Defining and Adjusting for High-Fat Meals

I’ve read here and other places that bolus insulin can be adjusted for a “high-fat” meal, giving a partial dose at first and the rest later. How much fat are we talking about? How do you calculate this adjustment?

Hi @Lmolmen Lisa, this is tough to generalize.

For most pump users, for most diets, you are already compensating for some base line of mixed meals (fats plus carbs) and the compensation is buried in your carb ratio, sensitivity, and basal rate. So this issue is for the times that you are eating something with more than usual fats.

For me, if a portion has more than 3:1 or for each 3 gram carb there is 1 gram (or more) fat, then I like to adjust.

So let’s talk pizza. My pizza is about 35 grams carb per slice and probably 16 grams fat from the oil cheese and whatever flavor bomb I put on top. This is where I would have to adjust because if I bolused for 35 grams my blood sugar would crash and then be a million 3 hours later

So I use a 4 hour bolus with 25% up front and the rest over the 4 hours… if I am not planning any special level of activity.

The formula for this is “trial and error” it is common to start with 50% up front and the other half over 1-4 hours… so maybe start with 2 hours.

It is also helpful to develop this and make it custom for your favorite foods rather than as a hard rule. Ice cream is another one where the fats are high enough to have to do something special.

There is something called the rule of small numbers which is easy to remember: small number = small mistakes. So when you do a test it’s best to not try it by for example, eating an entire pizza.

You will have to test probably every hour to track if you are on target, and remember this is highly dependent on activity levels

Good luck

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Thanks, Joe. Even the general points you mention are a good place to start! You’re a bright light on this murky path.

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