Splitted Bolus

Here we are. You know when in a game the final boss is introduced? So it is for the splitted bolus technique: nothing, and with nothing I mean truly nothing, has been comprable in terms of importance and effectiveness in my diabetes management history. When I first heard about it, I simply thought that it would have been an unuseful complication to my already demanding pancreas-substitute life. But the knowledge of the diverse effects of different foods on BG and the confidence I gained with prebolusing made me change my mind. 

Why did I mention this last technique? Because the splitted bolus is based on the same concept: acting in advance, in order not to allow what we ingest to surprise us. Namely, the first injection which we perform before a meal, for what concerns timing, always has to be made following the rules of prebolusing (check this article out if you don't know about it!) but it's for the choice of the right amount of insulin that the splitted bolus intervenes: we will calculate it mainly taking into accout the macronutrients partition of a meal, and always, of course, keeping an eye on our starting BG. 

Macros perform a fundamental role in this technique, because, as we know from my last article (check it out!) their absorption time isn't quite the same, and the digestion of a single macronutrient could be influenced by another. For this reason, in a complete meal (ex.: 50% carbs, 25% fats, 25%  proteins)  carbohydrates will not be absorbed all in one shot immediately after the meal, because they would be slowed down by fats and even by proteins, and the late effects of these two last macronutrients also have to be taken into account: in fact, performing a single injection before the meal which aims to cover all the carbs you will ingest will probably result in an early hypo followed by a huge rebound. 

But no worries: the splitted bolus techniques will help us avoid these annoying tendencies. Ok, but how does it work? It is usully composed by 3 early boluses and some other late ones if thery are needed. As I said, following the rules of prebolusing, always in the case of the above-mentioned example, you will have to perform some minutes before the meal a first injection which covers around 65% of the carbohydrates load, a second one right when you are starting to eat which will cover another 20%, and a third one 15 to 30 minutes after your meal to cover the remaining portion of carbs. Then, in a time range between 2 to 3 hours after your meal, the conversion to sugar of proteins and fats will occur and you will have to perform an usually small bolus to fight it (of course, following the conversion ratios which I mentioned in this article).

However, the macros partition of our meals can vary a lot, and, doing so, it will obviously influence the use of splitted bolus. Namely, if the amount of carbs grows at the expense of fats and proteins, you will have to inject a larger percentage of insulin in your first shot, while, on the contrary, a greater amount of proteins, but especially of fats, will require smaller and slightly delayed early boluses and closer attention to the late effects of these ones. 

Needless to say, we always have to take into account our starting BG. If, before your meal, you are running high, add the extra insulin needed for the correction to your first early injection; on the contrary, if you find yourself in a hypo, subtract the extra insulin from your first early bolus. 

Thank you for your time. This article is a bit longer than my usual ones, but, because of the importance of the subject, I needed to explain every detail. Further articles will come about this wonderful technique, which could seem extremely complicate at first, but, if you persevere by trial and error, i promise that it will give you incredible satisfaction, not reachable in any other manner, at least for what concerns my experience. Meanwhile, don't forget to keep reading my website! ;)