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Insulin Pump Therapy

Bolus and Correction Differences

As a reminder, meal bolus insulin covers the carbohydrate eaten at a meal or snack and correction insulin is given if the blood sugar is high. There are some differences in how these insulins are g​iven with MDI compared to insulin pump therapy.

The most obvious difference is that MDI requires more injections than insulin pump therapy. Meal and correction insulin is delivered using insulin pens or syringes in MDI. However, in pump therapy this insulin is delivered through a small cannula under the skin, without the need for a separate needle​ poke.

In MDI, some snacks or meals don’t need a separate injection of rapid-acting insulin. For example, in children, intermediate insulin is often given in the morning to cover the daytime snacks and the lunch meal. However, in pump therapy, a meal bolus must be given for all meals and most snacks.

Here are some other bolus differences with the insulin pump vs. MDI. The pump has:

  • push buttons (on pump or handheld device) to deliver boluses
  • a built-in calculator (programmed by the user) to:
    • suggest meal bolus and correction doses
    • determine active insulin on board
    • suggest reduced doses if active insulin is on board
    • deliver partial units (e.g., 2.3 or 2.7 units)
  • different ways to deliver a bolus (all at once or over an extended period of time)

Although insulin pumps can calculate suggested meal and correction insulin, the user must still decide if the suggested dose is appropriate to use.

Here’s an example:

Before her meal, Selina uses buttons on her pump to open a bolus calculator. She inputs the grams of carbohydrate that she plans to eat, as well as her blood sugar level. (Some pumps wirelessly accept blood sugar readings from select meters).

The calculator suggests an insulin bolus dose based on:

  • her blood sugar level
  • grams of carbohydrate to be eaten
  • her individualized insulin-to-carbohydrate ratio
  • her individualized insulin sensitivity factor
  • insulin on board.

Selina reviews the suggested dose. Since she plans to be more active after lunch, she reduces the dose. She decides she wants it as a regular bolus - delivered right away and all at once. She pushes the appropriate buttons​ to deliver this dose.

Knowledge Check

1. Meal bolus insulin is needed:
 
 

Correct! Meal bolus insulin covers the carbohydrate eaten. It is basal insulin that works with the sugar the liver makes.

The correct answer is B. Meal bolus insulin covers the carbohydrate eaten. It is basal insulin that works with the sugar the liver makes.

2. True or false? Insulin pumps can calculate suggested meal and correction insulin doses. However, the pump user must decide if the suggested dose is appropriate to use.
 
 

Correct!

The correct answer is TRUE.

3. True or false? Meal bolus insulin from the pump is different because it can be programmed to be delivered over a period of time, instead of all at once.
 
 

Correct!

The correct answer is TRUE.​​​​​​​