Well, Kevin McMahon “outed” my new application of the extended bolus we used very successfully at diabetes camp this year. It was borne out of necessity. With over 200 campers, 50% of whom used insulin pumps, we would sometimes face the dilemma of what to do with an out of range high blood sugar level at the midnight check. Certainly, every parent out there with a pumper (or perhaps pumping themselves) gets a little anxious about taking a correction bolus and then going to sleep. Of course the best thing to do is to check a BG in 2-3 hours. That puts it right smack in the middle of the night. Many of us are more inclined to do this so that we avoid a trip into the “3 AM Club” (severe hypoglycemia) which I’ve written about before (http://challengediabetes.diabetech.net/2008/12/23/are-you-a-member-of-the-3-am-club/).

So, here is the solution that worked so well for us. Using the smart pump’s bolus calculator (i.e., “wizard”, “EZ BG”), we calculated the correction dose of insulin needed to reduce the blood sugar back into the camper’s target range. But instead of giving it all at once, we programmed it as a 6 hour extended bolus instead. In each case we had a smooth descent back into target range. For campers we were uncertain about, we delivered 2/3rd of the correction over 6 hours (midnight to 6AM) and validated the effect the next morning. If we “got close, but still a little higher than target”, we went with the full dose the next time. That’s called titrating to effect.

Anyway, it worked like a charm. I use it myself. Now, purists out there would understandably want to still set the alarm clock and check a 3AM reading just to make sure. I understand and respect that. But once you can assure yourself that a slow descent works for the overnight correction, you might allow you (and your child) a more complete night’s sleep. If this is being done or promoted by others I sure would like to know about it so we can compare notes and perfect the Sleep Bolus as commonplace and just one more reason why a pump should be considered over injection therapy. Please share this information with as many of us who need and would benefit from the knowledge.

How many more subtle applications of seldom used pump features are out there? How do you squeeze every ounce of utility out of the tools you use today? And lastly, of the tools available today, are you leveraging them to their fullest?

Last 5 posts by Steve

• Halloween and Diabetes CAN mix! - October 5th, 2009
• Introducing Healthy Families of South Texas - October 5th, 2009
• Complications 101 - About Kidney Failure - August 23rd, 2009
• The Dirty Truth Behind DCCT - August 16th, 2009
• Day Fourteen - Sixteenth Camp Blog Entry - July 31st, 2009

This entry was posted on Tuesday, August 18th, 2009 at 12:31 am and is filed under Clinical. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.