Continuous Subcutaneous Insulin Infusion (CSII) enables greater food freedom for people with type 1 diabetes (T1DM). Evidence supporting advanced insulin bolus options with CSII is poor, with no clinical guidelines. This national survey establishes current practice among type 1 diabetes (T1DM) specialist dietitians.
A 10 question survey was sent out electronically to the British Dietetic Association’s Diabetes Specialist Group in 2015 and in 2019.
101 dietitians responded in 2015, 78 in 2019. The most popular extended bolus format in both 2019 and 2015 was the 50:50 dual wave, which 85% recommended (89% in 2015). Square wave boluses were the second most popular bolus in 2015 with 80% recommending it’s use, falling to 59% in 2019. In 2015 the 30:70 dual wave was third most popular with 75% recommending, falling to 49% in 2019. Extending over 2-3 hours was most commonly recommended in 2019 (43%), with 1-2 hours most common in 2015 (39%). The maximum duration recommended was 5-6 hours (36%) in 2019 (23% in 2015). 36% of 2019 respondents recommend that patients bolus additional insulin for protein or fat and protein (compared with 9% in 2015). 45% of respondents recommended superbolusing, an increase from 2015 (25%).
Bolus advice from specialist dietitians has improved over 4 years with longer combination boluses, superboluses and protein and fat counting advocated. This reflects improved education and suggest improved tools to support total macronutrient and superbolusing may be required.