An Analysis of the “Bolus Guide,” A New Insulin Bolus Dosing Support Tool Based on Selection of Carbohydrate Ranges

In this issue of Journal of Diabetes Science and Technology, Shapira and colleagues present new concepts of carbohydrate load estimation in intensive insulin therapy. By using a mathematical model, they attempt to establish how accurately carbohydrate food content should be maintained in order to keep postprandial blood glucose levels in the recommended range. Their mathematical formula, the “bolus guide” (BG), is verified by simulating prandial insulin dosing and responding to proper blood glucose levels. Different variants such as insulin sensitivity factor, insulin-to-carbohydrate ratio, and target blood glucose were taken into this formula in establishing the calculated proper insulin dose. The new approach presented here estimates the carbohydrate content by rearranging the carbohydrate load instead of the simple point estimation that the current bolus calculators (BCs) use. Computerized estimations show that the BG directives, as compared to a BC, result in more glucose levels above 200 mg/dl and thus indicate less hypoglycemia readings. J Diabetes Sci Technol 2010;4(4):903-905 ORIGINAL ARTICLES The current studies suggest that effective treatment of type 1 diabetes mellitus (T1DM) presents a challenge to health care providers. Evidence indicates that the basal/bolus, also referred to as intensive insulin therapy,1 is currently the chosen method of treatment in patients with T1DM. Continuous subcutaneous insulin infusion (CSII) has become a convenient treatment method and is now offered frequently.2 The CSII therapy is based on three main elements: (1) insulin administration, (2) blood glucose monitoring, and (3) food content calculation. Proper accounting for and proportioning of these three elements gives stable and satisfactory metabolic control to the diabetes patients. With CSII, many obvious, documented benefits are met by failures as well. The main documented reasons for CSII pump therapy failure, resulting in inappropriately high levels of hemoglobin A1c, are erroneous programming of the dose meter, setting a wrong type of bolus for a meal, or missing the existing prandial bolus.3–5 All these set functions depend on the patient’s compliance and level of knowledge. To facilitate this complex calculative process, and to make it more patient friendly and more efficient as well, health care providers and scientists are working on a technical device that could more adequately assist patients in making informed error-free decisions in their daily prandial insulin dose self-treatment routine. In addition to an already existing tool, the bolus calculator (BC), Shapira and colleagues6 present the bolus guide (BG)—a new concept and new tool in prandial insulin dosing.