Continuous Subcutaneous Insulin Infusion (CSII) enables food freedom in type 1 diabetes (T1DM). Evidence supporting advanced insulin bolus options with CSII is lacking or conflicting, and clinical guidelines are absent. The aim of this national survey was to establish current practice among T1DM specialist dietitians.
A 19 question survey was sent to the British Dietetic Association’s Diabetes Specialist Group, which consists of approximately 600 Dietitians with a special interest in Diabetes.
78 people completed the questionnaire. 97% always or mostly recommended using bolus advisor on their pumps. 78% said their patients mostly used it. 61% recommended bolusing insulin before their meal. 97% recommended their patients use extended boluses in some form. The most recommended option was the 50:50 combination bolus. Extended boluses were recommended by 91% of respondents for high fat meals, and for foods high in protein and fat (78%), when eating high-fat home-cooked meals (77%) and foods containing significant soluble fibre (60%). 36% of respondents recommend that patients bolus additional insulin for protein or fat and protein. 45% recommended superbolusing.
Bolus advisors are generally used widely, allowing consistent calculation and tracking of insulin. The range of bolus types recommended by dietitians varied reflecting the conflicting evidence, but initial bolus and duration may be insufficient to inhibit hepatic glucose production and cover delayed macronutrient absorption. Extended bolusing was recommended, mostly appropriately. Relatively small numbers advise protein and fat counting. Superbolusing is under-utilised, reflecting the lack of published data, and inconvenience.