Sunday, October 7, 2012

Maximum Bolus

I had to reprogram my pump this morning.  Given my recent blog posts about new basal rates and new carb:insulin ratios, I'm sure that many of you are thinking "so what?"  And while I have to hand it to you that reprogramming my pump is definitely becoming old news, this particular change in set up is a big deal to me and an official diabetes first... I had to increase my max bolus rate.

I've probably explained this before and I know it's off to the right side here in the diabetes vocab column, but a bolus of insulin is what I inject via the pump to cover the number of carbohydrates that I eat during any given meal or snack.  Back before I was pregnant, I would typically bolus 1 unit of insulin for every 22 to 25 grams of carbohydrates depending on the time of day (it's not a stagnant ratio, our bodies aren't that simple).  So for an extremely large, carb heavy meal - say 100 grams for mashed potatoes, a dinner roll, a glass of wine and 1/3 a dessert (gotta share with HB and GW) - before pregnancy I might inject a total of 4 to 5 units of insulin.

Well, as I've perviously explained is due to dear old Mrs. Placenta, my current carb:insulin ratios are much lower than they were and now three out of four of them are actually below 10 grams per unit.  So to have a heavier carb meal (as I did this morning with GW's early-bday pancake breakfast) I am bolusing what I consider to be exorbitant amounts of insulin to cover what would have previously been "just" four or five units.  This morning I needed to bolus for 100 grams (three of HB's large pancakes with sugar free syrup) and my pump started beeping at me something fierce and the screen read "MAXIMUM BOLUS EXCEEDED."

I've never seen this screen before.

I went back into my pump and looked more closely at the numbers -- 100 grams of carbs at a ratio of 8.5:1 came to 11.75 units of insulin.  ELEVEN POINT SEVEN FIVE UNITS. Do you have any idea how crazy that is?!  Since 2011 I've been notorious with my endocrinologists for being truly insulin sensitive as a little goes a looooooong way.  But now, at just under 31 weeks pregnant, insulin sensitivity is a thing of the past and my 11.7 units now covers less than half of what it used to!  No longer is a maximum bolus of 10 units appropriate when I require more than that for a singular meal.


The whole point of a maximum bolus rate is to protect insulin pump wearers from accidentally injecting too much insulin at any given point.  Like when your toddler grabs your pump while you're sleeping and pushes the buttons to play the beeping noise and all of a sudden you've got 35 units of active insulin in your system to eat your way out of (happened to the type 1 medtronic employee who trained me to use my pump; scary).   Just to give you an idea, at my current ratio 35 units is just about 300 grams of carbs which is equivalent to: 5 slices of apple pie, 4.5 blueberry scones, 8 cups of Kemps Old Fashioned Chocolate Chip ice cream or 12 of HB's large pancakes.  I don't know about you, but I can't eat that much and that's exactly the point of the max bolus.

Long story short, I had to go into the bolus settings and increase the max bolus allotment - something I've never done before.  I only increased it from 10 units to 12 out of mere passive aggression toward my pancreas and placenta (what's up with me and malfunctioning "p" letter body parts?)... I'm guessing they'll retaliate sooner rather than later, but for the time being I'm relishing my effective, minor counter measure.

Take that.

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