the bolus, over the extended time period, or dividing the required bolus into a percentage taken before the meal, and the rest extended over the desired time period. The only way to know is trial and error.

Another option in matching insulin infusion to meal absorption times could be the use of a temporary basal rate increase over a desired period of time. A temporary basal rate increase can be programmed in ten percent increments up to 200% of the basal rate. A temporary increase can be put into stop at any point when the increase needs to be cancelled.

A third option could be giving several small boluses using the standard bolus feature in pre-determined increments of time to approximate digestion time.

Another important consideration is the timing of the beginning of the bolus. Even with an extended bolus, it may work best to start it at the end of the meal rather than before. That way you can be sure of your insulin dose because it is based on what you were actually able to eat rather than what you thought you were going to eat. This also gives your gastroparesis medication, if you take any, time to begin to work and stimulate movement of your food before the insulin starts to work.

The consistency of your food may also affect how well you can match the bolus with the food. If your meal is primarily liquid, you may need to change the timing, amount or duration of your bolus. Again, learning from experience will assist you in determining what works best, but consulting your health care team up-front will help you achieve optimal results much more effectively.

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